Medicare 2026

The fork in the road for Medicare enrollees in East Providence

East Providence, R.I. — If you're turning 65 or rethinking your Medicare coverage this year, you've probably run into the same fork in the road every new enrollee faces: stick with Original Medicare and add a Medigap policy, or go with a Medicare Advantage plan? They both cover you, but they're built very differently — and the choice shapes how you see doctors, what you pay, and how predictable your costs feel.

Here's a plain-English walk-through to help you weigh the two.

Two different structures, not just two different prices

Original Medicare is the federal program — Part A (hospital) and Part B (doctor and outpatient). You can use it at any provider in the country that accepts Medicare, and there's no network. But it doesn't cap what you pay out of pocket, and it doesn't cover prescription drugs on its own.

That's where the "add-ons" come in. Most people who choose Original Medicare also buy:

• A Medigap (Medicare Supplement) policy from a private insurer, which helps pay some of the deductibles, copays, and coinsurance Original Medicare leaves behind, and
• A standalone Part D plan for prescription drugs.

Medicare Advantage (Part C) takes a different path. It's an all-in-one plan from a private insurer, approved by Medicare, that replaces how you receive your Part A and Part B benefits. Most Advantage plans also include Part D drug coverage and may offer extras like dental, vision, hearing, or fitness benefits. In exchange, you generally use the plan's network of doctors and hospitals, and the plan sets rules like referrals or prior authorization for certain services.

You cannot use a Medigap policy with a Medicare Advantage plan. It's one path or the other.

What Original Medicare + Medigap tends to feel like

If predictability and provider freedom matter most to you, this combination leans that direction. You can see any doctor or specialist nationwide that accepts Medicare. Medigap policies are standardized by letter (Plan G, Plan N, and so on), so a "Plan G" from one insurer covers the same core things as a "Plan G" from another — the difference is usually price and customer service.

The trade-offs: you'll typically pay a monthly premium for Part B, a monthly Medigap premium, and a monthly Part D premium. And in most states, if you try to switch Medigap plans after your initial enrollment window, insurers can ask health questions before approving you. Rhode Island residents should confirm their state's specific Medigap rules with SHIP or the state insurance department.

What Medicare Advantage tends to feel like

Advantage plans package hospital, medical, and usually drug coverage together, and they cap your yearly out-of-pocket medical spending — something Original Medicare alone does not do. Many plans include extra benefits Original Medicare doesn't cover.

The trade-offs: networks matter. If your preferred doctor or hospital isn't in the plan's network, you may pay much more or not be covered at all outside emergencies. Plans can also require prior authorization before certain treatments or tests. Benefits, networks, and drug lists can change year to year, which is why the fall Annual Enrollment Period exists.

What's available around East Providence

East Providence is in Providence County, where a range of Medicare Advantage and Part D plans are offered by multiple private insurers each year. For 2027, Providence County has 18 Medicare Advantage plans from 4 carriers, compared with 23 plans from 4 carriers in 2026; 18 plans continue, 1 is not returning, and 4 have been renamed, with 8 continuing plans changing something in their terms (see each plan's ANOC for details). Availability is set at the county level, not the city level, so a neighbor across the state line in Massachusetts may see a different lineup. You can see the current options for your ZIP code using the Plan Finder tool at medicare.gov.

2027 numbers worth knowing

A few program-wide figures apply no matter which path you choose:

• Part D out-of-pocket cap: $2,100 in 2026 and $2,400 in 2027. Once your drug spending hits that amount, you pay nothing for covered drugs the rest of the year.
• Part D maximum deductible: $615 in 2026 and $700 in 2027 (plans can set a lower one).
• The old coverage gap ("donut hole") is gone as of 2025 — Part D now has three phases instead of four.
• The Medicare Prescription Payment Plan lets you spread your drug costs over monthly payments instead of paying big amounts at the pharmacy counter.
• IRMAA — the income-related surcharge on Part B and Part D premiums — starts above $109,000 in income for a single filer in 2026.

Key dates

• Annual Enrollment Period: Oct. 15 – Dec. 7. You can join, switch, or drop a Medicare Advantage or Part D plan for coverage starting Jan. 1.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31. If you're already in an Advantage plan, you get one chance during this window to switch to a different Advantage plan or return to Original Medicare (and pick up a Part D plan).

How to think it through

There isn't a universally "right" answer. A few honest questions can point you:

• Do you travel often or split time between states? Original Medicare's nationwide access may matter more.
• Do specific doctors and hospitals matter to you? Check whether they're in a given Advantage plan's network before you enroll.
• How steady is your budget? Medigap tends to mean higher monthly premiums but fewer surprises at the doctor; Advantage often means lower premiums but more variable costs when you use care.
• Do you take prescription drugs? Compare each plan's drug list (formulary), not just the premium.

For personalized help — free and unbiased — Rhode Islanders can reach the state's SHIP program (called THE POINT / RI SHIP), or call 1-800-MEDICARE (24/7). You can also compare plans yourself at medicare.gov.