Medicare 2026

Why the Medicare path split matters in San Antonio

SAN ANTONIO — If you are turning 65 in the Alamo City or rethinking your coverage during fall enrollment, one choice sits at the center of every other Medicare decision: do you want Original Medicare paired with a Medigap policy, or do you want a Medicare Advantage plan? The two paths are built very differently, and understanding that structure early can save you a lot of second-guessing later.

What "Original Medicare + Medigap" actually means

Original Medicare is the federal program itself — Part A (hospital) and Part B (doctor and outpatient). You can see any doctor or hospital in the country that accepts Medicare, and there is no network to check. Medicare pays its share, and you are responsible for the rest.

Because that "rest" has no yearly cap on its own, many people add a Medigap policy (also called Medicare Supplement Insurance) sold by a private insurer. Medigap helps pay the deductibles, coinsurance and copays Original Medicare leaves behind. If you want drug coverage, you add a stand-alone Part D plan separately.

So the full package is usually three pieces: Original Medicare + Medigap + a Part D plan.

What "Medicare Advantage" actually means

Medicare Advantage (Part C) is a way to get your Medicare benefits through a private plan approved by Medicare. You still have Medicare, but the plan administers your Part A and Part B, almost always includes Part D drug coverage, and often bundles extras like dental, vision or hearing.

Advantage plans typically use provider networks (HMO or PPO), and you generally follow the plan's rules for referrals, prior authorization and in-network care. Each plan sets its own copays, deductible and yearly out-of-pocket maximum for medical services.

The structural trade-off in plain terms

Think of it as two different shapes:

• Original Medicare + Medigap spreads your costs out into predictable monthly premiums (Part B, Medigap, Part D) in exchange for very broad provider access and fewer surprises at the point of care.
• Medicare Advantage often has lower fixed monthly costs but concentrates more decisions — and more variable costs — at the moment you use care, within a defined network and a yearly cap.

Neither is "better." They are built for different priorities: nationwide flexibility versus a bundled, managed package.

What is the same either way in 2027

No matter which path you pick, some 2027 rules apply across the board:

• Part D has a $2,400 out-of-pocket cap on covered prescriptions.
• The Part D deductible can be up to $700.
• The old coverage gap ("donut hole") is gone as of 2025 — Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread drug costs over the calendar year in monthly installments.
• IRMAA income-based surcharges on Part B and Part D start above $109,000 for a single filer in 2026.

These figures come from Medicare and apply whether your drug coverage is stand-alone or built into an Advantage plan.

The San Antonio picture

San Antonio sits in Bexar County, and Medicare plan availability is set at the county level. That means the specific Medicare Advantage and Part D options you can shop are the ones offered in Bexar County, not the city itself. Neighbors across the county line in Comal, Guadalupe or Medina County may see a different menu.

If you are weighing the two paths locally, the county lens matters for a second reason: Medigap policies are sold by private insurers under Texas rules, and your ability to buy one with the strongest protections is tied to timing — most notably your six-month Medigap open enrollment window that starts when you are 65 and enrolled in Part B.

Key dates to keep on your calendar

• October 15 – December 7: Medicare Annual Enrollment Period. You can join, switch or drop Medicare Advantage and Part D plans.
• January 1 – March 31: Medicare Advantage Open Enrollment. If you are already in an Advantage plan, you can switch to another Advantage plan or return to Original Medicare (and pick up a Part D plan).
• Your Initial Enrollment Period: the seven-month window around your 65th birthday — the cleanest time to think through this structural choice from scratch.