Medicare 2026

Why Medicare Advantage and Medigap are built differently, Minneapolis

MINNEAPOLIS — Every fall, thousands of people across the Twin Cities sit down at the kitchen table with a stack of Medicare mail and try to answer one big question: should I stick with Original Medicare and add a Medigap policy, or should I go with a Medicare Advantage plan? The two paths look similar in ads, but they are built very differently. Understanding that difference up front can save you from a mistake that is hard to undo later.

Two different structures, not two flavors of the same thing

Original Medicare is the traditional, federally run program. It has two parts: Part A (hospital) and Part B (doctor and outpatient). You can see any provider in the country who accepts Medicare, and there is no network. Original Medicare pays its share, and you are responsible for the rest — deductibles, coinsurance, and there is no annual out-of-pocket limit built in.

That is where Medigap (also called Medicare Supplement Insurance) comes in. Medigap is a separate private policy you buy to help pay the out-of-pocket costs Original Medicare leaves behind. Because Original Medicare does not include drug coverage, most people on this path also add a standalone Part D prescription plan.

Medicare Advantage (Part C) is a different structure. Instead of Medicare paying providers directly, you get all your Part A and Part B coverage — and usually Part D — through a private plan approved by Medicare. These plans typically use provider networks (HMO or PPO), require referrals or prior authorization for some services, and set their own copays. They also include a yearly cap on your in-network medical out-of-pocket costs, which Original Medicare alone does not have.

What Minneapolis residents should know about availability

Minneapolis is in Hennepin County, where a range of Medicare Advantage and Part D plans are offered each year by several private carriers. The exact number changes annually. You can see the current count for your ZIP code using the Plan Finder at medicare.gov. Availability is set at the county level, not the city level, so a neighbor across the river in Ramsey County may see a different list.

The trade-off in plain language

The choice usually comes down to two things: flexibility versus predictability.

• Original Medicare + Medigap tends to offer more freedom to pick doctors and hospitals anywhere in the U.S. that takes Medicare, with fewer surprise bills — but the monthly premium for the Medigap policy is an added cost, and you pay a separate Part D premium.
• Medicare Advantage often has a lower monthly premium and bundles extras like dental or vision, but you generally have to stay in-network and follow the plan's rules for approvals and referrals.

Neither path is "better" in the abstract. The right fit depends on your health, your doctors, your prescriptions, whether you travel, and your budget.

The mistake people make — and how to avoid it

The most common regret we hear about is switching from Medigap to Medicare Advantage, then wanting to switch back later. Here is the catch: when you first become eligible for Medicare, you have a one-time Medigap Open Enrollment Period (six months starting when you are 65 and enrolled in Part B) during which insurers must sell you a Medigap policy regardless of your health. Outside that window, in most states, Medigap insurers can use medical underwriting and turn you down or charge more based on your health.

Minnesota has some state-level Medigap protections that go beyond the federal rules, but they are not unlimited. Before you drop a Medigap policy to try Advantage, talk to your State Health Insurance Assistance Program (SHIP) — in Minnesota, that is the Senior LinkAge Line at 1-800-333-2433 — so you know what returning would look like.

Key Part D numbers to keep in mind

Regardless of which path you choose, these program-level Part D figures apply as you compare 2026 and 2027 coverage:

• The out-of-pocket cap on covered Part D drugs is $2,100.
• The maximum Part D deductible is $615.
• The old "donut hole" coverage gap is gone as of 2025; Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the calendar year in monthly amounts instead of paying at the pharmacy counter.
• IRMAA surcharges on Part B and Part D begin above $109,000 in income for a single filer (based on your 2024 tax return).

When you can make a change

• Annual Enrollment Period: Oct. 15 – Dec. 7 each year. You can join, switch, or drop a Medicare Advantage or Part D plan.
• Medicare Advantage Open Enrollment Period: Jan. 1 – March 31. If you are already in an Advantage plan, you can switch to another Advantage plan or go back to Original Medicare (and add a Part D plan). You cannot use this window to switch from Original Medicare into Advantage.