Medicare 2026

How Medigap and Medicare Advantage Are Built in Hillsboro

HILLSBORO, Ore. — Choosing between Original Medicare paired with a Medigap policy and a Medicare Advantage plan is a big decision — and in many cases, the calendar decides just as much as the coverage itself. The two paths are built differently, and the enrollment windows that let you switch between them do not all work the same way.

For Hillsboro residents weighing their options this fall, here is how the dates line up and what happens if one slips by.

The two structures, in one minute

Original Medicare is the federal program: Part A (hospital) and Part B (medical). You can add a stand-alone Part D drug plan, and you can add a Medigap (Medicare Supplement) policy from a private insurer to help cover deductibles and coinsurance Original Medicare leaves behind.

Medicare Advantage (Part C) is different. A private plan, approved by Medicare, delivers your Part A and Part B benefits — usually with Part D drug coverage built in — often through a network of doctors and hospitals.

You cannot use a Medigap policy with a Medicare Advantage plan. That is why the switch between the two paths is not just a paperwork change; it is a structural one, and timing matters.

The Medigap window is the one people miss

The single most important date for anyone leaning toward Original Medicare plus Medigap is your Medigap Open Enrollment Period — a one-time, six-month window that starts the month you are 65 and enrolled in Part B.

During that window, insurers in Oregon must sell you any Medigap policy they offer at their standard rate, regardless of your health history. Once it closes, in most situations insurers can use medical underwriting — meaning they can ask health questions and decide whether to offer you a policy and at what price.

If you enroll in Medicare Advantage first and later want to switch to Original Medicare with a Medigap policy, you can change during the Medicare enrollment periods below — but getting the Medigap policy itself is a separate step, and it may not be guaranteed. This is where a call to Oregon’s SHIBA counselors can save real heartache.

The Annual Enrollment Period: Oct. 15 – Dec. 7

This is the window most Hillsboro readers already know. From Oct. 15 through Dec. 7, you can:

• Switch from Original Medicare to a Medicare Advantage plan, or vice versa.
• Join, drop, or change a Part D drug plan.
• Change from one Medicare Advantage plan to another.

Changes made in this window take effect Jan. 1, 2027. If Dec. 7 passes and you did nothing, your current coverage generally rolls into 2027 with any updates described in your plan's Annual Notice of Change.

One reminder for 2026: Part D has a new $2,100 annual out-of-pocket cap on covered drugs, the Part D maximum deductible is $615, and the old coverage gap (“donut hole”) has been eliminated as of 2025. The optional Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly installments.

The Medicare Advantage Open Enrollment Period: Jan. 1 – March 31

If you are already in a Medicare Advantage plan on Jan. 1, you get a second chance. From Jan. 1 through March 31, you can:

• Switch to a different Medicare Advantage plan, or
• Drop your Medicare Advantage plan and return to Original Medicare (and add a stand-alone Part D plan).

What this window does not guarantee is Medigap. Dropping an Advantage plan in February and returning to Original Medicare is straightforward — but buying a Medigap policy at that point may involve underwriting unless a specific guaranteed-issue right applies to your situation. Check before you make the move.

People on Original Medicare cannot use this window to jump into Medicare Advantage. That is an Oct. 15 – Dec. 7 decision.

What happens if you miss a window

Missing the Annual Enrollment Period usually means waiting a full year, unless you qualify for a Special Enrollment Period. Common triggers include moving out of your plan’s service area, losing other creditable coverage, or qualifying for Extra Help or Medicaid.

Missing your initial enrollment in Part B or Part D, without other creditable coverage, can lead to late enrollment penalties that stay with you as long as you have Medicare. That is a separate deadline from the annual windows above and worth confirming on medicare.gov if you are unsure where you stand.

A quick note on Hillsboro’s options

Hillsboro is in Washington County, where a range of Medicare Advantage and Part D plans are offered by multiple carriers each year. Availability, networks and drug formularies can change annually, so even if you are happy with your current coverage, it is worth reviewing the Annual Notice of Change your plan sends each fall before Dec. 7.

Higher-income beneficiaries should also note that IRMAA surcharges on Part B and Part D premiums begin above $109,000 in income for a single filer in 2026.