Medicare 2026

Medigap or Medicare Advantage: the Cleveland Fork

CLEVELAND, Ohio — Every fall, Ohioans sitting down to sort out their Medicare coverage run into the same fork in the road: stay with Original Medicare and add a Medigap policy, or move to a Medicare Advantage plan. Both are legitimate paths, both are offered under federal Medicare rules, and both come with real trade-offs. Understanding how they are built — not just what they cost — is the clearest way to pick the one that fits your life.

Path one: Original Medicare with a Medigap policy

Original Medicare is the traditional, federally run program. It has two parts: Part A (hospital) and Part B (doctor visits and outpatient care). You can see any doctor or hospital in the country that accepts Medicare, and you don't need referrals.

The catch is that Original Medicare doesn't cap what you pay out of pocket. That's where Medigap — also called Medicare Supplement Insurance — comes in. Medigap is a private policy that pays some or all of the deductibles, coinsurance, and copays Original Medicare leaves for you. Plans are standardized by letter (Plan G, Plan N, and so on), so a Plan G from one company covers the same gaps as a Plan G from another.

If you go this route, you typically also add a stand-alone Part D drug plan.

Path two: Medicare Advantage (Part C)

Medicare Advantage, or Part C, is a way to get your Medicare benefits through a private plan approved by Medicare. Instead of the government paying your providers directly, the plan does. These plans must cover everything Original Medicare covers, and most bundle in prescription drug coverage. Many also include extras like dental, vision, or hearing benefits.

The trade-off is structure. Medicare Advantage plans usually use provider networks (HMOs or PPOs), may require referrals, and set their own rules for prior authorization. They also set their own yearly out-of-pocket maximum for medical care, which Original Medicare alone does not have.

Cleveland is in Cuyahoga County, where multiple carriers offer Medicare Advantage plans. The exact number changes each year, and you can see current options for your ZIP code on the Plan Finder at medicare.gov.

The key structural difference

Here's the simplest way to think about it:

• Original Medicare + Medigap + Part D = government coverage, with a private policy filling the gaps and a separate drug plan.
• Medicare Advantage = a single private plan that delivers your Part A, Part B, and usually Part D benefits together.

You cannot use a Medigap policy to pay costs under a Medicare Advantage plan. They are two different systems, and you generally pick one or the other.

What's the same either way

No matter which path you choose, some rules apply across the board for 2027:

• Part D has a $2,400 out-of-pocket cap on covered drugs in 2027.
• The Part D maximum deductible is $700 in 2027.
• The old coverage gap ("donut hole") is gone; Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread drug costs across the calendar year in monthly installments if you opt in.
• IRMAA income-based surcharges begin above $109,000 for a single filer.

When you can make changes

Two windows matter most:

• Annual Enrollment Period: Oct. 15 – Dec. 7. You can join, switch, or drop a Medicare Advantage or Part D plan for coverage starting Jan. 1.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31. If you're already in an Advantage plan, you can switch to a different one or return to Original Medicare.

Medigap has its own rules. Your strongest guaranteed right to buy a Medigap policy — with no medical underwriting — is generally during the six-month window that begins when you're 65 and enrolled in Part B. Outside that window, in most states insurers can consider your health history.