Medicare 2026

Medicare Advantage vs. Medigap: the Nashua structural gap

NASHUA, N.H. — If you're turning 65 in Nashua, or helping a parent sort out coverage, one choice tends to loom over all the others: should you pair Original Medicare with a Medigap policy, or enroll in a Medicare Advantage plan? They sound similar. Structurally, they're very different — and understanding that difference up front can save you a lot of second-guessing later.

Two different structures, not just two different prices

Original Medicare is the traditional, federally run program. Part A covers hospital stays, and Part B covers doctor visits and outpatient care. You can go to essentially any doctor or hospital in the country that accepts Medicare — and most do. But Original Medicare doesn't cap what you pay out of pocket in a year, and it doesn't include prescription drug coverage on its own.

That's where the other pieces come in. Many people on Original Medicare add a Medigap (Medicare Supplement) policy from a private insurer to help pay the deductibles and coinsurance Medicare leaves behind. They also add a separate Part D plan for prescriptions.

Medicare Advantage (Part C) is a different setup entirely. You're still in Medicare, but a private plan — approved by Medicare — delivers your Part A and Part B benefits, usually through a network of doctors and hospitals. Most Advantage plans include Part D drug coverage and may include extras like routine dental, vision or hearing. Advantage plans have a yearly out-of-pocket maximum for medical costs, which Original Medicare alone does not.

What that means day to day

The practical trade-off usually comes down to flexibility versus simplicity.

With Original Medicare plus a Medigap and a Part D plan, you're juggling more cards and more premiums, but you have wide provider access and predictable cost-sharing. If you split time between Nashua and, say, Florida in the winter, seeing in-network providers isn't something you have to think about.

With Medicare Advantage, you typically have one plan, one card and often lower monthly premiums, but you'll want to check that your doctors and preferred hospitals are in the plan's network and that any prescriptions you take are on its formulary. Referrals and prior authorizations may apply.

Neither structure is "better" in the abstract. The right fit depends on your health, your providers, your prescriptions and how you like to handle paperwork.

The Nashua picture

Nashua is in Hillsborough County, where plan availability is set at the county level by Medicare. That means the specific Medicare Advantage and Part D plans offered — and the number of them — are the same for a Nashua resident as for someone elsewhere in Hillsborough County. To see the current count and details for your ZIP code, the Plan Finder at Medicare.gov is the official source.

Medigap works differently. It's regulated at the state level, and in New Hampshire the standardized Medigap plan letters (Plan G, Plan N and so on) offer the same core benefits no matter which insurance company sells them. Premiums, however, can vary by carrier.

Part D rules worth knowing for 2027

A few program-level facts apply across the board:

• Part D out-of-pocket cap: $2,100 in 2026 and $2,400 in 2027. Once your drug spending hits that ceiling, you're done paying for covered drugs for the rest of the year.
• Part D maximum deductible: $615 in 2026 and $700 in 2027.
• No more "donut hole." As of 2025, the coverage gap phase is gone; Part D now has three phases instead of four.
• Medicare Prescription Payment Plan. This optional program lets you spread your out-of-pocket drug costs across the year in monthly installments instead of paying at the pharmacy counter.
• IRMAA. Higher-income beneficiaries pay a surcharge on Part B and Part D premiums. In 2026, IRMAA begins above $109,000 in income for a single filer.

When you can make changes

Mark two windows on the calendar:

• Annual Enrollment Period: Oct. 15 – Dec. 7. You can switch between Original Medicare and Medicare Advantage, change Advantage plans, or join or change a 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 Advantage plan or drop back to Original Medicare (and add a Part D plan).

One important note: moving from Medicare Advantage back to Original Medicare and then trying to buy a Medigap policy later isn't always guaranteed. Outside of specific guaranteed-issue situations, insurers may use medical underwriting. If you're weighing this move, talk it through with a counselor before you switch.

Where to get unbiased help

For personal questions, you have free, non-sales resources:

• Medicare.gov — official plan comparisons and rules.
• 1-800-MEDICARE (1-800-633-4227) — 24/7 help.
• NH SHIP (ServiceLink) — New Hampshire's State Health Insurance Assistance Program offers free, one-on-one Medicare counseling, including a ServiceLink office serving the Greater Nashua area.