Medicare 2026

How Medicare Advantage and Medigap are built in San Angelo

SAN ANGELO, Texas — If you are new to Medicare, or helping a parent sort through the mail piling up on the kitchen table, you have probably run into the same fork in the road: stay with Original Medicare and add a Medigap policy, or pick a Medicare Advantage plan instead. They sound similar, but they are built very differently — and understanding that structure is the single most useful thing you can do before you enroll.

Here in San Angelo, both paths are available, and both come with tradeoffs. This is a plain-English look at how each one is put together, not a pitch for either one.

Path one: Original Medicare plus Medigap

Original Medicare is the traditional, government-run program. Part A covers hospital stays. Part B covers doctor visits and outpatient care. You can see any provider in the country that accepts Medicare, and there is no network.

The catch is that Original Medicare does not pay 100% of your costs. There are deductibles and coinsurance, and there is no yearly cap on what you might owe out of pocket. That is where Medigap — also called Medicare Supplement Insurance — comes in. Medigap is a separate policy you buy from a private insurance company. Its only job is to help pay the gaps in Original Medicare, like coinsurance and some deductibles.

Medigap does not include prescription drug coverage. If you go this route, you typically also sign up for a standalone Part D drug plan.

Path two: Medicare Advantage (Part C)

Medicare Advantage is different in structure. Instead of getting your Part A and Part B benefits directly from the federal program, you get them through a private plan approved by Medicare. The plan is required to cover everything Original Medicare covers, and most Advantage plans also bundle in Part D drug coverage.

Advantage plans usually work through a network of doctors and hospitals — think HMO or PPO — and often include extras Original Medicare does not, such as routine dental, vision or hearing benefits. They also have a yearly out-of-pocket maximum for medical costs, which Original Medicare alone does not.

San Angelo is in Tom Green County, where a number of Medicare Advantage plans from several carriers are offered each year. The exact count changes annually, and you can see current-year options for your ZIP code at medicare.gov/plan-compare.

How the two paths compare

The clearest way to think about it: with Original Medicare plus Medigap, you are stacking pieces — the federal program, a supplement, and usually a drug plan. With Medicare Advantage, you are choosing one private plan that handles it all in one package.

• Provider choice: Original Medicare works with any provider that takes Medicare. Advantage plans typically use networks.
• Predictability: Medigap tends to smooth out medical bills month to month. Advantage plans have copays plus a yearly out-of-pocket cap.
• Extras: Advantage plans often include benefits Original Medicare does not. Medigap sticks to filling in medical cost-sharing.
• Drug coverage: Built into most Advantage plans; purchased separately alongside Medigap.

Neither path is universally better. The right fit depends on your doctors, your prescriptions, your travel habits and your budget.

What is new for 2027

Some program-level rules apply no matter which path you pick:

• The Part D out-of-pocket cap is $2,100 for 2026. Once your covered drug spending hits that ceiling, you pay $0 for covered drugs the rest of the year.
• The Part D deductible can be no higher than $615.
• 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 across the calendar year in monthly amounts instead of paying big bills at the pharmacy counter. It is optional and free to opt into.
• IRMAA — the income-related surcharge on Part B and Part D — begins above $109,000 in income for a single filer in 2026.

Enrollment dates to circle

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

One important note on Medigap: outside your initial six-month Medigap Open Enrollment window when you first sign up for Part B, insurers in most states can use medical underwriting. That means switching from Medicare Advantage back to Original Medicare plus Medigap later in life is not always guaranteed. It is worth understanding that door before you walk through it.

Where to get unbiased help

Before you commit to either path, use resources that do not sell plans:

• medicare.gov — the official site, with a plan finder for your ZIP code.
• 1-800-MEDICARE (1-800-633-4227) — 24/7 help from Medicare directly.
• Texas SHIP — the state’s free, unbiased Medicare counseling program. In Texas it is run through the Health Information, Counseling and Advocacy Program (HICAP), part of the Texas Health and Human Services benefits counseling network.