Medicare 2026

Medicare coverage structure for Mandan residents at 65

MANDAN, N.D. — Turning 65 in Mandan comes with a decision that shapes how your health coverage will work for years: stay with Original Medicare and pair it with a Medigap policy, or move your benefits into a Medicare Advantage plan. Both are legitimate paths. They just work very differently, and understanding the structure is the key to picking what fits your life.

Two different roads, same starting point

Everyone eligible for Medicare starts in the same place: Part A (hospital insurance) and Part B (medical insurance). From there, the roads split.

• Path 1: Original Medicare + Medigap (+ usually a standalone Part D drug plan). You keep Parts A and B, and add a Medigap (Medicare Supplement) policy from a private insurer to help cover things Original Medicare doesn't, like coinsurance and deductibles. Drug coverage is added separately through a Part D plan.
• Path 2: Medicare Advantage (Part C). You still have Medicare, but a private plan administers your Part A, Part B, and usually Part D benefits in one package. These plans often include extras Original Medicare doesn't cover, and they operate through networks.

Neither path is "better" in the abstract. They're built on different trade-offs.

How the two paths actually behave

With Original Medicare + Medigap, you can generally see any doctor or hospital in the country that accepts Medicare — no network, no referrals. Medigap policies are standardized by letter (Plan G, Plan N, and so on), so a Plan G from one company covers the same medical costs as a Plan G from another. What changes is the premium and the company's service.

With Medicare Advantage, you use the plan's provider network — typically an HMO or PPO — and you may need referrals or prior authorization for certain services. Advantage plans have an annual out-of-pocket maximum for Part A and Part B services, which Original Medicare alone does not have. That's a meaningful structural difference.

Mandan is in Morton County, where residents choose from a selection of Medicare Advantage plans offered by multiple carriers in 2026. Availability counts are set at the county level, so a neighbor a few miles away in a different county may see a different lineup. The 2027 lineup is spelled out in each plan's ANOC and on Medicare.gov's Plan Finder.

Drug coverage: where the 2027 rules matter

However you get your coverage, Part D rules apply to your prescriptions.

• The Part D out-of-pocket cap is $2,100 in 2026. Once you hit it, you pay $0 for covered drugs the rest of the year.
• The maximum Part D deductible a plan can charge is $615 in 2026.
• The old "donut hole" coverage gap was eliminated in 2025. Part D now has three phases instead of four.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the calendar year in monthly payments instead of paying large amounts at the pharmacy counter. It's optional and free to opt into.

These figures come from CMS and apply whether your drug coverage sits inside a Medicare Advantage plan or a standalone Part D plan.

The Medigap timing trap

Here's a structural point that catches people off guard. When you first enroll in Part B at 65, you get a six-month Medigap Open Enrollment Period during which insurers must sell you any Medigap policy they offer, at their best available rate, regardless of your health.

After that window closes, in most states insurers can use medical underwriting — meaning they can charge more or decline you based on health history. That makes the switch from Medicare Advantage back to Original Medicare + Medigap harder later on than it looks on paper. It's worth thinking about at the start, not just when a problem arises.

Higher-income surcharges (IRMAA)

If your income is above certain thresholds, you'll pay an Income-Related Monthly Adjustment Amount (IRMAA) on top of your Part B and Part D premiums. For 2026, IRMAA begins above $109,000 in income for a single filer (higher for joint filers). Social Security uses your tax return from two years back to determine whether it applies. If your income has dropped since — for example, because you retired — you can ask for a reconsideration.

Key dates to keep on the calendar

• October 15 – December 7: Medicare Annual Enrollment Period. You can join, switch, or drop a Medicare Advantage or Part D plan. Changes take effect January 1.
• January 1 – March 31: Medicare Advantage Open Enrollment Period. If you're already in an Advantage plan, you get one chance to switch to a different Advantage plan or return to Original Medicare (and add a Part D plan).
• Your Initial Enrollment Period: a seven-month window around your 65th birthday.

Missing an enrollment window can mean waiting or paying late-enrollment penalties, so mark them down.