Medicare 2026

Medicare Advantage vs. Medigap plan design for Salt Lake City

SALT LAKE CITY — If you are new to Medicare, or thinking about switching during the fall enrollment window, one choice shapes almost everything else: do you want Original Medicare paired with a Medigap policy, or do you want a Medicare Advantage plan? The two paths cover the same basic care, but they are built very differently. Understanding that structure — before you compare any single plan — is the clearest way to decide what fits your life in Salt Lake City.

The two paths, side by side

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, with no referrals. Original Medicare pays its share, and you are responsible for the rest. There is no yearly cap on what you might owe out of pocket, which is why many people add two things: a Medigap (Medicare Supplement) policy to help cover deductibles and coinsurance, and a standalone Part D plan for prescription drugs.

Medicare Advantage (Part C) is different. It is Medicare coverage delivered through a private plan approved by CMS. The plan takes over your Part A and Part B benefits, usually adds Part D drug coverage, and often includes extras like dental, vision, or fitness benefits. In exchange, you generally use the plan's provider network and follow its rules — prior authorizations, referrals in some cases, and defined copays. Every Advantage plan must include an annual out-of-pocket maximum for medical care.

What "structural difference" really means

Think of it this way: with Original Medicare + Medigap, you are stacking pieces (Part A, Part B, Medigap, Part D) so that together they act like one broad, predictable plan you can use almost anywhere. With Medicare Advantage, you are choosing one package that handles everything — usually with lower monthly costs, but with more rules about where and how you get care.

Neither is universally better. What matters is how you use care.

Questions that help you decide

• Do you travel or split time between states? Original Medicare works with any participating provider nationwide. Advantage networks are usually built around a service area.
• Do you already have doctors you want to keep? Check whether they accept Original Medicare, and — if you are considering Advantage — whether they are in that plan's network.
• How steady do you want your costs to be? Medigap tends to mean higher monthly premiums but very predictable bills. Advantage often means lower premiums but costs that vary by service.
• How do you feel about prior authorization? Advantage plans use it more often than Original Medicare does.
• What prescriptions do you take? Every Part D formulary is different, whether it is standalone or built into an Advantage plan.

The Salt Lake City picture

Salt Lake City sits in Salt Lake County, and Medicare plan availability is set at the county level. That means the specific menu of Medicare Advantage and Part D plans you can choose from is determined by your county, not your ZIP code alone. Salt Lake County residents typically have a wide selection of Advantage plans and standalone Part D plans from multiple carriers. To see the current list for your address, use the Plan Finder at medicare.gov.

One note specific to Medigap: rules for buying a Medigap policy — and the protections you have when you buy one — are set by both federal law and Utah state law. Your strongest guaranteed-issue rights generally apply during your six-month Medigap Open Enrollment Period, which starts when you are 65 or older and enrolled in Part B. Outside that window, insurers in most states can consider your health history.

2027 drug coverage rules to know

Whether your drug coverage comes through a standalone Part D plan or through an Advantage plan, the same program-level rules apply in 2027:

• The out-of-pocket cap for Part D is $2,400 in 2027. Once you hit it, you pay nothing for covered drugs the rest of the year.
• The maximum Part D deductible is $700 in 2027. Plans can charge less.
• The old coverage gap ("donut hole") is gone as of 2025. Part D now has three phases: deductible, initial coverage, and catastrophic.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly bills instead of paying at the pharmacy counter.
• IRMAA surcharges on Part B and Part D start above $109,000 in income for a single filer in 2026.

Enrollment windows to circle

• Annual Enrollment Period: Oct. 15 – Dec. 7. You can join, switch, or drop a Medicare Advantage or Part D plan. Changes take effect Jan. 1.
• Medicare Advantage Open Enrollment Period: Jan. 1 – March 31. If you are already in an Advantage plan, you get one chance to switch to a different Advantage plan or return to Original Medicare (and pick up a Part D plan).
• Medigap Open Enrollment: the six-month window that begins when you are 65 or older and first enrolled in Part B.