Medicare 2026

Why the Medicare path matters in Kennewick

In Kennewick, one of the biggest Medicare questions has nothing to do with a specific plan. It's a bigger, more structural choice: do you want Original Medicare paired with a Medigap policy, or do you want a Medicare Advantage plan? These are two different ways of getting the same underlying Medicare coverage, and they work very differently once you actually use them.

The two paths, side by side

Original Medicare is the federal program itself — Part A (hospital) and Part B (doctor and outpatient). You can see any doctor or hospital in the country that accepts Medicare, with no network and no referrals. But Original Medicare alone has no yearly cap on what you might pay out of pocket. That's why many people add a Medigap (Medicare Supplement) policy to help cover coinsurance and deductibles, plus a stand-alone Part D plan for prescriptions.

Medicare Advantage (Part C) is different. You're still enrolled in Medicare, but a private plan administers your Part A and Part B benefits, usually through a local HMO or PPO network. Most Advantage plans include Part D drug coverage and often add extras like dental or vision. In exchange, you generally use in-network providers and follow the plan's rules for things like prior authorization.

What that means day to day

The practical difference shows up when you need care. With Original Medicare and a Medigap policy, you can walk into almost any clinic in the country, hand over your red-white-and-blue card, and be covered. That matters if you split time between Kennewick and, say, family in another state.

With Medicare Advantage, care is coordinated through a network that's built county by county. Kennewick is in Benton County, where the plans available to you are set by CMS based on where you live. If you travel often or spend part of the year elsewhere, it's worth checking how a given plan handles out-of-area care.

The cost structures work differently

Original Medicare charges standard, program-set amounts: the Part B premium, the Part A and B deductibles, and coinsurance. A Medigap policy has its own monthly premium and, in return, picks up much of what Original Medicare leaves behind.

Medicare Advantage plans set their own premiums, copays, and yearly out-of-pocket maximums within federal limits. Because the private plan is bundling everything together, the math looks very different from the Medigap path. Neither is universally cheaper — it depends on your health, your prescriptions, and how often you use care.

For drugs, 2027 keeps the same style of protections either way: a Part D deductible of no more than $700 and a hard $2,400 cap on out-of-pocket drug spending. The old coverage gap, or "donut hole," is gone. If your drug costs are uneven month to month, the Medicare Prescription Payment Plan lets you spread them out.

When you can switch paths

You have real chances to change your mind. During the Annual Enrollment Period (Oct. 15 – Dec. 7), you can move between Original Medicare and Medicare Advantage, or change Part D plans. During Medicare Advantage Open Enrollment (Jan. 1 – March 31), people already in an Advantage plan can switch to another Advantage plan or return to Original Medicare.

One important caution: moving from Medicare Advantage back to Original Medicare doesn't automatically guarantee you a Medigap policy. Outside of your initial Medigap open enrollment window, insurers in Washington and elsewhere may be able to use medical underwriting. Ask questions before you switch.

A note on Star Ratings and IRMAA

CMS publishes Star Ratings each year to measure plan quality on things like customer service and care coordination. They're a useful research tool, not a scoreboard. Higher-income beneficiaries should also know about IRMAA — an income-related surcharge on Part B and Part D premiums that kicks in above $109,000 for a single filer in 2026.