Medicare 2026

Two Medicare Roads Before Dec. 7: Which Fits Your Life?

SUN VALLEY, Nev. — With the Annual Enrollment Period running through December 7, people around Sun Valley are once again weighing the same underlying question: should Medicare coverage come through Original Medicare paired with a Medigap policy, or through a Medicare Advantage plan? The two are built differently, and understanding that structure matters more than comparing brochures side by side.

Sun Valley is in Washoe County, where residents can shop from a full slate of Medicare Advantage and Part D plans during the fall window. But before you compare any specific option, it helps to understand what you are actually choosing between.

Two structures, not two brands

Original Medicare is the federal program itself — Part A (hospital) and Part B (doctor and outpatient). You can see any provider in the country that accepts Medicare, and there are no networks. To fill in the gaps Original Medicare leaves — like the Part A deductible and the 20% coinsurance under Part B — many people add a Medigap (Medicare Supplement) policy sold by a private insurer. Prescription coverage comes separately through a stand-alone Part D plan.

Medicare Advantage (Part C) is different. It is offered by private insurers approved by Medicare to deliver your Part A and Part B benefits, usually with Part D built in. These plans typically use networks (HMO or PPO), have their own cost-sharing structures, and often include extras that Original Medicare does not cover.

Neither approach is universally better. They are built for different priorities.

How you pay is where they diverge

Under Original Medicare with a Medigap plan, you generally pay: your Part B premium, a Medigap premium, and a Part D premium. In return, most of your per-visit costs are predictable — the Medigap plan absorbs a large share of what Medicare does not pay.

Under Medicare Advantage, you still pay the Part B premium, plus any premium the plan charges. Then you pay copays or coinsurance as you use care, up to the plan's annual out-of-pocket maximum. Costs can be lower in a light-use year and higher in a heavy-use year.

Program-level Part D rules apply either way: the out-of-pocket cap on covered drugs is $2,100 in 2026 and $2,400 in 2027, the maximum deductible is $615 in 2026 and $700 in 2027, and there is no coverage gap. If your drug bills land unevenly through the year, the Medicare Prescription Payment Plan lets you spread them into monthly installments.

Access to doctors and hospitals

This is often the deciding factor. Original Medicare works anywhere in the U.S. that accepts Medicare — helpful if you travel, split time between states, or want the freedom to see specialists without referrals.

Medicare Advantage plans generally require you to use in-network providers, and HMOs may require referrals. For Sun Valley residents who mostly see local providers in the Reno–Sparks area, that can work well. For someone who winters elsewhere or wants a specialist across state lines, it may feel restrictive.

What Medigap covers — and when you can buy it

Medigap policies are standardized by letter (Plan G, Plan N, and so on), so the benefits within each letter are the same no matter which insurer sells it. Premiums, however, vary.

Timing matters. Your best chance to buy Medigap without medical underwriting is during your six-month Medigap Open Enrollment Period, which starts when you are 65 or older and enrolled in Part B. Outside that window, in most states insurers can consider your health history. Nevada residents can check state-specific rules through the Nevada Division of Insurance or a SHIP counselor.

Extras, ratings, and the fine print

Medicare Advantage plans frequently package benefits like dental, vision, hearing, or fitness. Original Medicare does not include these, though some are available as separate coverage.

CMS publishes Star Ratings (1 to 5) for Medicare Advantage and Part D plans, based on quality and member experience. Ratings are one useful data point — not a substitute for checking whether your doctors, hospitals, and medications are actually covered.

Also worth knowing: if your income is above $109,000 as a single filer in 2026, IRMAA surcharges may raise your Part B and Part D premiums regardless of which path you choose.

Key dates to keep on your calendar

• October 15 – December 7: Annual Enrollment Period. Join, drop, or switch Medicare Advantage and Part D plans.
• January 1 – March 31: Medicare Advantage Open Enrollment Period. If you are already in an Advantage plan, you can switch to another or return to Original Medicare (and pick up a Part D plan).

Changes made during AEP take effect January 1.