Medicare 2026

Medigap or Medicare Advantage? Two Paths, Explained

UNIONTOWN, Pa. — Turning 65 in Fayette County usually comes with the same big question: should you stick with Original Medicare and add a Medigap policy, or go with a Medicare Advantage plan? Both are legitimate ways to get your Medicare coverage, but they are built differently, and the choice shapes how you see doctors, how you pay, and how your drug coverage fits in.

Here is a plain-English look at how the two paths compare as you weigh 2027 coverage.

Path one: Original Medicare + Medigap + Part D

Original Medicare is the federal program itself — Part A (hospital) and Part B (doctor and outpatient). You can see any doctor or hospital in the country that accepts Medicare, and you do not need referrals.

Original Medicare pays its share, and you are responsible for the rest. That "rest" can add up, because Part B has no yearly out-of-pocket limit on its own. That is where Medigap (also called Medicare Supplement Insurance) comes in. A Medigap policy, sold by a private insurer, helps pay some of the deductibles, copays, and coinsurance that Original Medicare leaves behind.

Because Medigap does not include drug coverage, people on this path usually add a stand-alone Part D prescription drug plan.

So the structure looks like: Part A + Part B + Medigap + Part D — four pieces working together.

Path two: Medicare Advantage (Part C)

Medicare Advantage, also called Part C, is offered by private insurance companies approved by Medicare. When you enroll in a Medicare Advantage plan, that plan takes over the job of delivering your Part A and Part B benefits, and most plans also include Part D drug coverage in one package.

Advantage plans typically use provider networks (HMO or PPO), and referrals or prior authorizations may be required for certain services. In exchange, plans often bundle in extras that Original Medicare does not cover, such as routine dental, vision, or hearing benefits. Every Advantage plan must also include an annual out-of-pocket maximum for Part A and Part B services.

Uniontown sits in Fayette County, where residents typically have a wide range of Medicare Advantage plans to choose from during enrollment. The exact count changes each year, and Medicare.gov's plan finder shows the current options by ZIP code.

How costs are structured differently

This is where the two paths really diverge:

• Original Medicare + Medigap: You generally pay a monthly premium for Part B, a premium for your Medigap policy, and a premium for your Part D plan. In return, your out-of-pocket costs when you actually use care tend to be more predictable.
• Medicare Advantage: You still pay the Part B premium, plus any premium the plan itself charges. Costs at the point of care come as copays or coinsurance, up to the plan's yearly out-of-pocket cap.

Neither path is automatically cheaper. It depends on your health, the providers you want to see, and the medicines you take.

What is the same on both paths

Some rules apply no matter which way you go:

• Part D out-of-pocket cap: $2,100 in 2026 and $2,400 in 2027. Once your covered drug costs hit that amount, you pay nothing for covered Part D drugs the rest of the year.
• Part D maximum deductible: $615 in 2026 and $700 in 2027.
• No more donut hole: As of 2025, the old coverage gap is gone. Part D now has three phases — deductible, initial coverage, and catastrophic.
• Medicare Prescription Payment Plan: An optional program that lets you spread your drug costs across the calendar year in monthly amounts instead of paying big bills at the pharmacy counter.
• IRMAA: Higher-income beneficiaries pay more for Part B and Part D. In 2026, IRMAA surcharges begin above $109,000 in income for a single filer.

Enrollment windows to know

• Initial Enrollment Period: The seven-month window around your 65th birthday.
• Medigap Open Enrollment: A one-time six-month window that starts when you are 65 or older and enrolled in Part B. During this window, insurers cannot deny you a Medigap policy or charge you more based on health. Outside of it, in most states, they can.
• Annual Enrollment Period (AEP): Oct. 15 – Dec. 7 every year. You can join, switch, or drop a Medicare Advantage or Part D plan.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31. If you are already in an Advantage plan, you can switch to another one or return to Original Medicare (and pick up a Part D plan).

The Medigap Open Enrollment window is the piece people often miss, and it matters because switching from Medicare Advantage back to Medigap later in life is not always guaranteed.