Medicare 2026

Medigap and Medicare Advantage: the Charlotte comparison

CHARLOTTE, N.C. — One of the biggest decisions new Medicare enrollees face isn't which plan to pick. It's which kind of coverage to build around: Original Medicare paired with a Medigap policy, or a Medicare Advantage plan. The two paths look similar on the surface, but they're built very differently — and switching later isn't always easy.

Here's how to think it through before you sign anything.

The two structures, side by side

Original Medicare is the federal program: Part A (hospital) and Part B (doctor and outpatient). You can see any provider in the country who accepts Medicare, and there's no network. But Original Medicare alone doesn't cap what you might pay out of pocket. That's where a Medigap (Medicare Supplement) policy comes in — a private policy that helps pay the deductibles, coinsurance, and copays Original Medicare leaves behind. With this path, you typically also buy a standalone Part D plan for prescription drugs.

Medicare Advantage (Part C) is a private plan that replaces the way you get your Part A and Part B benefits. Most Advantage plans include Part D drug coverage and often extras like dental, vision, or fitness benefits. In exchange, you generally use the plan's network of doctors and hospitals, and you may need referrals or prior approval for certain care.

Neither path is "better." They're built for different priorities.

What changes month to month

With Original Medicare + Medigap + Part D, you're usually paying:

• The standard Part B premium (set by Medicare each year),
• A Medigap premium to the private insurer, and
• A Part D premium.

With Medicare Advantage, you still pay the Part B premium, plus whatever the Advantage plan charges (which varies). Instead of Medigap filling in the gaps, the Advantage plan uses copays and a yearly out-of-pocket maximum for medical services.

We're not going to quote specific plan prices here — those are individual to each plan and each person. But the structure of what you pay is one of the clearest differences between the two paths.

Drug coverage in 2027

No matter which path you choose, the same federal Part D rules apply. Here's what changes for 2027:

• Out-of-pocket drug costs are capped at $2,100 for the year.
• The Part D deductible can be no higher than $615.
• The old "donut hole" coverage gap is gone as of 2025 — Part D now has three phases.
• You can opt into the Medicare Prescription Payment Plan, which spreads your drug costs into level monthly payments instead of hitting you all at once at the pharmacy counter.

Higher-income enrollees pay an IRMAA surcharge on Part B and Part D. In 2026, IRMAA starts above $109,000 in income for a single filer (based on your tax return from two years earlier).

Charlotte-area availability

Charlotte is in Mecklenburg County, where Medicare beneficiaries generally have a wide selection of Medicare Advantage plans and standalone Part D plans to compare each year. Availability and plan details are set at the county level, so two people living just a few miles apart — but in different counties — may see different options. You can see exactly what's offered at your address using the Plan Finder at medicare.gov.

The mistake to avoid: assuming you can always switch later

This is the piece most people don't hear until it's too late.

When you first become eligible for Medicare, you have a Medigap Open Enrollment Period — a one-time, six-month window when insurance companies must sell you a Medigap policy at their best available rate, regardless of your health history. Outside that window, in most states, Medigap insurers can use medical underwriting — meaning they can charge you more, or turn you down, based on your health.

So if you choose Medicare Advantage first and try to move to Original Medicare + Medigap later, you may or may not be able to get the Medigap policy you want. North Carolina follows the federal baseline on this, with only limited guaranteed-issue situations.

You can switch between Medicare Advantage plans, or from Advantage back to Original Medicare, during:

• Annual Enrollment Period: October 15 – December 7, and
• Medicare Advantage Open Enrollment Period: January 1 – March 31.

But the Medigap piece is the part that can lock in — so think of your first choice as a serious one, not a trial run.

Questions worth asking yourself

• Do I travel often, or spend part of the year outside North Carolina?
• Do I already have doctors and specialists I want to keep?
• Am I comfortable with networks and prior authorization, or do I want the fewest restrictions possible?
• How predictable do I need my monthly costs to be versus my at-the-doctor costs?
• What prescriptions do I take, and is each one covered on the plan's formulary?

There's no universal right answer. The right answer is the one that fits your health, your budget, and how you use care.

Where to get unbiased help

• medicare.gov — the official site, with the Plan Finder tool.
• 1-800-MEDICARE (1-800-633-4227) — 24/7 help line.
• North Carolina SHIIP (Seniors' Health Insurance Information Program) — the state's free counseling service for Medicare questions. Counselors don't sell plans; they help you understand your options.