Medicare 2026

Medicare Advantage vs Medigap: how they differ in Morgantown

MORGANTOWN, W.Va. — If you are turning 65 in the Mountain State — or helping a parent sort through the mail that starts arriving around that birthday — you have probably run into two very different-sounding ideas: Medicare Advantage on one side, and Original Medicare paired with a Medigap policy on the other.

They are both legitimate ways to get your Medicare coverage. But they are built differently, and understanding that structure up front makes every other decision easier.

Start with Original Medicare

Original Medicare is the federal health insurance program run by the Centers for Medicare & Medicaid Services. It has two main parts:

• Part A covers inpatient hospital care, skilled nursing facility stays, hospice, and some home health care.
• Part B covers doctor visits, outpatient care, preventive services, and durable medical equipment.

With Original Medicare, you can see any doctor or hospital in the country that accepts Medicare — and most do. There is no network. But Original Medicare does not cover everything. You are responsible for deductibles, coinsurance (typically 20% of the Part B–approved amount), and there is no annual cap on what you might pay out of pocket.

That last part is where the two paths split.

Path one: Original Medicare + Medigap (+ a Part D drug plan)

Medigap — also called Medicare Supplement Insurance — is a private policy that sits on top of Original Medicare and helps pay the cost-sharing Original Medicare leaves behind. Depending on the lettered plan you choose (Plan G and Plan N are common examples), it can cover some or most of your deductibles and coinsurance.

Because Medigap only pays after Medicare pays, it works anywhere Original Medicare works. There are no plan networks.

Two important notes:

• Medigap does not include prescription drug coverage. If you go this route, you'll usually add a stand-alone Part D drug plan.
• Medigap has its own enrollment rules. Your best pricing and guaranteed acceptance generally come during your six-month Medigap Open Enrollment Period, which starts the month you're 65 and enrolled in Part B. After that window, insurers in most states can use medical underwriting.

So this path is really a bundle: Part A + Part B + Medigap + Part D.

Path two: Medicare Advantage (Part C)

Medicare Advantage plans are offered by private insurance companies approved by Medicare. When you enroll in one, you still have Medicare — but the plan is now handling your Part A and Part B benefits, usually bundles in Part D drug coverage, and often adds extras like dental, vision, hearing, or fitness programs.

The trade-offs look different here:

• Advantage plans typically use provider networks (HMO, PPO, and others). Care outside the network may cost more or may not be covered except for emergencies.
• Plans set their own copays, deductibles, and rules like prior authorization.
• Every Medicare Advantage plan must have an annual out-of-pocket maximum for Part A and B services — a built-in ceiling Original Medicare alone does not have.
• You generally cannot have both Medicare Advantage and Medigap.

Morgantown is in Monongalia County, where multiple Medicare Advantage plans from several carriers were offered in 2026. The specific number changes annually; the 2027 lineup is detailed in each plan's Annual Notice of Change and on Medicare's Plan Finder at medicare.gov for your ZIP code.

What's new for 2027

A few program-level changes affect both paths — especially anyone taking prescription drugs:

• The Part D out-of-pocket cap is $2,400 in 2027 (up from $2,100 in 2026). Once your covered drug costs hit that ceiling, you pay nothing for covered drugs the rest of the year.
• The Part D deductible cannot exceed $700 in 2027 (it is $615 in 2026).
• The old coverage gap (the "donut hole") was eliminated in 2025. Part D now has three phases: deductible, initial coverage, and catastrophic.
• The Medicare Prescription Payment Plan lets you spread your out-of-pocket drug costs across the calendar year in monthly installments instead of paying at the pharmacy counter.
• IRMAA — the income-related surcharge on Part B and Part D premiums — starts above $109,000 in income for a single filer in 2026 (based on your 2024 tax return).

These rules apply whether your drug coverage comes through a stand-alone Part D plan or is built into a Medicare Advantage plan.

Enrollment periods to circle

• Initial Enrollment Period: The seven-month window around your 65th birthday.
• Annual Enrollment Period (AEP): Oct. 15 – Dec. 7. You can join, switch, or drop a Medicare Advantage or Part D plan for the following year.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31. If you're already in an Advantage plan, you can switch to a different one or go back to Original Medicare (and add Part D).
• Medigap Open Enrollment: The six months starting the month you turn 65 and are enrolled in Part B — the strongest window for guaranteed-issue rights.

How to decide which path fits

There is no single right answer, and the honest truth is that the "better" structure depends on your health, your budget, your doctors, and how you like to handle risk.

Some questions worth sitting with:

• Do I travel often or live in more than one state during the year?
• Are my current doctors and hospitals in the plan's network?
• Are my prescriptions on the plan's formulary, and at what tier?
• Am I comfortable with predictable monthly premiums (Medigap) or lower premiums with variable costs at the point of care (many Advantage plans)?
• What does my budget look like if I have a serious health year?

Where to get unbiased help

For personalized answers about your situation, use official sources — not a sales call:

• Medicare.gov — the official site, including the Plan Finder tool.
• 1-800-MEDICARE (1-800-633-4227), available 24/7.
• West Virginia SHIP (State Health Insurance Assistance Program) offers free, one-on-one Medicare counseling to West Virginia residents, including folks in Monongalia County.