Medicare 2026

Why Medicare's two paths look different in Youngstown

YOUNGSTOWN, Ohio — If you're turning 65 soon or rethinking your coverage during this fall's Annual Enrollment Period, you've probably run into the same fork in the road that trips up almost everyone new to Medicare: Should you stick with Original Medicare and add a Medigap policy, or should you go with a Medicare Advantage plan?

They sound similar. They are not. Understanding how each path is built — not just what it costs — is the single most useful thing you can do before you sign anything.

Two different ways to get the same Medicare

Everyone eligible for Medicare starts in the same place: Part A (hospital) and Part B (doctor and outpatient care), together called Original Medicare. From there, you choose how you want that coverage delivered.

• Path 1: Original Medicare + a Medigap policy (and usually a separate Part D drug plan). You keep Original Medicare as your main coverage. A Medigap policy, sold by a private insurer, helps pay the out-of-pocket costs Original Medicare leaves behind, like coinsurance and deductibles. Drug coverage is a separate purchase.
• Path 2: Medicare Advantage (Part C). A private insurer, approved by Medicare, provides all of your Part A and Part B coverage in one bundled plan. Most Advantage plans also include Part D drug coverage and sometimes extras like vision, dental, or hearing.

Both are legitimate. Both are regulated. They just work very differently once you actually need care.

How Original Medicare + Medigap works

With Original Medicare, you can see any doctor or hospital in the country that accepts Medicare — and most do. There is no network. You don't need a referral to see a specialist.

The trade-off is that Original Medicare has cost-sharing with no yearly out-of-pocket limit. That's where Medigap comes in. A Medigap policy fills in some or most of those gaps, depending on which lettered plan (like Plan G or Plan N) you choose. Because drug coverage isn't included, you'd typically add a stand-alone Part D plan.

This path tends to appeal to people who want predictable bills and broad access to providers, and who don't mind paying a monthly Medigap premium on top of their Part B premium.

How Medicare Advantage works

Medicare Advantage plans package everything together. In exchange, they generally use provider networks (HMO or PPO), and many require referrals or prior authorization for certain services. Each plan sets its own copays and its own yearly out-of-pocket maximum for in-network care — a built-in ceiling that Original Medicare alone does not have.

Advantage plans can also include benefits Original Medicare doesn't cover. The rules, networks, and covered extras vary from plan to plan and can change each year, which is why reviewing your plan's Annual Notice of Change every fall matters.

Youngstown is in Mahoning County, where residents typically have a broad menu of Medicare Advantage plans and stand-alone Part D plans to compare during Open Enrollment. You can see the exact options for your ZIP code using the Plan Finder at medicare.gov.

What's new for 2027 (and why it matters to both paths)

A few program-wide updates apply no matter which path you choose, as long as you have Part D drug coverage:

• The Part D out-of-pocket cap is $2,100 in 2026. Once your drug spending hits that ceiling, you pay $0 for covered drugs the rest of the year.
• The Part D deductible can be no higher than $615 in 2026 ($700 in 2027).
• The old coverage gap ("donut hole") is gone as of 2025. Part D now has three simpler phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the calendar year in monthly installments instead of paying at the pharmacy counter.
• IRMAA — the income-related surcharge on Part B and Part D — begins above $109,000 in income for a single filer in 2026.

These changes affect your drug costs whether you get Part D through a stand-alone plan (Path 1) or bundled inside a Medicare Advantage plan (Path 2).

The switching rules aren't the same in both directions

This is the part many people miss. Moving between the two paths is not always symmetrical.

• Anyone can switch between Original Medicare and Medicare Advantage during the Annual Enrollment Period, October 15 – December 7.
• If you're already in a Medicare Advantage plan, you get a second window — the Medicare Advantage Open Enrollment Period, January 1 – March 31 — to switch to a different Advantage plan or return to Original Medicare.
• But if you leave Medicare Advantage and try to buy a Medigap policy later, insurers in most states can use medical underwriting. That means you might be denied or charged more based on your health. Your strongest Medigap rights typically exist when you first enroll in Part B at 65.

Before you switch, it's worth calling Ohio's SHIP (State Health Insurance Assistance Program) — the free, unbiased counseling service — to walk through your specific situation.

Which path fits which person?

There's no universal answer, and anyone who tells you otherwise isn't being straight with you. But the honest questions to ask yourself are:

• Do I travel often or split time between states? Original Medicare's nationwide access may matter more.
• Do I want one card, one plan, and built-in extras — and am I comfortable with a network? Medicare Advantage may fit.
• Can I afford a monthly Medigap premium in exchange for very predictable bills?
• Are my current doctors and preferred hospitals in the plan's network? Check before enrolling, not after.
• What drugs do I take, and how is each option's formulary going to treat them next year?