Medicare 2026

Medicare Advantage or Medigap? Two Paths, One Choice

Eau Claire, Wis. — For people turning 65 in the Chippewa Valley, one decision tends to shape everything else about their Medicare coverage: whether to stay with Original Medicare and add a Medigap policy, or to enroll in a Medicare Advantage plan. The two paths look similar from a distance, but they are built very differently underneath.

Here is a plain-language look at how each one works, so you can decide which structure fits your life.

The two paths, side by side

Path 1: Original Medicare + Medigap (and usually a separate Part D drug plan). Original Medicare is the federal program itself — Part A (hospital) and Part B (doctor and outpatient). You can see any provider in the country that accepts Medicare, and no referrals are required. Because Original Medicare has deductibles and coinsurance with no yearly out-of-pocket cap, many people add a Medigap (Medicare Supplement) policy from a private insurer to help pay those gaps. Drug coverage is separate — you add a stand-alone Part D plan.

Path 2: Medicare Advantage (Part C). Medicare Advantage is an all-in-one plan offered by a private insurance company that contracts with Medicare. You still have Medicare, but your Part A, Part B, and usually Part D benefits are delivered through that one plan. These plans typically use networks (HMO or PPO) and often include extras like dental, vision, or hearing. They have a yearly out-of-pocket maximum built in, but you generally must use the plan's network and follow its rules.

You can pick one path or the other — you cannot use a Medigap policy with a Medicare Advantage plan.

What each path is really trading

The choice usually comes down to what you value more: flexibility or simplicity.

• Original Medicare + Medigap tends to offer broad provider access and predictable costs, in exchange for a monthly Medigap premium and a separate drug plan.
• Medicare Advantage tends to offer lower monthly premiums and bundled extras, in exchange for network rules and prior authorization for some services.

Neither is "better." They are structured differently on purpose.

What's true for everyone in 2026

No matter which path you take, some Medicare rules are set at the federal level and apply the same way in Eau Claire as they do anywhere else:

• Part D out-of-pocket cap of $2,100. Once your covered drug costs reach $2,100 in a calendar year, you pay $0 for covered prescriptions the rest of the year.
• Part D deductible capped at $615. Plans can charge less, but not more.
• The old coverage gap ("donut hole") is gone as of 2025. Part D now has three phases instead of four.
• Medicare Prescription Payment Plan. You can choose to spread your yearly drug costs into level monthly payments instead of paying at the pharmacy counter.
• IRMAA — higher-income surcharges on Part B and Part D — begin above $109,000 in income for a single filer in 2026.

These figures come from Medicare itself (medicare.gov) and apply to both paths.

The Eau Claire picture

Eau Claire is in Eau Claire County, and Medicare Advantage and Part D plan availability is set at the county level. That means the specific menu of plans a neighbor in another county sees may look different from yours, even a short drive away. If you want to know exactly which plans and carriers serve Eau Claire County in 2026, the Medicare Plan Finder at medicare.gov lets you enter your ZIP code and see the current list, along with each plan's network and drug formulary.

Medigap is different. Medigap policies are standardized by letter (Plan G, Plan N, and so on), so a Plan G from one company covers the same core benefits as a Plan G from another. What varies is the premium and the company's customer service — not the benefits themselves.

Timing matters more than most people realize

Two windows to keep on your calendar:

• Annual Enrollment Period: Oct. 15 – Dec. 7. This is when anyone with Medicare 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 a Medicare Advantage plan, you get one chance during this window to switch to a different Advantage plan or return to Original Medicare.

There is also a quieter but very important rule: your Medigap Open Enrollment Period is the six months that starts when you're 65 and enrolled in Part B. During that one-time window, insurers must sell you any Medigap policy they offer at their best available rate, regardless of your health. After it closes, medical underwriting can apply in most states, including Wisconsin — which uses its own standardized Medigap plan design. That is why the initial choice between the two paths carries more weight than people expect.

How to decide

A few honest questions can narrow it quickly:

1. Do you travel or split time out of state? Original Medicare's nationwide access may matter more. 2. Do you prefer one card, one plan, and built-in extras? Medicare Advantage is structured for that. 3. Are your doctors and hospitals in a specific plan's network? Check before enrolling. 4. How steady is your budget? Medigap trades higher monthly premiums for fewer surprises; Advantage trades lower premiums for cost-sharing when you use care. 5. What prescriptions do you take? Every Part D formulary is different — look up your drugs by name.