Medicare 2026

Two Medicare coverage frameworks compared for Bennington

BENNINGTON, Vt. — If you're new to Medicare, or rethinking your coverage during this fall's Annual Enrollment Period, the biggest decision you'll face isn't which plan to pick. It's which kind of coverage to build around: Original Medicare paired with a Medigap policy, or a Medicare Advantage plan. The two paths are structured very differently, and understanding that difference up front can save you from a mistake that's hard to undo later.

The two paths, side by side

Original Medicare is the federal program itself — Part A (hospital) and Part B (medical). You can see any doctor or hospital in the country that accepts Medicare, which is most of them. But Original Medicare has no cap on what you might pay out of pocket in a bad year. That's where a Medigap policy (also called Medicare Supplement) comes in. Medigap is sold by private insurers and helps pay the deductibles, coinsurance, and copays that Original Medicare leaves behind. Because Medigap doesn't cover prescriptions, most people who go this route also enroll in a stand-alone Part D drug plan.

Medicare Advantage (Part C) is a different structure. Instead of using Original Medicare directly, you're getting your Part A and Part B benefits through a private plan approved by Medicare. Most Advantage plans include Part D drug coverage and may include extras like dental, vision, or hearing benefits. In exchange, plans generally use provider networks (HMO or PPO), may require referrals or prior authorization, and set their own rules for how care is delivered. Every Advantage plan is required by CMS to include an annual out-of-pocket maximum for in-network Part A and B services.

What "structural difference" really means

The clearest way to think about it: with Original Medicare + Medigap, you're using the government program and buying a second policy to smooth out costs. With Medicare Advantage, you're getting your Medicare benefits through a private plan that manages both the coverage and the network.

That distinction affects almost everything downstream — which doctors you can see, how prior authorization works, whether your drug plan is bundled or separate, and how predictable your yearly costs are.

Availability in the Bennington area

Bennington is in Bennington County, where plan availability is set at the county level. Vermont has historically had fewer Medicare Advantage plans on offer than many other states, and the mix of stand-alone Part D plans and Medigap options is also determined by what carriers file with regulators. You can see the current year's plans for your ZIP code using the Plan Finder at medicare.gov.

The 2027 numbers worth knowing

Regardless of which path you choose, a few program-wide figures for 2026 are worth writing down:

• Part D out-of-pocket cap: $2,100. Once your covered drug spending hits that amount, you pay $0 for covered drugs the rest of the year.
• Part D maximum deductible: $615 (plans can set theirs lower).
• The 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 over the calendar year in monthly installments, at no extra charge, if that helps with budgeting.
• IRMAA — the income-related surcharge on Part B and Part D premiums — begins above $109,000 for a single filer in 2026.

The switching question people often miss

One reason to think this decision through carefully: moving from Medicare Advantage back to Original Medicare + Medigap later isn't automatic. You can switch your Advantage plan or return to Original Medicare during the Annual Enrollment Period (Oct. 15 – Dec. 7) or the Medicare Advantage Open Enrollment Period (Jan. 1 – March 31). But buying a Medigap policy after your initial six-month Medigap Open Enrollment window has closed often means going through medical underwriting in most states, and you can be turned down or charged more based on your health. Vermont has some of its own consumer protections around Medigap, so it's worth calling the state's SHIP to understand exactly what applies to you.

Where to get unbiased help

Two calls are almost always worth making before you enroll:

• Medicare.gov and 1-800-MEDICARE (1-800-633-4227) for official plan details, comparisons, and rules.
• Your local SHIP (State Health Insurance Assistance Program), which offers free, one-on-one counseling. In Vermont, that program is called Vermont SHIP, and counselors can walk you through both paths without trying to sell you anything.