Medicare 2026

Medicare coverage structure in University Place: two frameworks

# Original Medicare with a Medigap plan vs. Medicare Advantage: how to think it…

UNIVERSITY PLACE, Wash. — With the Medicare Annual Enrollment Period running through Dec. 7, many people here are weighing the same big question: stick with Original Medicare and add a Medigap policy, or move to a Medicare Advantage plan? The choice sounds technical, but it really comes down to how the two paths are built — and what each one asks of you.

Two different structures, not just two different prices

Original Medicare is the traditional federal program. Part A covers hospital stays, Part B covers doctor visits and outpatient care, and you can see any provider in the U.S. who accepts Medicare. It does not cap your yearly out-of-pocket costs on its own, and it does not include prescription drugs.

That is why many people on Original Medicare add two more pieces: a stand-alone Part D drug plan, and a Medigap (Medicare Supplement) policy that helps pay the deductibles and coinsurance Original Medicare leaves behind.

Medicare Advantage (Part C) works differently. A private insurer, approved by Medicare, takes over your Part A and Part B coverage and usually rolls in Part D. These plans often use provider networks (HMO or PPO), require referrals or prior authorization for some services, and set their own copays. By law, they must cap your yearly out-of-pocket costs for Part A and B services.

You cannot have both a Medigap policy and a Medicare Advantage plan at the same time.

What each path asks of you

With Original Medicare + Medigap + Part D, you are managing three cards and paying separate premiums, but you have wide provider choice and predictable cost-sharing. You are not tied to a network.

With Medicare Advantage, you typically have one card and one plan to deal with. Extras like dental, vision, hearing, or fitness benefits are common. In exchange, you generally use the plan's network and follow its rules for approvals.

Neither structure is automatically better. It depends on your doctors, your prescriptions, your travel habits, and how much administrative work you want to do.

The Medigap timing trap

This is the part many people miss. When you first enroll in Part B at 65 or older, you get a six-month Medigap Open Enrollment Period. During that window, insurers cannot turn you down or charge you more because of health conditions.

After that window closes, in most states, Medigap insurers can use medical underwriting. That means if you try to move from Medicare Advantage back to Original Medicare + Medigap later, you might be denied a Medigap policy or charged more based on your health. Washington has some consumer-friendly rules on this, but the details matter — check with your State Health Insurance Assistance Program (SHIP), called SHIBA in Washington, before you assume you can switch freely.

2027 numbers worth knowing

A few program-wide figures apply no matter which path you choose:

• Part D has a $2,100 annual out-of-pocket cap on covered drugs in 2026 and $2,400 in 2027.
• The Part D maximum deductible is $615 in 2026 and $700 in 2027.
• The old coverage gap, or "donut hole," is gone — Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly installments instead of paying a big bill at the pharmacy.
• IRMAA surcharges on Part B and Part D premiums start above $109,000 in income for a single filer in 2026.

What's available around University Place

University Place is in Pierce County, where Medicare beneficiaries can choose from a range of Medicare Advantage plans and stand-alone Part D drug plans offered by multiple carriers. Availability is set at the county level, not the city level, so your options in University Place are the same as elsewhere in Pierce County.

To see the specific plans available at your address — and compare them against your doctors and medications — use the Plan Finder at medicare.gov.

Key dates to keep in mind

• Oct. 15 – Dec. 7: Annual Enrollment Period. You can join, switch, or drop a Medicare Advantage or Part D plan. Changes take effect Jan. 1.
• Jan. 1 – March 31: Medicare Advantage Open Enrollment Period. If you are already in an Advantage plan, you get one chance to switch to another Advantage plan or drop back to Original Medicare (and add a Part D plan).

Star Ratings, published by Medicare each fall, are one tool for comparing plan quality. They are worth reading, but they are not a substitute for checking whether your own doctors and drugs are covered.