Medicare 2026

Two Medicare structures Springfield residents pick between at 65

In Springfield, most people turning 65 face the same fork in the road: stay with Original Medicare and add a Medigap policy, or move everything under a Medicare Advantage plan. Both paths are legal, both are common, and both are approved by Medicare — but they are built very differently. Understanding that structure is the first step to picking what fits your life.

The two paths, in plain language

Original Medicare is the federal program itself — Part A (hospital) and Part B (doctor and outpatient). It lets you see almost any provider in the country that accepts Medicare. But it doesn't cap what you pay out of pocket, and it doesn't include drug coverage. That's why many people on this path add two things: a stand-alone Part D drug plan, and a Medigap (Medicare Supplement) policy that helps cover the deductibles and coinsurance Original Medicare leaves behind.

Medicare Advantage (Part C) is different. You still have to be enrolled in Parts A and B, but a private insurance company takes over how your benefits are delivered. Most Advantage plans include drug coverage and often bundle extras like dental or vision. In return, they usually ask you to use a network of doctors and hospitals, and they set the copays and rules for each service.

What changes about your doctor visits

On Original Medicare with a Medigap policy, the doctor question is simple: does the provider accept Medicare? If yes, you're covered anywhere in the country. That matters if you split time between Springfield and family in another state, or travel often.

On Medicare Advantage, the plan's network is the key. HMO plans generally require you to stay in-network except for emergencies. PPO plans give more flexibility but charge more out-of-network. Before enrolling, it's worth checking that your Springfield-area primary care doctor, specialists, and preferred hospital are in the plan you're considering.

How costs are structured

The two paths handle money in almost opposite ways.

With Original Medicare + Medigap, you pay a monthly premium for Part B, a monthly premium for the Medigap policy, and a monthly premium for a Part D drug plan. In exchange, most of your medical bills are predictable — the Medigap policy smooths out the coinsurance.

With Medicare Advantage, monthly premiums are often lower, sometimes as low as the Part B premium alone. But you pay copays or coinsurance each time you use a service, up to the plan's yearly out-of-pocket maximum. Your costs depend on how much care you use in a given year.

Neither path is automatically cheaper. It depends on your health, your prescriptions, and how you use care.

Prescription drugs on each path

Drug coverage is where the two paths intersect most.

If you choose Original Medicare, you'll typically add a stand-alone Part D plan. If you choose Medicare Advantage, drug coverage is usually built in (these are called MA-PD plans).

The Part D rules are set nationally. The maximum deductible any plan can charge is $615 in 2026 and $700 in 2027. Once your out-of-pocket spending on covered drugs reaches the annual cap — $2,100 in 2026 and $2,400 in 2027 — you pay nothing more for covered drugs for the rest of the year. The old "donut hole" gap phase is gone as of 2025 — Part D now has three phases instead of four. You can also ask to spread your drug costs across the year through the Medicare Prescription Payment Plan, which is optional and free to join.

The Springfield picture

Springfield sits in Greene County, where plan availability is set at the county level by CMS. That means every ZIP code in Springfield sees the same menu of Medicare Advantage and Part D options as the rest of Greene County. Medigap policies, by contrast, are sold statewide in Missouri and are standardized by letter (Plan G, Plan N, and so on), so the benefits inside each letter plan don't change from carrier to carrier — only the premium does.

For a current, side-by-side look at what's offered locally, the Medicare Plan Finder at medicare.gov lets you enter your ZIP code and compare.

Enrollment windows to know

The two big dates apply no matter which path you're on:

• Annual Enrollment Period: October 15 – December 7. You can join, switch, or drop a Medicare Advantage or Part D plan. Changes take effect January 1.
• Medicare Advantage Open Enrollment Period: January 1 – March 31. If you're already in an Advantage plan, you can switch to a different Advantage plan once or drop back to Original Medicare.

Medigap is different. When you first sign up for Part B at 65, you have a six-month Medigap Open Enrollment window when insurers must sell you a policy at the standard rate. After that, they can ask health questions and, in most states including Missouri, turn you down for a policy or charge more. That one-time window is worth knowing before you decide.

A note on higher-income enrollees

If your income is above $109,000 as a single filer (or $218,000 filing jointly) in 2026, you'll pay an IRMAA surcharge on top of your standard Part B and Part D premiums. That applies whether you're on Original Medicare or Medicare Advantage — the surcharge follows the person, not the path.

Where to get personalized help

Nobody should pick between these two paths from a TV ad. In Missouri, the free State Health Insurance Assistance Program (SHIP) is called CLAIM, and their counselors can walk through your situation without trying to sell you anything. You can also call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, or use the Plan Finder at medicare.gov.