Medicare 2026

Why Medicare Advantage and Medigap work differently in Arlington

# Medicare Advantage or Medigap? Understanding the two…

ARLINGTON, Va. — If you are turning 65 in Arlington, or helping a parent sort through a stack of Medicare mail, you have probably noticed that the choices seem to boil down to two very different routes. One keeps you inside Original Medicare and adds a Medigap policy on the side. The other moves your coverage into a Medicare Advantage plan run by a private insurer. Both are legal, both are common, and both are built on the same Medicare program — but they are structured very differently, and that structure shapes how you see the doctor, how you pay, and what paperwork lands in your mailbox.

Path one: Original Medicare, plus Medigap, plus Part D

Original Medicare is the federal program itself. Part A covers hospital stays, and Part B covers doctor visits and outpatient care. You can go to any provider in the country that accepts Medicare, and you do not need a referral to see a specialist.

The trade-off is that Original Medicare alone has no yearly limit on what you can spend out of pocket. That is where Medigap (also called Medicare Supplement Insurance) comes in. Medigap is a private policy that helps pay the deductibles, coinsurance, and copays that Original Medicare leaves behind. It does not cover prescription drugs, so most people on this path also buy a stand-alone Part D plan.

So the "path one" stack is really three pieces: Original Medicare + Medigap + Part D.

Path two: Medicare Advantage (Part C)

Medicare Advantage, sometimes called Part C, is an all-in-one alternative offered by private insurers that Medicare contracts with. When you enroll in a Medicare Advantage plan, you still have Medicare — but the plan takes over managing your Part A and Part B benefits, and almost all of these plans include Part D drug coverage inside the same package.

Advantage plans usually work through a network of doctors and hospitals (HMO or PPO style), and many require referrals or prior authorization for certain services. In exchange, they often include extras that Original Medicare does not cover, and they must cap your yearly out-of-pocket costs for Part A and B services.

Important rule: you cannot use a Medigap policy with a Medicare Advantage plan. Medigap only works alongside Original Medicare.

What's the same on both paths in 2027

No matter which path you choose, the program-level rules for prescription drugs are identical, because they come from Medicare itself:

• The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. Once you hit it, you pay nothing for covered drugs the rest of the year.
• The Part D maximum deductible is $615 in 2026 and $700 in 2027.
• The old "donut hole" coverage gap is gone — Part D now has three simpler phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs into monthly installments instead of paying big amounts at the pharmacy counter.
• IRMAA surcharges on Part B and Part D premiums begin above $109,000 in income for a single filer (2026).

Those figures come from Medicare and apply whether your drug coverage is stand-alone or bundled inside an Advantage plan.

The Arlington snapshot

Arlington is in Arlington County, where plan availability is set at the county level by the Centers for Medicare & Medicaid Services (CMS). That means every Medicare-eligible resident in the county sees the same menu of Medicare Advantage plans, stand-alone Part D plans, and Medigap policies sold in Virginia. When you shop on medicare.gov, entering an Arlington ZIP code will pull up the plans available in Arlington County — the tool does the county lookup for you.

Because the two paths are structured so differently, comparing them side by side takes a little patience. A local SHIP counselor (in Virginia, the program is called VICAP) can walk through your specific doctors, medications, and budget without trying to sell you anything.

Key dates to remember

• Oct. 15 – Dec. 7: Annual Enrollment Period. Anyone with Medicare can join, switch, or drop a Medicare Advantage or Part D plan for coverage starting Jan. 1.
• Jan. 1 – March 31: Medicare Advantage Open Enrollment Period. 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, when Medigap protections are strongest.

That last point matters. In most states, including Virginia, you have a one-time guaranteed-issue right to buy any Medigap policy sold in your area when you first enroll in Part B at 65. Outside that window, insurers can use medical underwriting, which can make switching from Advantage back to Original Medicare + Medigap harder later on. It is worth understanding before you choose your first path.