Medicare 2026

Medicare in Concord: Medigap and Advantage Structures

In Concord, New Hampshire, one of the biggest Medicare decisions isn't which plan to pick — it's which path to take. Original Medicare paired with a Medigap policy works one way. Medicare Advantage works another. The two are built on different structures, and understanding that difference is the first step to choosing wisely.

Two different structures, not two flavors

Original Medicare is the federal program itself — Part A (hospital) and Part B (doctor and outpatient). You can use almost any provider in the country that accepts Medicare. There's no network. But Original Medicare alone has no cap on what you might pay out of pocket in a year.

That's where Medigap (also called Medicare Supplement Insurance) comes in. It's a private policy that sits on top of Original Medicare and helps pay the deductibles, coinsurance, and copays Original Medicare leaves behind. Medigap does not include drug coverage, so most people who go this route also add a standalone Part D plan.

Medicare Advantage (Part C) is a different structure. It's a private plan, approved by Medicare, that takes over the job of delivering your Part A and Part B benefits. Most Advantage plans also include drug coverage and may include extras that Original Medicare doesn't cover. In exchange, you generally use the plan's provider network and follow its rules for referrals and prior authorization.

What that means day to day

With Original Medicare + Medigap, your care decisions run through Medicare's rules, and your Medigap policy handles most of the cost-sharing math in the background. You typically don't need referrals, and you can see any provider nationwide that accepts Medicare.

With Medicare Advantage, your plan is your point of contact. It sets the network, the copays, the prior authorization rules, and the yearly out-of-pocket maximum. Benefits and rules can change each year, so the plan you have today may look different next January.

Neither path is universally better. They're built for different priorities — flexibility and predictable supplemental coverage on one side, an all-in-one plan with extra features on the other.

Local snapshot: Concord and Merrimack County

Concord is in Merrimack County, where Medicare plan availability is set at the county level. That means when you shop on medicare.gov using your ZIP code, the plan list you see reflects what carriers have filed to offer in Merrimack County, not just in Concord itself.

New Hampshire also has some unique rules around Medigap — the state has its own consumer protections, and pricing and enrollment rights for Medigap policies work differently than in some other states. It's worth asking about them directly.

Drug coverage and Part D numbers to know

Whichever path you choose, drug coverage matters. In 2026, Part D has a $2,100 out-of-pocket cap on covered prescriptions, and the maximum Part D deductible is $615. The old "donut hole" coverage gap was eliminated in 2025, so Part D now has three phases instead of four.

If your drug costs hit hard in any single month, the Medicare Prescription Payment Plan lets you spread those out-of-pocket costs across the rest of the plan year in monthly amounts instead of paying all at once at the pharmacy.

Higher-income enrollees should also know about IRMAA — an income-related surcharge on Part B and Part D premiums that begins above $109,000 for a single filer in 2026.

When you can make changes

• Annual Enrollment Period: Oct. 15 – Dec. 7. Anyone with Medicare can join, switch, or drop a Medicare Advantage or Part D plan.
• Medicare Advantage Open Enrollment Period: Jan. 1 – March 31. If you're already in an Advantage plan, you can switch to a different one or return to Original Medicare (and add a Part D plan).

Switching from Medicare Advantage back to Original Medicare + Medigap later can be tricky — outside your initial enrollment window, Medigap insurers in many situations are allowed to use medical underwriting. That's one reason the initial choice deserves careful thought.

Where to get unbiased help

For personalized answers, use official sources rather than a sales call:

• Medicare.gov — official plan finder and program information.
• 1-800-MEDICARE (1-800-633-4227) — 24/7 help line.
• NH SHIP (ServiceLink Aging & Disability Resource Center) — New Hampshire's free State Health Insurance Assistance Program offers one-on-one Medicare counseling to Concord residents at no cost.