Medicare 2026

Medicare Advantage or Medigap? Two Very Different Paths

BOTHELL, Wash. — If you're turning 65 in Bothell, or helping a parent sort through the mail piling up on the kitchen counter, you've probably run into the same fork in the road every new Medicare beneficiary faces: stay with Original Medicare and add a Medigap policy, or enroll in a Medicare Advantage plan.

Two roads out of the same starting point

They sound similar. They are not. They're built differently, they pay for care differently, and switching between them later isn't always easy. Understanding how each path is put together is the single most useful thing you can do before you sign anything.

Path 1: Original Medicare + Medigap + (usually) a Part D plan

Original Medicare is the traditional federal program. It has two parts:

• Part A covers hospital stays, skilled nursing, hospice, and some home health.
• Part B covers doctor visits, outpatient care, preventive services, and durable medical equipment.

Original Medicare pays most of your care, but not all of it. Part A has a deductible for each hospital benefit period, and Part B generally pays 80% of approved costs, leaving you responsible for the other 20% — with no annual out-of-pocket limit built in.

That's where Medigap (also called Medicare Supplement Insurance) comes in. Medigap is a private policy you buy in addition to Original Medicare. It helps pay some of the deductibles, copays, and coinsurance that Original Medicare leaves behind. Medigap plans are standardized by letter (Plan G and Plan N are common examples), so the benefits of "Plan G" from one company are the same as "Plan G" from another.

Because Original Medicare doesn't include prescription drug coverage, most people on this path also add a stand-alone Part D drug plan.

Key features of this path:

• You can see any doctor or hospital in the country that accepts Medicare.
• No referrals or network rules.
• You pay a Part B premium, plus a Medigap premium, plus a Part D premium.

Path 2: Medicare Advantage (Part C)

Medicare Advantage, sometimes called Part C, is an "all-in-one" alternative offered by private insurance companies that contract with Medicare. 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 Medicare Advantage plans include Part D drug coverage bundled in.

Many plans also include extras that Original Medicare doesn't cover, such as routine dental, vision, hearing, or fitness benefits. What's offered varies plan by plan.

The trade-off is structure. Medicare Advantage plans typically:

• Use provider networks (HMOs, PPOs) — care is cheapest, and sometimes only covered, within the network.
• May require referrals to see specialists.
• May require prior authorization for certain services.
• Have an annual out-of-pocket maximum for Part A and B services, which Original Medicare alone does not.

Bothell is in King County, where beneficiaries have a wide selection of Medicare Advantage plans from multiple carriers to compare during enrollment. Availability and specifics change every year, which is why the fall shopping window matters.

How the money flows — the real structural difference

The clearest way to think about it:

• With Original Medicare + Medigap, you're paying more in monthly premiums in exchange for very predictable costs when you actually use care, and broad access to providers.
• With Medicare Advantage, you generally pay less in monthly premiums, but your costs when you use care depend on the plan's copays, network, and rules — capped by that yearly out-of-pocket maximum.

Neither is universally "better." It depends on your health, your budget, whether you travel, and how much you value provider choice versus bundled extras.

What's new for 2026 that affects both paths

A few program-level updates apply no matter which road you take, as long as you have Part D coverage (either stand-alone or built into an Advantage plan):

• The Part D out-of-pocket cap is $2,100 in 2026. Once your drug spending hits that ceiling, you pay $0 for covered drugs the rest of the year.
• The Part D deductible can be no higher than $615.
• The old 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 yearly drug costs across monthly payments instead of paying big amounts at the pharmacy counter.
• IRMAA — the income-related surcharge on Part B and Part D — begins above $109,000 in income for a single filer in 2026.

The switching question people don't ask early enough

Here's the part that often surprises people: moving between the two paths later isn't always symmetrical.

You can generally switch from Original Medicare to Medicare Advantage, or between Advantage plans, during the Annual Enrollment Period (Oct. 15 – Dec. 7) or, if you're already in an Advantage plan, during the Medicare Advantage Open Enrollment Period (Jan. 1 – March 31).

But if you later want to leave Medicare Advantage and pick up a Medigap policy, Medigap insurers in most states can use medical underwriting — meaning they can consider your health history and, in some cases, decline you or charge more. The one window where you generally have a guaranteed right to buy any Medigap policy sold in your state is during your six-month Medigap Open Enrollment Period, which starts when you're 65 or older and first enrolled in Part B.

That's a big reason to think carefully at the start, not just at 65 but every year during AEP.