Medicare 2026

The structural gap between Medicare paths in Franklin

FRANKLIN, Tenn. — If you're turning 65 in Franklin, or helping a parent sort through the mail piling up on the kitchen counter, you've probably run into the same fork in the road: should you pair Original Medicare with a Medigap policy, or should you enroll in a Medicare Advantage plan? The two paths look similar on the surface, but they're built very differently — and the choice you make now shapes how you get care, what you pay, and how easy it is to switch later.

Two different structures, not two flavors of the same thing

Original Medicare is the federal program itself — Part A (hospital) and Part B (medical). You can see any doctor or hospital in the country that accepts Medicare, and there's no network. Because Original Medicare doesn't cap what you pay out of pocket, most people add a Medigap (Medicare Supplement) policy to help cover deductibles and coinsurance, plus a stand-alone Part D plan for prescriptions.

Medicare Advantage (Part C) is different. It's Medicare benefits delivered through a private plan approved by CMS. The plan takes over the job of paying your claims, usually through a local network of doctors and hospitals, and it almost always bundles in Part D drug coverage. Advantage plans set their own rules — copays, prior authorization, referrals — within limits Medicare requires.

Access to providers

This is often the biggest practical difference. With Original Medicare, if a provider takes Medicare, you're in. That matters for people who travel, spend winters out of state, or want access to specialty hospitals outside the region.

Medicare Advantage plans generally require you to use in-network providers, or pay more to go out of network. Franklin is in Williamson County, where a number of Medicare Advantage plans are offered each year, and networks vary from one plan to the next — a doctor who's in-network for one plan may not be for another. Before you enroll in any Advantage plan, it's worth checking that your current doctors and preferred hospital participate.

How costs are structured

Under Original Medicare, you pay the Part B premium, and typically a Medigap premium and a Part D premium. In exchange, your share of the bill at the doctor's office or hospital is usually predictable and small, because Medigap fills in most of the gaps. There's no yearly cap on Original Medicare alone, which is why most people don't go without a supplement.

Medicare Advantage plans often have lower monthly premiums but shift more cost to the point of care — copays for visits, hospital stays, imaging and the like. Every Advantage plan must include an annual out-of-pocket maximum for Part A and B services, which Original Medicare by itself does not have.

For prescriptions, the same program rules apply either way: the maximum Part D deductible is $615 in 2026 and $700 in 2027, and the out-of-pocket cap on covered drugs is $2,100 in 2026 and $2,400 in 2027. The coverage gap — the old "donut hole" — is gone, replaced by a simpler three-phase structure. If your drug bills are heavy early in the year, the Medicare Prescription Payment Plan lets you spread those costs across monthly installments.

Switching later isn't always simple

A lot of people don't realize this until it's too late. When you first become eligible for Medicare, you have a guaranteed right to buy a Medigap policy without medical underwriting. Later on, if you're on Medicare Advantage and decide you'd rather move to Original Medicare + Medigap, insurers in most states — including Tennessee — can look at your health history and either charge more or decline to sell you a Medigap policy at all.

That doesn't mean Advantage is a trap; millions of people are happy with it. But it does mean the "I'll just switch back if I don't like it" plan isn't always available. Think through the long-term picture, not just the first year.

Enrollment windows to keep on the calendar

• Initial Enrollment Period: the seven-month window around your 65th birthday.
• Annual Enrollment Period: Oct. 15 – Dec. 7 each year. You can join, drop, or change Medicare Advantage and Part D plans.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31, for people already in an Advantage plan who want to switch to a different Advantage plan or move back to Original Medicare.

Also worth knowing: higher-income beneficiaries pay an IRMAA surcharge on Part B and Part D premiums. In 2026, IRMAA begins above $109,000 in income for a single filer, based on your tax return from two years earlier.