Medicare 2026

Why Medicare works two ways for Upper Arlington residents

In Upper Arlington, turning 65 often comes with a familiar question: should you stick with Original Medicare and add a Medigap policy, or take the Medicare Advantage route? Both are legal, both are common, and both are built very differently. Understanding how they're structured is the first step to picking the path that fits your life.

Two different structures, not just two different prices

The biggest thing to understand is that these are not just two flavors of the same product. They are two different structures.

With Original Medicare, the federal government pays your doctors and hospitals directly. You can see any provider in the country who accepts Medicare — no networks, no referrals. But Original Medicare has cost-sharing (deductibles and coinsurance) with no cap on what you could owe in a bad year. That's where Medigap (also called Medicare Supplement Insurance) comes in. It's a private policy that sits on top of Original Medicare and picks up much of what Parts A and B leave behind. You'd then add a stand-alone Part D plan for prescription drugs.

With Medicare Advantage (Part C), a private insurer takes over the job of delivering your Part A and Part B benefits, usually adds Part D drug coverage, and often includes extras like dental or vision. In exchange, you generally use the plan's provider network and follow its rules for referrals and prior authorization. Every Advantage plan has a yearly out-of-pocket maximum on medical costs.

Where Upper Arlington fits in

Upper Arlington is in Franklin County, where residents can shop from a wide field of Medicare Advantage and Part D plans during enrollment periods. Plan availability, benefits, and networks are set at the county level, so what's offered in Franklin County may differ from what a friend or relative sees a county away.

Medigap works differently. In Ohio, Medigap policies are standardized by letter (Plan G, Plan N, and so on), meaning the core benefits of "Plan G" are the same no matter which company sells it — though prices and customer service vary.

What's the same in 2027, no matter which path you pick

A few program-level rules apply across the board:

• Part D out-of-pocket cap: $2,100 in 2026 and $2,400 in 2027. Once your covered drug costs hit that ceiling, you pay nothing for covered drugs the rest of the year.
• Part D deductible: no plan can charge more than $615 in 2026 or more than $700 in 2027.
• The coverage gap ("donut hole") is gone as of 2025. Part D now has three phases instead of four.
• Medicare Prescription Payment Plan: an optional program that lets you spread your drug costs across the calendar year in monthly bills instead of paying all at once at the pharmacy counter.
• IRMAA: higher-income beneficiaries pay surcharges on Part B and Part D premiums. For a single filer in 2026, IRMAA kicks in above $109,000 in income.

Switching between paths

You can move between Original Medicare and Medicare Advantage, but the timing matters.

• The Annual Enrollment Period (Oct. 15 – Dec. 7) lets anyone with Medicare join, switch, or drop a Medicare Advantage or Part D plan.
• The Medicare Advantage Open Enrollment Period (Jan. 1 – March 31) lets people already in an Advantage plan switch to a different one or return to Original Medicare.

One important catch: if you leave Medicare Advantage and want to buy a Medigap policy later, you may have to answer medical questions and could be turned down or charged more, depending on state rules. Your best Medigap protections generally apply when you first sign up for Part B at 65. It's worth talking with Ohio SHIP (OSHIIP) before making a switch.

Star Ratings, briefly

Medicare publishes Star Ratings (1 to 5) each year for Advantage and Part D plans. They measure things like customer service, member complaints, and preventive care. They're a useful data point — not a verdict — and shouldn't be the only thing you weigh.