Medicare 2026

Original Medicare + Medigap vs. Advantage: How Tacoma Retirees Can Decide

When you turn 65 in Tacoma, one of the first real choices you face isn't which plan has the flashiest ad — it's which structure of Medicare you want to live inside. Original Medicare paired with a Medigap policy works one way. Medicare Advantage works another. Both are legitimate paths, and the right one depends on how you use care, how you travel, and how much predictability you want in your monthly budget.

Here's a plain-language walk-through of how the two paths are built, so you can think it through before the next Annual Enrollment Period (October 15 – December 7).

Path 1: Original Medicare + a Medigap policy

Original Medicare is the federal program itself — Part A (hospital) and Part B (doctor and outpatient). You can go to any doctor or hospital in the country that accepts Medicare, and most do. There is no network and no referral needed for specialists.

The catch is that Original Medicare alone leaves you responsible for deductibles, the 20% Part B coinsurance, and hospital costs that can add up. That's where a Medigap (Medicare Supplement) policy comes in. You buy it from a private insurer, pay a monthly premium, and it fills in much of what Original Medicare doesn't pay.

With this path, you typically also add a stand-alone Part D plan for prescription drugs.

So the "stack" looks like: Part A + Part B + Medigap + Part D.

Path 2: Medicare Advantage (Part C)

Medicare Advantage is offered by private insurers approved by Medicare. When you enroll, that plan takes over the job of delivering your Part A and Part B benefits, and almost all of them bundle in Part D drug coverage as well. Many include extras Original Medicare doesn't cover, like routine dental, vision, or hearing benefits.

Advantage plans use provider networks (HMO, PPO, and others), often require referrals for specialists, and may need prior authorization for certain services. Your costs come in the form of copays and coinsurance up to a yearly out-of-pocket maximum set by the plan.

So the "stack" looks like: one plan that packages Part A + Part B + (usually) Part D + extras.

The structural trade-off in one sentence

Original Medicare + Medigap tends to trade a higher, more predictable monthly premium for broad provider access and fewer surprises at the point of care. Medicare Advantage tends to trade a lower or no additional premium for a network and plan rules that manage how care is delivered.

Neither is "better." They're built differently.

What this looks like in Tacoma

Tacoma is in Pierce County, where Medicare eligibles can choose from a range of Medicare Advantage and Part D options during enrollment periods. Availability and the number of plans offered are set at the county level, so what's available to a neighbor in Gig Harbor or Lakewood may not match what shows up in your ZIP code search on Medicare.gov's Plan Finder.

One local wrinkle worth knowing: Medigap in Washington has some of the most flexible switching rules in the country. Washington allows Medigap enrollees to change to another Medigap plan (of equal or lesser benefits) at almost any time without new medical underwriting. That's unusual — in most states, you get one guaranteed-issue window when you first enroll, and after that insurers can consider your health. If Medigap is on your radar, ask a SHIBA counselor to walk you through Washington's rules before you commit.

Drug coverage: the same rules apply either way

Whether your Part D is stand-alone (Path 1) or built into an Advantage plan (Path 2), the program rules are the same:

• The out-of-pocket cap on Part D drug spending is $2,100 for 2026.
• The maximum Part D deductible is $615.
• The old "donut hole" coverage gap was eliminated in 2025 — Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the calendar year in monthly installments instead of paying big amounts at the pharmacy counter.
• Higher-income beneficiaries pay IRMAA surcharges on Part B and Part D premiums; for 2026, those begin above $109,000 in income for a single filer.

How to think it through

A few honest questions can point you toward the right structure:

• Do you travel or split time out of state? Original Medicare + Medigap travels with you anywhere in the U.S.
• Do you have specialists you want to keep? Check whether they're in an Advantage plan's network before you enroll.
• How much monthly premium can you commit to? Medigap premiums are ongoing; Advantage may have lower premiums but more cost-sharing at the point of care.
• Do you want dental, vision, or hearing bundled in? Original Medicare doesn't cover routine care in those areas; many Advantage plans do.
• How stable is your health right now? Because Medigap medical underwriting rules vary by state and situation, the easiest time to enroll is usually during your initial Medigap open enrollment when you first sign up for Part B.

Key dates to keep on the fridge

• October 15 – December 7: Annual Enrollment Period. Anyone with Medicare can switch between Original Medicare and Advantage, change Advantage plans, or change Part D plans.
• January 1 – March 31: Medicare Advantage Open Enrollment. If you're already in an Advantage plan, you get one chance to switch to another Advantage plan or return to Original Medicare (and pick up a Part D plan).