Medicare 2026

The federal framework behind Medicare choices in Burien

In Burien, people turning 65 or thinking about switching coverage often bump into the same fork in the road: stay with Original Medicare and add a Medigap policy, or move to a Medicare Advantage plan. Both are legitimate paths, and both are shaped by the same federal program — but they are built very differently. Understanding that structure is the clearest way to pick what fits your life.

Two different structures, not two versions of the same thing

Original Medicare is the federal program itself: Part A (hospital) and Part B (doctor and outpatient). You can see any provider in the country who accepts Medicare, and there is no network. But Original Medicare has no yearly out-of-pocket cap on Part A and B costs, which is why many people add a Medigap policy (also called a Medicare Supplement) sold by a private insurer. Medigap fills in coinsurance, copays, and deductibles that Original Medicare leaves behind.

Medicare Advantage (Part C) is different. It is a private plan that Medicare pays to deliver your Part A and Part B benefits, usually with Part D drug coverage folded in. Advantage plans set their own networks, copays, and rules like prior authorization, and they must include a yearly out-of-pocket maximum for in-network care.

So the real question isn't "which is better." It's which structure fits how you use care.

What Medigap does — and what it doesn't

A Medigap policy sits alongside Original Medicare and pays some or most of what Medicare doesn't. It does not include prescription drug coverage, so people on this path usually enroll in a stand-alone Part D plan too.

One important detail: in most states, you have a one-time Medigap Open Enrollment Period — six months starting when you're 65 or older and enrolled in Part B — during which insurers can't turn you down or charge more for health reasons. Outside that window, medical underwriting may apply. Washington has some of its own consumer protections around switching Medigap policies, and the state's SHIBA program (Washington's SHIP) can walk you through them.

How Medicare Advantage is built

Advantage plans are offered by private insurers approved by Medicare. Most are HMOs or PPOs, meaning you'll generally use a network of doctors and hospitals. Many bundle extras like dental, vision, hearing, or fitness benefits. In exchange, you agree to the plan's rules — referrals, prior authorization, in-network providers — and your costs vary by the services you use, up to the plan's yearly maximum.

Burien is in King County, where a wide range of Medicare Advantage plans and Part D plans are offered each year. The specific plans and their details reset every plan year, which is why the fall Annual Enrollment Period matters.

The drug coverage rules that apply either way

Whether your drug coverage comes through a stand-alone Part D plan (with Original Medicare) or is built into an Advantage plan, the same federal rules shape it. Key figures for 2027:

• The Part D deductible can be up to $700 in 2027 (it was up to $615 in 2026).
• Out-of-pocket drug spending is capped at $2,400 for 2027 (it was $2,100 in 2026).
• The old "donut hole" coverage gap is gone as of 2025 — Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly payments instead of paying at the pharmacy counter.

Higher-income enrollees may also pay an IRMAA surcharge on Part B and Part D; for 2026, that begins above $109,000 in income for a single filer.

How to think it through in Burien

A few plain questions tend to sort people quickly:

• Do you travel or split time between states? Original Medicare + Medigap travels easily because there's no network.
• Do your doctors and Burien-area hospitals matter more than extras? Check whether they're in-network for any Advantage plan you're considering, or whether they simply accept Medicare.
• How do you feel about prior authorization and referrals? Advantage plans use them; Original Medicare largely does not.
• How predictable do you need your monthly costs to be? Medigap tends to trade a higher premium for fewer surprises; Advantage often has a lower premium with cost-sharing as you use care.

The Annual Enrollment Period (Oct. 15 – Dec. 7, 2026) is when most people can change between these paths for 2027. The Medicare Advantage Open Enrollment Period (Jan. 1 – March 31, 2027) allows people already in an Advantage plan to switch to another Advantage plan or return to Original Medicare. Moving from Advantage back to Original Medicare and adding Medigap, though, can involve underwriting depending on your situation — a good reason to ask questions before you switch.