Medicare 2026

How Medicare and Medigap Differ in Martinsville, VA

In Martinsville, Virginia, older adults facing Medicare for the first time — or thinking about a change during fall Annual Enrollment — usually run into the same fork in the road. Do you stay with Original Medicare and add a Medigap policy? Or do you go with a Medicare Advantage plan? The two paths are built differently, and understanding that structure matters more than any brochure you'll receive in the mail.

The two paths, side by side

Path 1: Original Medicare + Medigap (+ usually a Part D drug plan). Original Medicare is the federal program itself — Part A (hospital) and Part B (doctor and outpatient). It pays a set share of covered services, and you're responsible for the rest. To cover those gaps, many people buy a Medigap policy (also called Medicare Supplement Insurance) from a private insurer. Because Original Medicare doesn't include prescription coverage, most people on this path also enroll in a standalone Part D drug plan.

Path 2: Medicare Advantage (Part C). Medicare Advantage is offered by private insurance companies approved by Medicare. When you enroll in an Advantage plan, that plan takes over the job of delivering your Part A and Part B benefits, and most plans also fold in Part D drug coverage. The plan sets its own network, rules, and cost-sharing within the limits Medicare allows.

You can be on one path or the other — not both at the same time. Medigap policies only work with Original Medicare, not with Medicare Advantage.

How the money and access differ

The structural difference shows up in three places: networks, cost predictability, and extras.

• Networks. Original Medicare lets you see any doctor or hospital in the country that accepts Medicare. Medicare Advantage plans typically use provider networks (HMOs, PPOs), and going outside the network can cost more or not be covered.
• Cost predictability. Medigap policies are designed to smooth out costs — you pay a monthly premium and, in return, the policy picks up much of what Original Medicare doesn't. Medicare Advantage often has lower or no additional premium beyond Part B, but you'll pay copays and coinsurance as you use services, up to an annual out-of-pocket maximum set by the plan.
• Extras. Medicare Advantage plans may include benefits Original Medicare doesn't cover, such as some dental, vision, or hearing services. Medigap does not add extra benefits — it fills in cost-sharing.

What's the same for everyone in 2027

Whichever path you choose, some rules apply across the board. Part D drug coverage — whether it's a standalone plan or built into an Advantage plan — now has a $2,100 annual out-of-pocket cap for 2026 and a maximum deductible of $615, according to CMS. The old coverage gap, or "donut hole," was eliminated in 2025, so drug coverage now moves through three phases instead of four.

You can also opt into the Medicare Prescription Payment Plan, which spreads your drug costs into monthly payments across the year instead of paying at the pharmacy counter.

Higher-income beneficiaries pay IRMAA surcharges on Part B and Part D premiums; those begin above $109,000 in income for a single filer in 2026.

What's available around Martinsville

Martinsville is in Martinsville City, and Medicare plan availability is set at the county level. That means the specific mix of Medicare Advantage plans and standalone Part D plans a Martinsville resident can choose from is determined by which insurers offer coverage in Martinsville City. To see the current list for your address — and compare them fairly — use the Plan Finder tool at medicare.gov or call 1-800-MEDICARE.

Deadlines to keep in mind

• Annual Enrollment Period: Oct. 15 – Dec. 7. This is when anyone with Medicare can join, drop, or switch a Medicare Advantage or Part D plan for the following year.
• Medicare Advantage Open Enrollment Period: Jan. 1 – March 31. If you're already in a Medicare Advantage plan, you get one chance during this window to switch to a different Advantage plan or return to Original Medicare (and add a Part D plan).
• Medigap: The strongest consumer protections for buying Medigap apply during your one-time six-month Medigap Open Enrollment Period, which starts the month you're 65 or older and enrolled in Part B. Outside that window, in most states, insurers can use medical underwriting.