Medicare 2026

Before Dec. 7: The Real Difference Between Medigap and Advantage

ROWLETT, Texas — With the Medicare Annual Enrollment Period running through December 7, many Rowlett residents are sitting at the kitchen table trying to answer one question: should I stick with Original Medicare and add a Medigap policy, or go with a Medicare Advantage plan? The two paths cover the same person under the same federal program, but they are built very differently — and knowing how they differ is the first step to a choice you can live with.

Two different structures, not two versions of the same thing

Original Medicare is the federal program itself — Part A (hospital) and Part B (doctor and outpatient). You can see any provider in the country that accepts Medicare, and there is no network. But Original Medicare has no annual limit on what you pay out of pocket, and it does not include drug coverage.

Medicare Advantage (Part C) is different. A private insurance company, approved by Medicare, takes over how you receive your Part A and Part B benefits. These plans usually have provider networks, often include drug coverage, and must cap your yearly out-of-pocket costs for covered medical services.

So the first question is not "which plan is better?" It is "which structure fits my life?"

Where Medigap fits in

Medigap (also called Medicare Supplement Insurance) only works with Original Medicare. It is a separate policy from a private insurer that helps pay some of the costs Original Medicare leaves you with — things like coinsurance and copays.

A few things to know:

• Medigap does not work with Medicare Advantage. You pick one path or the other.
• Medigap plans are standardized by letter, so a Plan G from one company covers the same core benefits as a Plan G from another.
• Your best window to buy a Medigap policy with the strongest protections is the six-month Medigap Open Enrollment Period that starts when you are 65 and enrolled in Part B. After that window, in most states an insurer can consider your health history.

If you go the Original Medicare + Medigap route, you will also want to add a stand-alone Part D drug plan.

How drug coverage works on each path

Prescription coverage is where a lot of confusion starts.

• With Original Medicare + Medigap, you typically add a stand-alone Part D drug plan.
• With Medicare Advantage, drug coverage is usually built into the plan (these are called MA-PD plans).

Either way, Part D has the same program-level rules across all plans. In 2026 the maximum deductible is $615 and the annual out-of-pocket cap on covered drugs is $2,100; in 2027 the maximum deductible is $700 and the out-of-pocket cap is $2,400. 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 month to month, you can also ask about the Medicare Prescription Payment Plan, which spreads your out-of-pocket drug costs across the year.

What's available around Rowlett

Rowlett is in Dallas County, where residents have a wide range of Medicare Advantage and stand-alone Part D options offered by multiple carriers. The exact number of plans changes every year, so the most reliable way to see current-year availability is the Plan Finder at medicare.gov, which lets you enter your ZIP code and, if you like, your prescriptions and preferred pharmacies.

Availability alone should not drive the decision. A long list of choices does not tell you which structure — Original Medicare with a Medigap policy, or Medicare Advantage — is the better fit for your doctors, your medications, and your travel habits.

Trade-offs to think through

A few honest questions to ask yourself:

• Do I travel or split time between states? Original Medicare's nationwide access can matter more than it looks on paper.
• Are my current doctors in-network? Medicare Advantage plans have networks; Original Medicare does not.
• How predictable do I want my costs to be? Medicare Advantage caps yearly medical out-of-pocket costs. Original Medicare does not, which is why many people pair it with Medigap.
• Am I in my initial Medigap window? If yes, you have the strongest right to buy a Medigap policy. If not, ask about the rules in Texas before assuming you can switch later.
• Does my income trigger IRMAA? In 2026, the income-related surcharge on Part B and Part D begins above $109,000 for a single filer.

Key dates to keep in mind

• October 15 – December 7: Annual Enrollment Period. You can join, switch, or drop a Medicare Advantage or Part D plan. Changes take effect January 1.
• January 1 – March 31: Medicare Advantage Open Enrollment. If you are already in a Medicare Advantage plan, you get one chance to switch to a different Advantage plan or return to Original Medicare (and add a Part D plan).