Medicare 2026
Why Medicare's two paths are built differently in Upper Darby
In Upper Darby, turning 65 often comes with a stack of mail, a few TV commercials, and one big question: should you stick with Original Medicare and add a Medigap policy, or go with a Medicare Advantage plan? Both are legitimate paths, but they are built very differently — and understanding that structure matters more than any glossy brochure.
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Key takeaways
- Original Medicare + Medigap and Medicare Advantage are two different structures, not two versions of the same product.
- Medigap helps pay the out-of-pocket costs Original Medicare leaves behind, while Medicare Advantage replaces how you receive your Part A and Part B benefits.
- In 2026, Part D has a $2,100 out-of-pocket cap and a maximum $615 deductible; in 2027, the cap is $2,400 and the maximum deductible is $700 — no matter which path you choose.
- The Annual Enrollment Period runs October 15 to December 7, and Medicare Advantage Open Enrollment runs January 1 to March 31.
The two paths, in plain terms
Original Medicare is the federal program itself — Part A (hospital) and Part B (doctor and outpatient). It pays a share of your covered care, and you pay the rest. To help with that "rest," many people add two things: a stand-alone Part D drug plan and a Medigap policy (also called Medicare Supplement Insurance), which is sold by private insurers and helps cover deductibles, coinsurance, and copays.
Medicare Advantage (Part C) is different. It is a private plan approved by Medicare that takes over the job of delivering your Part A and Part B benefits, usually bundles in Part D drug coverage, and often includes extras. When you're in an Advantage plan, you still have Medicare — but you get your care through that plan's rules and network.
What Medigap actually does
Medigap only works alongside Original Medicare. It doesn't cover drugs, and it doesn't add dental or vision. What it does is fill in cost-sharing gaps. Because you're using Original Medicare, you can generally see any provider in the country who accepts Medicare — no network to check before a specialist visit.
There's an important timing rule: your best window to buy a Medigap policy is the 6-month Medigap Open Enrollment Period that starts when you're 65 or older and enrolled in Part B. During that window, insurers can't turn you down or charge more for health reasons. Outside it, in most states, they can.
What Medicare Advantage actually does
Medicare Advantage plans package your coverage. Most include prescription drugs, and many include extras like routine dental, vision, hearing, or fitness benefits. In exchange, plans typically use provider networks (HMO or PPO), and you may need referrals or prior approval for certain services. Each plan sets its own copays and its own annual out-of-pocket maximum for medical care.
Upper Darby is in Delaware County, where a range of Medicare Advantage and Part D plans are offered each year by multiple carriers. The exact list — and the details of each plan — changes annually, which is why comparing during Open Enrollment matters.
Drug coverage: the same rules apply to both paths
Whether your drug coverage comes through a stand-alone Part D plan (paired with Original Medicare) or is built into a Medicare Advantage plan, the 2027 program-level rules are the same:
- The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027.
- The maximum Part D deductible is $615 in 2026 and $700 in 2027.
- The old coverage gap ("donut hole") is gone as of 2025 — Part D now has three phases.
- You can ask to join the Medicare Prescription Payment Plan, which spreads your drug costs into monthly payments instead of paying at the pharmacy counter.
Higher-income beneficiaries may pay an IRMAA surcharge on Part B and Part D. In 2026, IRMAA starts above $109,000 in income for a single filer.
How to think about the choice
There's no universally "right" answer. The honest questions to ask yourself are:
- Do I want the freedom to see any Medicare provider nationwide, or am I comfortable using a plan's network?
- Do I want predictable cost-sharing through Medigap, or bundled extras through Medicare Advantage?
- What are my prescriptions, and how does each plan's drug list handle them?
- What is my Medigap eligibility window, and am I inside it?
Your local State Health Insurance Assistance Program (SHIP) — called APPRISE in Pennsylvania — offers free, unbiased counseling and can walk through these questions with Upper Darby residents one-on-one.
Key dates to remember
- October 15 – December 7: Annual Enrollment Period. Join, switch, or drop a Medicare Advantage or Part D plan.
- January 1 – March 31: Medicare Advantage Open Enrollment. If you're already in an Advantage plan, you can switch to another one or return to Original Medicare (and add a Part D plan).
- Your Medigap Open Enrollment Period: The 6 months starting when you're 65 or older and enrolled in Part B.
By the numbers
Medicare Part B premium, 2006–2026
The standard monthly Part B premium has climbed from $88.50 in 2006 to $202.90 in 2026. Hover any point for that year’s premium.
Source: CMS. Standard premium shown; in some hold-harmless years many existing enrollees paid less. Confirm at Medicare.gov.
By the numbers
How people get Medicare in Delaware County
(MA penetration in Delaware County)
MA penetration from CMS enrollment data; Medigap share is an estimate. U.S. average is about 54% Medicare Advantage. These are area-level figures, not plan-specific.
Explore
When can you enroll? An interactive year
Enrollment windows are federal and the same nationwide. Confirm your personal dates at Medicare.gov or 1-800-MEDICARE.
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The parts of Medicare
Good to know
Frequently asked questions
Can I have both Medigap and Medicare Advantage?
If I choose Medicare Advantage now, can I switch to Medigap later?
Does Original Medicare include prescription drug coverage?
Where can I get personalized help in Upper Darby?
- CMS — Medicare basics (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.
Also for Upper Darby
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This page was last updated: September 29, 2026.