Medicare 2026

Medicare Advantage and Medigap: the structural gap in Fridley

FRIDLEY, Minn. — When you first sign up for Medicare, one choice shapes almost everything that follows: do you stay with Original Medicare and add a Medigap policy, or do you enroll in a Medicare Advantage plan? The two paths look similar on the surface, but they are built very differently underneath. Understanding that difference is the single most useful thing a new Medicare beneficiary in Fridley can do before Annual Enrollment closes on December 7.

Two Paths, Two Different Structures

Original Medicare is the federal program run directly by the Centers for Medicare & Medicaid Services. Part A covers hospital care, Part B covers doctor visits and outpatient care, and you can use any provider in the country that accepts Medicare. There is no network. There is also no annual out-of-pocket limit on Parts A and B by themselves — which is why many people pair Original Medicare with a Medigap (Medicare Supplement) policy from a private insurer to help pay the coinsurance and deductibles Medicare leaves behind. Drug coverage is separate, purchased as a standalone Part D plan.

Medicare Advantage (Part C) is different. Instead of using Original Medicare directly, you enroll in a private plan that Medicare pays to deliver your benefits. The plan replaces the way you access Parts A and B, usually through an HMO or PPO network, and most Advantage plans include Part D drug coverage and sometimes extras like dental, vision, or fitness benefits. Advantage plans do have a yearly out-of-pocket maximum for medical services, which Original Medicare on its own does not.

How the Money Flows

On the Original Medicare + Medigap path, you typically pay:

• Your Part B premium
• A Medigap premium
• A standalone Part D premium

In exchange, once your Medigap kicks in, most covered services are predictable — the supplement pays much of what Medicare doesn't.

On the Medicare Advantage path, you still pay your Part B premium, plus any premium the Advantage plan charges. Costs then come in the form of copays and coinsurance as you use services, up to that plan's yearly out-of-pocket cap.

Neither path is automatically cheaper. It depends on your health, your prescriptions, how often you travel, and which doctors you want to keep.

What's the Same for Everyone in 2027

No matter which path you choose, some rules apply across the board:

• Part D out-of-pocket cap: $2,100 in 2026 and $2,400 in 2027. Once your covered drug spending hits that limit, you pay nothing for covered drugs the rest of the year.
• Part D maximum deductible: $615 in 2026 ($700 in 2027).
• The coverage gap ("donut hole") is gone as of 2025. Part D now has three phases instead of four.
• Medicare Prescription Payment Plan: An optional way to spread your drug costs into monthly payments across the year.
• IRMAA surcharges on Part B and Part D begin above $109,000 in income for a single filer in 2026.

These are program-level facts from Medicare, not features of any one plan.

The Local Picture in Anoka County

Fridley is in Anoka County, where residents choose from a broad set of Medicare Advantage and Part D options each year. Because plan availability is set at the county level — not the city level — two neighbors on opposite sides of University Avenue see the same menu of plans. Medigap availability in Minnesota works a bit differently than in most states: Minnesota is one of three states with its own standardized Medigap plan structure, so the "Plan G" and "Plan N" labels you see nationally don't apply here the same way.

How to Think Through the Decision

There is no universally right answer, but a few honest questions help:

1. Do you have doctors or a clinic you want to keep? Check whether they accept Original Medicare, and if you're leaning Advantage, whether they're in that plan's network. 2. Do you travel or spend part of the year outside Minnesota? Original Medicare travels with you nationwide; Advantage networks may not. 3. How stable is your health? Medigap is easiest to buy when you first become eligible for Medicare. Later on, in most states, insurers can use medical underwriting. 4. What prescriptions do you take? Compare how each path's drug coverage handles your specific medications on Medicare's Plan Finder.

Key Dates to Remember

• Annual Enrollment Period: October 15 – December 7. You can join, switch, or drop a Medicare Advantage or Part D plan.
• Medicare Advantage Open Enrollment: January 1 – March 31. If you're already in an Advantage plan, you get one chance to switch to another Advantage plan or return to Original Medicare.