Medicare 2026

The Manassas guide to Medigap and Medicare Advantage design

In Manassas, turning 65 often comes with the same question: should you stick with Original Medicare and add a Medigap policy, or take the Medicare Advantage route? Both are legitimate paths, and both are common in Northern Virginia — but they are built very differently. Understanding that structure is the first step to picking what fits your life.

The two structures, side by side

Original Medicare is the federal program: Part A (hospital) and Part B (doctor and outpatient). It lets you see almost any provider in the country that accepts Medicare, but it does not cap your yearly out-of-pocket spending on its own. To fill that gap, many people add two things: a stand-alone Part D drug plan, and a Medigap (Medicare Supplement) policy that pays some of the deductibles and coinsurance Original Medicare leaves for you.

Medicare Advantage (Part C) is different by design. A private insurer, approved by Medicare, bundles your Part A and Part B — and usually Part D — into a single plan. These plans generally use provider networks (HMO or PPO) and must include a yearly out-of-pocket maximum for medical services. Extras like dental, vision, or fitness benefits are common, but the trade-off is that you typically use the plan's network and follow its rules.

What Medigap actually does

Medigap is not a stand-alone health plan. It sits on top of Original Medicare and pays a share of the costs Medicare doesn't. Policies are sold by private insurers but standardized by letter (Plan G, Plan N, and so on), so a Plan G from one company covers the same medical costs as a Plan G from another. Price and customer service can still vary.

One important detail: Medigap has its own best-time-to-buy window. During your six-month Medigap Open Enrollment Period — which starts when you're 65 and enrolled in Part B — insurers can't turn you down or charge more because of your health. Outside that window, in most states including Virginia, medical underwriting can apply.

How Medicare Advantage is built

An Advantage plan replaces the way you receive your Part A and Part B benefits. You still have Medicare, but the plan administers it. Because the plan is coordinating your care, it can set network rules, require referrals, or ask for prior authorization on certain services. In exchange, it caps your annual in-network out-of-pocket spending on Part A and B services and often folds in drug coverage and extra benefits.

Manassas is in Manassas City, where a range of Medicare Advantage and Part D options are offered each year. The plan-availability list changes annually, which is why CMS builds in the fall Annual Enrollment Period for reviewing your coverage.

Drug coverage in 2027, either way

Whichever path you take, Part D rules apply. The maximum Part D deductible is $615 in 2026 and $700 in 2027, and the annual out-of-pocket cap on covered prescriptions is $2,100 in 2026 and $2,400 in 2027. The old "donut hole" coverage gap was eliminated in 2025, so Part D now has three phases instead of four. If big pharmacy bills tend to hit early in the year, the Medicare Prescription Payment Plan lets you spread those costs across monthly payments instead of paying at the counter.

Higher-income beneficiaries should also know about IRMAA — an income-related surcharge on Part B and Part D premiums that begins above $109,000 for a single filer in 2026.

How to decide which path fits

There's no universal right answer. A few honest questions help:

• Do you travel often or split time between states? Original Medicare plus Medigap travels easily because it isn't network-based.
• Do you value predictable, bundled coverage with extras like dental or vision in one card? Medicare Advantage is built that way.
• Are your doctors and specialists in a specific plan's network? Check before you enroll.
• How comfortable are you with prior authorization and referrals versus paying a monthly Medigap premium?

For a personalized walk-through, Virginia's State Health Insurance Assistance Program (Virginia Insurance Counseling and Assistance Program, or VICAP) offers free, unbiased counseling to Manassas-area residents. They don't sell anything.

Key dates to remember

• Initial Enrollment Period: the seven months around your 65th birthday.
• Medigap Open Enrollment: six months starting when you're 65 and enrolled in Part B.
• Annual Enrollment Period: Oct. 15 – Dec. 7 for Advantage and Part D changes.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31, for people already in an Advantage plan who want to switch once or return to Original Medicare.