Medicare 2026

Medicare Advantage or Medigap? Understanding Two Paths

ST. LOUIS PARK, Minn. — If you are new to Medicare, or helping a parent sort it out, one choice tends to cause more confusion than any other: should you pair Original Medicare with a Medigap policy, or enroll in a Medicare Advantage plan? They are two different structures for getting the same underlying Medicare benefits, and understanding how each one is built makes the rest of the decision much easier.

Here is a plain-language look at how the two paths differ, and where St. Louis Park residents can go for personalized help.

Two ways to receive your Medicare benefits

Everyone who qualifies for Medicare is entitled to the same core program. What differs is how you receive it.

• Path 1: Original Medicare (Parts A and B), often paired with a Medigap policy and a stand-alone Part D drug plan. Here, the federal Medicare program pays your hospital and doctor claims directly. Medigap (also called Medicare Supplement Insurance) is private insurance that helps cover the out-of-pocket costs Original Medicare leaves behind, like coinsurance and deductibles. Drug coverage is separate.

• Path 2: Medicare Advantage (Part C). A private insurance company, approved by Medicare, delivers your Part A and Part B benefits — and usually your Part D drug coverage — in one bundled plan. Medicare pays the insurer a set amount per member to manage your care.

Both paths are legitimate. Neither is universally "better." They just work differently.

How Original Medicare + Medigap is built

With Original Medicare, you can generally see any doctor or hospital in the country that accepts Medicare — and most do. There are no plan networks to check.

A Medigap policy sits on top of that. It is standardized by the federal government, meaning a Plan G from one company covers the same things as a Plan G from another. The price is what differs. Medigap does not include prescription drug coverage, so most people also enroll in a stand-alone Part D plan.

One important detail: in most states, the strongest consumer protections for buying Medigap apply during your six-month Medigap Open Enrollment Period, which starts when you are 65 or older and enrolled in Part B. Outside that window, insurers can, in most states, use medical underwriting.

How Medicare Advantage is built

Medicare Advantage plans are offered by private insurers and typically operate through provider networks — HMOs, PPOs, and similar structures. Many plans include extras that Original Medicare does not cover, like routine dental, vision, or hearing benefits.

Because these plans manage care, they may require referrals, prior authorization for certain services, or in-network providers for the lowest cost-sharing. Every plan sets its own yearly out-of-pocket maximum for Part A and Part B services, which Original Medicare on its own does not have.

St. Louis Park is in Hennepin County, where residents typically have a wide range of Medicare Advantage plans available from multiple carriers. You can see the exact plans offered in your ZIP code using the Plan Finder tool at medicare.gov.

What is new for 2026

A few program-level updates apply no matter which path you choose:

• Part D out-of-pocket cap: In 2026, once your out-of-pocket spending on covered drugs reaches $2,100, you pay $0 for the rest of the calendar year.
• Part D deductible: The maximum allowed deductible is $615 in 2026.
• No more donut hole: The coverage gap phase was eliminated in 2025. Part D now has three phases: deductible, initial coverage, and catastrophic.
• Medicare Prescription Payment Plan: An optional program that lets you spread your yearly drug costs into monthly payments instead of paying at the pharmacy counter.
• IRMAA: Higher-income beneficiaries pay income-related surcharges on Part B and Part D. In 2026, these begin above $109,000 for a single filer.

Key enrollment windows to know

• Annual Enrollment Period: October 15 – December 7. You can join, switch, or drop a Medicare Advantage or Part D plan for the following year.
• Medicare Advantage Open Enrollment Period: January 1 – March 31. If you are already in a Medicare Advantage plan, you can switch to a different one, or return to Original Medicare (and add Part D).
• Initial Enrollment Period: The seven-month window around your 65th birthday.