Medicare 2026

Medicare structure explained for Elizabeth City residents

ELIZABETH CITY, N.C. — Turning 65 in the Albemarle region often comes with the same question at the kitchen table: should I stick with Original Medicare and add a Medigap policy, or go with a Medicare Advantage plan? Both are legitimate paths, and both are built into federal law — but they work very differently. Here's a plain look at how each one is structured, so you can decide which fits your life.

Two Different Roads, Same Starting Point

Everyone on Medicare starts with the same foundation: Part A (hospital insurance) and Part B (doctor and outpatient insurance). What you do next is the fork in the road.

• Path 1: Original Medicare + Medigap (+ a separate Part D drug plan). You stay in the federal program for your medical care and add private insurance to help pay the costs Medicare doesn't cover.
• Path 2: Medicare Advantage (Part C). You get your Part A, Part B, and usually Part D benefits bundled through a private plan approved by Medicare.

You cannot use both at the same time. A Medigap policy will not work with a Medicare Advantage plan.

How Original Medicare + Medigap Works

With this path, Medicare pays its share of your covered hospital and doctor bills first. Then your Medigap (also called Medicare Supplement) policy picks up some or all of what's left — things like the Part A deductible, coinsurance, and copays.

A few structural points to know:

• You can see any doctor or hospital in the country that accepts Medicare. There's no network.
• Medigap policies are standardized by letter (Plan G, Plan N, and so on). The benefits in each letter plan are the same from company to company, though the premium is not.
• Medigap does not cover prescription drugs. Most people add a stand-alone Part D plan.
• You usually pay a monthly premium for Medigap on top of your Part B premium.

How Medicare Advantage Works

Medicare Advantage plans are offered by private insurers under contract with Medicare. The plan takes over the job of paying your claims, and it must cover at least everything Original Medicare covers.

Key structural features:

• Plans typically use networks — HMOs, PPOs, and similar setups. You may need referrals or in-network providers.
• Most Advantage plans include Part D drug coverage in the same package.
• Many plans offer extras Original Medicare doesn't, such as routine dental, vision, hearing, or fitness benefits.
• You'll have an annual out-of-pocket maximum for medical services — something Original Medicare, by itself, does not have.
• Costs (premiums, copays, deductibles) vary plan by plan and change each year.

A Local Snapshot

Elizabeth City is in Pasquotank County, where residents can choose from a range of Medicare Advantage and Part D plans offered by private carriers. Plan availability, networks, and pharmacy options are set at the county level, so two neighbors across a county line may see different plan lists. To see what's actually offered where you live, use the Plan Finder at medicare.gov and enter your ZIP code.

2027 Rules That Apply No Matter Which Path You Pick

A few program-wide facts for the coming year, straight from CMS:

• Part D out-of-pocket cap: $2,100 for 2026. Once your covered drug spending hits that amount, you pay $0 for covered drugs the rest of the year.
• Part D deductible: up to $615 in 2026 ($700 in 2027) (plans may charge less).
• The old coverage gap ("donut hole") is gone as of 2025. Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly installments, at no extra charge.
• IRMAA income surcharges on Part B and Part D begin above $109,000 for a single filer in 2026.
• Annual Enrollment Period: Oct. 15 – Dec. 7. Medicare Advantage Open Enrollment: Jan. 1 – March 31.

The Timing Point People Miss

The best time to buy a Medigap policy is during your six-month Medigap Open Enrollment Period, which starts the month you're 65 and enrolled in Part B. During that window, insurers cannot turn you down or charge more because of health history. After that window closes, in most states — including North Carolina — Medigap carriers can use medical underwriting. That's why the choice between the two paths often needs to be made carefully the first time around.