Medicare 2026

Medicare Advantage or Medigap? The Two Paths Explained

LYNNWOOD, Wash. — When you first become eligible for Medicare, you face a choice that shapes how your coverage works for the rest of the year: stay with Original Medicare and consider adding a Medigap policy, or enroll in a Medicare Advantage plan. The two paths look similar on the surface, but they are built very differently. Understanding that difference is the single most useful thing a new enrollee can do before the Annual Enrollment Period closes on December 7.

Two Paths, One Program

Medicare is a federal program, but you access it through one of two structures.

Path 1: Original Medicare (Part A and Part B), often paired with a Medigap policy and a stand-alone Part D drug plan. Part A covers hospital stays. Part B covers doctor visits and outpatient care. You can see any provider in the country who accepts Medicare, and there is no network. Because Original Medicare leaves some costs to you — like the Part A hospital deductible and the 20% coinsurance under Part B — many people add a Medigap (Medicare Supplement) policy sold by a private insurer to help cover those gaps. Drug coverage is separate, through a stand-alone Part D plan.

Path 2: Medicare Advantage (Part C). These are private plans, approved by Medicare, that bundle your Part A, Part B, and usually Part D drug coverage into one plan. Many also include extras like vision, dental, or hearing. Advantage plans typically use networks (HMOs or PPOs), and you follow the plan's rules for referrals, prior authorization, and in-network care.

Both paths are Medicare. The difference is who administers the day-to-day coverage and how you use it.

How Costs Are Structured

Under Original Medicare, your costs are set by the federal program. If you add Medigap, that policy pays some or most of what Original Medicare doesn't. Your monthly outlay is more predictable, but you're often paying more than one premium (Part B, Medigap, and Part D).

Under Medicare Advantage, the private plan sets copays and an annual out-of-pocket maximum for medical services. You still pay your Part B premium, plus any plan premium. Your costs can be lower month-to-month, but they depend on how much care you use and whether you stay in network.

For prescription drugs in 2026, some rules apply no matter which path you choose:

• The Part D out-of-pocket cap is $2,100 for the year. Once you hit it, you pay $0 for covered drugs the rest of the year.
• The maximum Part D deductible is $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 drug costs across monthly payments instead of paying at the pharmacy counter.

Higher earners should also know that IRMAA surcharges on Part B and Part D begin above $109,000 in income for a single filer in 2026.

Choice of Doctors vs. Coordinated Care

This is often the deciding factor.

Original Medicare plus Medigap gives you the broadest access. If your doctor accepts Medicare — and most do — you're covered. That matters if you travel, split time between states, or want to see specialists at major medical centers without a referral.

Medicare Advantage plans work within a network. That coordination can be a benefit — one card, one plan, extra services — but it also means checking whether your doctors and preferred hospitals are in network, and understanding when the plan requires prior authorization.

What's Available Around Lynnwood

Lynnwood is in Snohomish County, where Medicare beneficiaries have access to a range of Medicare Advantage and Part D plans offered by multiple carriers. Plan lineups change every year — carriers enter and leave markets, and benefits get restructured — so even if you were happy with your coverage in 2025, it's worth checking your plan's Annual Notice of Change before you renew. The official plan finder at medicare.gov shows every plan available at your ZIP code.

Two Deadlines to Circle

• October 15 – December 7: Medicare's Annual Enrollment Period. You can join, switch, or drop a Medicare Advantage or Part D plan. Changes take effect January 1.
• January 1 – March 31: The Medicare Advantage Open Enrollment Period. If you're already in an Advantage plan, you get one chance to switch to a different Advantage plan or return to Original Medicare (and pick up a Part D plan).

One important note on switching later: when you first sign up for Medicare, you have guaranteed rights to buy a Medigap policy. If you choose Medicare Advantage first and try to move back to Original Medicare + Medigap years later, a Medigap insurer in most states can use medical underwriting to charge you more or deny coverage. This is one of the most common surprises new enrollees encounter, and it's worth understanding before you decide.