Medicare 2026

The structure behind Medicare choices in Fort Worth

FORT WORTH, Texas — When people first sign up for Medicare, they run into a fork in the road. One path is Original Medicare, often paired with a Medigap policy and a stand-alone Part D drug plan. The other path is Medicare Advantage, which bundles coverage through a private insurer. Both are legitimate ways to get your benefits, but they are built differently — and understanding the structure is the first step to picking the one that fits your life.

Path one: Original Medicare, plus Medigap and Part D

Original Medicare is the traditional program run directly by the federal government. It has two parts: Part A covers hospital stays, and Part B covers doctor visits and outpatient care. You can generally see any provider in the country who accepts Medicare, and there are no network restrictions or referrals.

The trade-off is that Original Medicare doesn't cap your out-of-pocket costs on its own. That's where Medigap — also called Medicare Supplement Insurance — comes in. Medigap is a private policy that helps pay some of the costs Original Medicare leaves behind, like coinsurance and deductibles. Medigap plans are standardized by letter (Plan G, Plan N and others), so a Plan G from one carrier covers the same core benefits as a Plan G from another.

Prescription drugs are not part of Original Medicare, so people on this path usually add a stand-alone Part D drug plan.

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 an Advantage plan, you still have Medicare — but the plan takes over the job of delivering your Part A and Part B benefits, and most plans also include Part D drug coverage and sometimes extras like vision or dental.

Advantage plans use networks. HMOs typically require you to stay in-network and get referrals; PPOs are more flexible but usually cost more out of network. Unlike Original Medicare, Advantage plans have a yearly limit on what you pay out of pocket for medical services.

Fort Worth is in Tarrant County, where residents have a wide range of Medicare Advantage plans and carriers to choose from during enrollment periods. Availability is set at the county level, so the exact lineup depends on where you live.

You can't mix the two paths

This is the point that trips people up: Medigap only works with Original Medicare. If you're on a Medicare Advantage plan, you cannot buy a Medigap policy to fill in the gaps, and it's actually illegal for someone to sell you one for that purpose.

That's why the choice matters. It's not just about next year's premium — it's about which system you want your care organized through.

Drug coverage works the same way underneath

No matter which path you choose, Part D follows the same federal rules. In 2027, the maximum Part D deductible is $700, and there's a $2,400 annual cap on what you pay out of pocket for covered drugs. The old "donut hole" coverage gap was eliminated in 2025, so Part D now has three phases instead of four.

If your drug costs are uneven through the year, you can ask to join the Medicare Prescription Payment Plan, which spreads your out-of-pocket drug costs into monthly bills instead of large hits at the pharmacy counter.

Switching between paths

You get chances each year to change your mind. The Annual Enrollment Period, Oct. 15 through Dec. 7, is when anyone with Medicare can switch between Original Medicare and Medicare Advantage, or change drug plans. From Jan. 1 through March 31, people already in a Medicare Advantage plan get a second window — the Medicare Advantage Open Enrollment Period — to switch to a different Advantage plan or return to Original Medicare.

One important caution: if you leave Medigap and later want to come back, you may have to answer health questions and could be charged more or turned down, depending on your state's rules. Talk to a counselor before switching.

Higher-income beneficiaries should also know that IRMAA surcharges — extra amounts added to Part B and Part D premiums — begin above $109,000 in income for a single filer in 2026.