Medicare 2026

Two Medicare Coverage Structures Compared in Norfolk

NORFOLK, Va. — When Norfolk residents weigh Original Medicare with a Medigap policy against a Medicare Advantage plan, the biggest surprise is usually not the plans themselves. It is the calendar. The structural difference between the two paths is real, but the deadlines that lock you into one path — or make it hard to switch later — are what quietly decide most people's coverage for years.

Here is how the timing works, and what to watch before the next window closes.

The structural difference, in one minute

Original Medicare is the federal program — Part A (hospital) and Part B (doctor and outpatient). You can add a stand-alone Part D drug plan, and you can add a Medigap (Medisupplement) policy sold by a private insurer to help cover the out-of-pocket costs Original Medicare leaves behind.

Medicare Advantage (Part C) is different in structure. A private insurer, under contract with Medicare, delivers your Part A and Part B benefits — usually with drug coverage and extras bundled in. Networks, prior authorization rules and referral requirements are set by the plan.

You cannot use a Medigap policy with a Medicare Advantage plan. That single fact is why the enrollment calendar matters so much: moving between the two paths later in life is not always as simple as it sounds.

The Medigap window most people only get once

In Virginia, your Medigap Open Enrollment Period is a six-month stretch that begins the month you are 65 or older and enrolled in Part B. During that window, insurers must sell you any Medigap policy they offer, at their best available rate for your age, without asking about your health.

Miss it, and in most cases insurers can use medical underwriting — they can charge more, or decline you — when you later apply. There are limited guaranteed-issue situations (for example, certain plan terminations or losing employer coverage), but they are narrower than most people expect.

This is the deadline that most quietly shapes the Original Medicare + Medigap path. If you start on Medicare Advantage at 65 and want to switch to Original Medicare with a Medigap policy at 70, you may be able to — but you may face underwriting.

The fall window everyone shares: Oct. 15 – Dec. 7

The Annual Enrollment Period (AEP) is the main window each year for Medicare Advantage and Part D. During AEP you can:

• Join, switch, or drop a Medicare Advantage plan.
• Join, switch, or drop a Part D drug plan.
• Move from Medicare Advantage back to Original Medicare (and pick up a Part D plan).

Changes made during AEP take effect Jan. 1. This is the window Norfolk residents should mark on the calendar every year, even if they expect to keep the coverage they have. Plans change their networks, formularies and cost-sharing from one year to the next, and your prescriptions and doctors may not.

The January-to-March window that trips people up

The Medicare Advantage Open Enrollment Period (MA-OEP) runs Jan. 1 through March 31. It sounds like a second bite at the apple, but it is narrower than AEP:

• It is only for people already enrolled in a Medicare Advantage plan on Jan. 1.
• You get one change — switch to a different Advantage plan, or drop back to Original Medicare and add a Part D plan.
• If you are on Original Medicare, you cannot use MA-OEP to join an Advantage plan.

Important: dropping Medicare Advantage during MA-OEP does not automatically give you a guaranteed right to buy a Medigap policy. That is the trap. You may be back on Original Medicare with no supplement, and subject to underwriting when you apply.

What happens if you miss a window

• Miss your Initial Enrollment Period for Part B (the seven-month window around your 65th birthday) without other creditable coverage, and you may owe a lifelong Part B late-enrollment penalty.
• Miss Part D enrollment without creditable drug coverage, and a lifelong Part D penalty can be added to your premium.
• Miss your six-month Medigap Open Enrollment Period, and future applications can be medically underwritten in most cases.
• Miss AEP, and you generally wait until the next fall to change Advantage or Part D coverage, unless you qualify for a Special Enrollment Period (a move out of a plan's service area, loss of other coverage, and certain other life events).

How the 2027 program-level numbers fit in

A few figures apply no matter which path you choose:

• Part D's annual out-of-pocket cap is $2,100 in 2026.
• The Part D maximum deductible is $615.
• The old coverage gap ("donut hole") was eliminated in 2025; Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread drug costs across the calendar year in monthly amounts, at no extra charge, if you opt in.
• IRMAA income-related surcharges on Part B and Part D begin above $109,000 for a single filer in 2026.

These figures follow you into either path. What changes between paths is how the rest of your medical costs are structured.

Norfolk-specific context

Norfolk is in Norfolk city, and Medicare plan availability is set at the county (or in Virginia, independent-city) level. That means the menu of Medicare Advantage and Part D plans a Norfolk resident sees on medicare.gov reflects what is offered in Norfolk city, not the state as a whole. When you compare options, use your ZIP code so you are looking at what actually applies to you.

Where to get unbiased help

• medicare.gov — the Plan Finder lets you compare Advantage and Part D options in Norfolk city using your prescriptions and preferred pharmacies.
• 1-800-MEDICARE (1-800-633-4227) — 24/7.
• Virginia Insurance Counseling and Assistance Program (VICAP) — Virginia's SHIP, offering free, one-on-one Medicare counseling that is not tied to selling any plan.