Medicare 2026

How Original Medicare and Medigap differ from Advantage in Las Vegas

LAS VEGAS — If you are turning 65 in the valley, or helping a parent sort out coverage, you have probably run into the same fork in the road that trips up almost everyone new to Medicare: do you stay with Original Medicare and add a Medigap policy, or do you go with a Medicare Advantage plan? They are built very differently, and understanding that structure is the first step to making a choice you can live with.

Two different structures, not two flavors of the same thing

Original Medicare is the federal program itself — Part A (hospital) and Part B (doctor and outpatient). You can go to almost any doctor or hospital in the country that accepts Medicare, and there is no network. But Original Medicare alone does not cap what you might pay out of pocket in a bad year, and it does not include prescription drug coverage.

That is where the two "add-on" paths come in.

A Medigap policy (also called Medicare Supplement) is private insurance that pays some of the costs Original Medicare leaves behind, like coinsurance and deductibles. You still use your red, white and blue Medicare card, and you typically add a separate Part D drug plan on top.

A Medicare Advantage plan (Part C) is a different approach. A private insurer, approved by Medicare, delivers your Part A and Part B benefits — usually with drug coverage built in — through its own plan design. That design typically includes a provider network (HMO or PPO), copays instead of coinsurance, and a yearly cap on in-network medical spending. Extra benefits like dental, vision or fitness may be included.

How the money works on each side

On the Original Medicare + Medigap side, you generally pay:

• Your Part B premium to Medicare,
• A premium to the Medigap insurer,
• A premium for a standalone Part D drug plan.

In exchange, your share of covered medical costs is very predictable, because the Medigap plan absorbs most of it.

On the Medicare Advantage side, you still pay your Part B premium, plus whatever the Advantage plan charges (which may be low). You then pay copays as you use care, up to the plan's annual out-of-pocket maximum for in-network services.

Neither structure is automatically cheaper — it depends on how much care you use, which doctors you see, and which prescriptions you take.

Networks, referrals and travel

This is where the structural difference shows up in daily life.

With Original Medicare + Medigap, if you split time between Las Vegas and, say, family in the Midwest, you can generally see any Medicare-accepting provider without worrying about network status or referrals.

With Medicare Advantage, care is usually organized around a local network. HMO plans often require you to stay in-network except for emergencies, and may require referrals to see specialists. PPO plans allow out-of-network care but usually at a higher cost share. For snowbirds and frequent travelers, that difference matters.

What the local picture looks like

Las Vegas is in Clark County, where Medicare beneficiaries typically have a wide selection of Medicare Advantage plans and standalone Part D plans offered by multiple carriers. Plan availability is set at the county level by the Centers for Medicare & Medicaid Services (CMS), so two neighbors in the same ZIP code will generally see the same menu of choices.

You can see the exact plans available at your address using the Plan Finder at medicare.gov.

2027 rules that apply either way

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

• Part D out-of-pocket cap: $2,100 for 2026. Once your covered drug spending hits that amount, you pay $0 for covered drugs the rest of the year.
• Part D maximum deductible: $615 in 2026.
• The old "donut hole" coverage gap was eliminated in 2025. Part D now has three phases (deductible, initial coverage, catastrophic).
• The Medicare Prescription Payment Plan lets you spread your out-of-pocket drug costs across the calendar year in monthly installments instead of paying at the pharmacy counter.
• IRMAA — an income-based surcharge on Part B and Part D — begins above $109,000 in income for a single filer in 2026.

Enrollment windows to write down

• Initial Enrollment Period: the seven months around your 65th birthday.
• Medigap Open Enrollment: the six-month window that starts when you are 65 and enrolled in Part B — the one time you have a guaranteed right to buy any Medigap policy sold in Nevada without medical underwriting.
• Annual Enrollment Period: Oct. 15 – Dec. 7 each year, for changes that take effect Jan. 1.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31, when Advantage members can switch to another Advantage plan or return to Original Medicare.

That Medigap underwriting point is worth pausing on: outside your one-time Medigap open enrollment window (and a few special situations), a Medigap insurer in Nevada can generally ask health questions and decline you. That is one reason many people think carefully before leaving a Medigap policy for an Advantage plan.