Medicare 2026

The plumbing behind Medicare choices in Clovis

In Clovis, turning 65 usually brings the same big question: should you stay with Original Medicare and add a Medigap policy, or go with a Medicare Advantage plan? Both are legal, both are common, and both are built on very different plumbing. Understanding that structure is the single most useful thing you can do before you sign anything.

The two paths, in plain English

Path 1: Original Medicare + Medigap (+ usually a Part D drug plan). 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. Because Original Medicare leaves some cost-sharing on the table (deductibles, the 20% Part B coinsurance, and no yearly out-of-pocket limit), many people buy a Medigap policy from a private insurer to help cover those gaps. Drug coverage is a separate purchase — a stand-alone Part D plan.

Path 2: Medicare Advantage (Part C). A Medicare Advantage plan is a private plan that Medicare pays to deliver your Part A and Part B benefits, usually with drug coverage rolled in. Instead of Medicare paying your doctor directly, the plan does. In exchange, the plan sets its own network, its own rules for referrals or prior authorization, and its own yearly out-of-pocket maximum.

The short version: with Medigap, you're adding a second policy on top of Medicare. With Advantage, you're routing your Medicare benefits through a private plan.

What that structural difference actually means day to day

The two paths tend to feel different at the doctor's office.

• Networks. Original Medicare doesn't have a network — if the provider takes Medicare, you're in. Medicare Advantage plans typically use HMO or PPO networks, which matters if you travel, own a second home, or see specialists outside Clovis.
• Referrals and approvals. Original Medicare rarely requires prior authorization. Advantage plans often do, especially for imaging, therapy, and hospital stays.
• Out-of-pocket protection. Medigap policies help pay the shares Original Medicare leaves behind. Advantage plans instead cap your yearly in-network spending on Part A and B services.
• Extras. Many Advantage plans bundle in benefits Original Medicare doesn't cover, like routine dental, vision, or hearing. Medigap does not add those extras.

None of this makes one path universally better. It makes them different tools.

The Clovis picture

Clovis sits in Curry County, and Medicare plan availability is set at the county level. That means every Clovis resident on Medicare is choosing from the same slate of Medicare Advantage and Part D plans as the rest of Curry County. Medigap policies, by contrast, are regulated by the New Mexico Office of Superintendent of Insurance, and availability and pricing can vary by carrier and by your age.

If you want to see the exact plans offered in your ZIP code, the Plan Finder at medicare.gov is the official source and is updated each fall.

2027 rules worth knowing before you choose

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

• Part D out-of-pocket cap: $2,100 for the year in 2026 and $2,400 in 2027. Once your covered drug spending hits that amount, you pay nothing for covered drugs the rest of the year.
• Part D deductible: cannot exceed $615 in 2026, or $700 in 2027.
• No more donut hole. As of 2025, Part D has three phases instead of four — the old coverage gap is gone.
• Medicare Prescription Payment Plan. You can ask to spread your drug costs across the calendar year in monthly payments instead of paying at the pharmacy counter.
• IRMAA. Higher-income beneficiaries pay a surcharge on Part B and Part D premiums; for a single filer in 2026, that kicks in above $109,000 in income.

When you can switch paths

• Annual Enrollment Period: Oct. 15 – Dec. 7. This is when most people move between Original Medicare, Medicare Advantage, and Part D plans for the following year.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31. If you're already in an Advantage plan, you get one chance in this window to change to a different Advantage plan or drop back to Original Medicare.

One important note on Medigap: your strongest right to buy a Medigap policy — with no medical underwriting — is generally your six-month Medigap Open Enrollment Period that starts when you're 65 and enrolled in Part B. After that, in most states including New Mexico, insurers can ask health questions. That's a structural detail worth understanding before you leave Medigap for Advantage, because getting back in later isn't automatic.

How to think it through

A few honest questions tend to sort people out:

• Do you travel a lot or split time outside New Mexico? Original Medicare's nationwide reach may matter more.
• Do you value predictable, low paperwork over lower monthly premiums? Medigap tends to favor predictability.
• Are you comfortable with networks and prior authorization in exchange for extras like dental or vision? Advantage may fit.
• Are you already managing several prescriptions? Look closely at Part D coverage under either path.

There is no single right answer — only the one that fits your health, your budget, and how you use care.