Medicare 2026

Medicare Advantage or Medigap? How the Two Paths Differ

VANCOUVER, Wash. — Picking a Medicare path can feel like standing at a fork in the road with no map. On one side is Original Medicare, often paired with a Medigap policy and a separate Part D drug plan. On the other is Medicare Advantage, which bundles your coverage through a private insurer. Both are legitimate ways to get your benefits, but they are built differently — and that structure shapes your costs, your doctor choices, and how you handle surprises.

Here is a plain-English look at how the two paths compare, and where to get personalized help if you live in the Vancouver area.

Path 1: Original Medicare + Medigap + Part D

Original Medicare is the traditional federal program. Part A covers hospital stays, and Part B covers doctor visits and outpatient care. You can see any provider in the country who accepts Medicare — no network, no referrals for specialists.

Original Medicare does not cap your out-of-pocket spending on its own. That is why many people add a Medigap (Medicare Supplement) policy from a private insurer. Medigap helps pay the deductibles, coinsurance, and copays that Original Medicare leaves behind. Because Original Medicare does not include prescription drug coverage, most people also add a standalone Part D plan.

So this path is really three pieces working together: Original Medicare + Medigap + Part D.

Path 2: Medicare Advantage (Part C)

Medicare Advantage is an "all-in-one" alternative offered by private insurers approved by Medicare. When you join a Medicare Advantage plan, the plan takes over your Part A and Part B benefits, and most plans include Part D drug coverage as well. Many plans also offer extras that Original Medicare does not cover, such as routine dental, vision, or hearing benefits.

The trade-off is structure. Advantage plans typically use provider networks (HMO or PPO), may require referrals, and often use prior authorization for certain services. Each plan sets its own yearly out-of-pocket maximum for medical care, which gives you a ceiling that Original Medicare alone does not have.

You cannot use Medigap with a Medicare Advantage plan. Medigap only works with Original Medicare.

What's available around Vancouver

Vancouver is in Clark County, where 44 Medicare Advantage plans from 9 carriers are offered for 2027, down from 76 plans and 12 carriers in 2026. Within that shift, 33 plans continue, 11 are new, 30 are not returning, and 13 have been renamed; 24 of the continuing plans change something in their terms, with the details in each plan's Annual Notice of Change. Carriers not offering plans in the county for 2027 include Blue Cross Blue Shield (HCSC), Elevance Health (Anthem), and Providence Medicare Advantage Plans. You can compare what is available in your ZIP code using the Plan Finder at medicare.gov.

Costs to keep in mind for 2027

A few program-level numbers apply no matter which path you choose:

• Part D out-of-pocket cap: $2,100 for 2026 and $2,400 for 2027. Once you hit that limit on covered drugs, you pay nothing more for covered drugs the rest of the year.
• Part D maximum deductible: $615 in 2026 and $700 in 2027.
• The coverage gap ("donut hole") is gone as of 2025. Part D now has three phases instead of four.
• Medicare Prescription Payment Plan: an optional program that lets you spread your drug costs into level monthly payments instead of paying big amounts at the pharmacy.
• IRMAA: higher-income beneficiaries pay an income-related surcharge on Part B and Part D. For 2026, that starts above $109,000 for a single filer.

How to decide which path fits

There is no universal right answer. A few questions can point you in the right direction:

• Do you travel or split time between states? Original Medicare + Medigap travels with you anywhere Medicare is accepted.
• Do you prefer predictable, bundled coverage with extras like dental or vision? Medicare Advantage may fit that preference, keeping in mind network rules.
• Do you have doctors you want to keep? Check whether they are in a plan's network before you enroll.
• Are you newly eligible? Your Medigap "guaranteed issue" rights are strongest when you first sign up for Part B. Switching from Advantage to Medigap later can be harder, because insurers may use medical underwriting outside protected windows.

When you can enroll or switch

Two key windows every year:

• Annual Enrollment Period: October 15 – December 7. You can join, switch, or drop a Medicare Advantage or Part D plan.
• Medicare Advantage Open Enrollment: January 1 – March 31. If you are already in an Advantage plan, you get one chance to switch to another Advantage plan or return to Original Medicare (and add a Part D plan).

Where to get unbiased help

For Vancouver readers, free, one-on-one counseling is available through Washington's SHIBA program (the state's SHIP — Statewide Health Insurance Benefits Advisors). SHIBA counselors do not sell insurance and do not work on commission.

• Medicare: medicare.gov or 1-800-MEDICARE (1-800-633-4227), 24/7
• Washington SHIBA: 1-800-562-6900