Medicare 2026

One Card or Two? How Medicare's Two Paths Really Work

LEBANON, Tenn. — If you're turning 65 in Lebanon, or helping a parent sort through the mail piling up on the kitchen table, you've probably run into the same fork in the road: stick with Original Medicare and add a Medigap policy, or go with a Medicare Advantage plan instead. Both paths are legal, both are common, and both are approved by the federal government. But under the hood, they work very differently — and understanding that difference is the single most useful thing you can do before you sign anything.

The two paths, side by side

Think of it like this: Medicare gives you a choice between using the government as your insurer or letting a private company do it on Medicare's behalf.

Path 1 — Original Medicare + Medigap (+ usually Part D). You keep Part A (hospital) and Part B (doctor) directly through the federal Medicare program. You can see any doctor or hospital in the country that accepts Medicare, which is most of them. Because Original Medicare has deductibles and coinsurance with no yearly out-of-pocket limit, many people add a Medigap (Medicare Supplement) policy from a private insurer to help pay those leftover costs. You then usually add a stand-alone Part D drug plan.

Path 2 — Medicare Advantage (Part C). You still have Medicare, but a private plan administers your Part A and Part B benefits, usually rolls in Part D drug coverage, and often includes extras Original Medicare doesn't cover. In exchange, you generally use the plan's network of doctors and hospitals and follow its rules for referrals and prior authorization. Advantage plans must cap your yearly in-network out-of-pocket spending for Part A and B services.

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

What Medigap actually does

Medigap is not Medicare. It's a private insurance policy that sits on top of Original Medicare and pays some of the costs Medicare doesn't — things like the Part A hospital deductible or the 20% coinsurance on Part B services, depending on which lettered plan (A, B, D, G, K, L, M, N, and, for those eligible, C and F) you buy.

Medigap policies are standardized by the federal government, so a Plan G from one company covers the same services as a Plan G from another. What differs is the premium and the company's customer service.

Timing matters. When you first enroll in Part B at 65 or later, you get a six-month Medigap Open Enrollment Period. During that window, insurers must sell you a policy at their best available rate regardless of your health. Outside that window — including if you try to switch from Medicare Advantage back to Medigap later — insurers in most states can use medical underwriting, which means they can charge more or turn you down.

What Medicare Advantage actually does

A Medicare Advantage plan is a private plan (an HMO, PPO, or similar) that agrees to provide all of your Part A and Part B benefits, and almost always your Part D drug coverage, in one package. Many plans also include coverage for things Original Medicare doesn't touch, such as routine dental, vision, or hearing.

The trade-off is structure. Advantage plans have provider networks, may require referrals, and often use prior authorization for certain services. Plans are set at the county level, so what's offered depends on where you live.

Lebanon is in Wilson County, where a range of Medicare Advantage and Part D plans are available from multiple carriers. You can see the current year's plan list, along with each plan's network and drug formulary, using the Plan Finder tool at medicare.gov.

Drug coverage in 2027

Whichever path you choose, pay attention to Part D. The annual out-of-pocket cap on covered Part D drugs 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 — the "donut hole" — was eliminated in 2025, so drug coverage now has three phases instead of four.

If a large bill early in the year would be hard to manage, ask about the Medicare Prescription Payment Plan. It's a free, optional program that lets you spread your out-of-pocket drug costs across the calendar year in monthly installments instead of paying at the pharmacy counter.

Higher-income enrollees should also know about IRMAA — the income-related surcharge that gets added to Part B and Part D premiums. For 2026, IRMAA starts above $109,000 in income for a single filer, based on your tax return from two years earlier.

When you can make changes

Two dates matter most:

• Oct. 15 – Dec. 7: Medicare's Annual Enrollment Period. You can join, switch, or drop a Medicare Advantage or Part D plan for the following year.
• Jan. 1 – March 31: Medicare Advantage Open Enrollment. If you're already in an Advantage plan, you can switch to a different Advantage plan or go back to Original Medicare (and add a Part D plan) once during this window.

Special Enrollment Periods can also open up if you move, lose other coverage, or qualify for Extra Help. Keep in mind: leaving Advantage for Original Medicare doesn't automatically guarantee you a Medigap policy — that's the underwriting issue mentioned above.

How to think it through

There's no universally right answer. A useful way to frame it: Original Medicare + Medigap tends to prioritize predictability and provider freedom, usually with higher monthly premiums. Medicare Advantage tends to prioritize lower or bundled premiums and extra benefits, in exchange for network rules and plan-managed care.

Before you decide, make a short list: the doctors and hospitals you want to keep, the medications you take, and how you feel about paperwork versus predictability. Then check each plan you're considering against that list on medicare.gov.