Medicare Advantage

Turning 65 in Missoula? Your First Medicare Money Decisions

Turning 65 in Missoula brings a stack of mail, a few deadlines, and one big question: what will Medicare actually cost you? The program is built out of separate pieces — a hospital part, a medical part, a drug part, and optional add-ons — and each piece has its own price tag. Before you compare a single plan, it helps to see how those cost pieces fit together as you look at 2027 coverage.

Start with the pieces, not the plans

Medicare is not one bill. It is several:

• Part A (hospital): Most people pay no premium because they or a spouse paid Medicare taxes long enough. It has its own deductible for hospital stays.
• Part B (doctor and outpatient): Has a monthly premium set by Medicare each year, plus an annual deductible, plus 20% coinsurance for most services once the deductible is met.
• Part D (prescription drugs): Has a premium (varies by plan), a deductible that can be no more than $615 in 2026 and $700 in 2027, and — in place for the last two years — a hard cap on what you pay out of pocket.
• Medigap (Supplement): An optional private policy that helps pay the gaps in Parts A and B. It has its own monthly premium.
• Medicare Advantage (Part C): A private alternative that bundles A, B, and usually D. You still owe the Part B premium; the plan sets its own cost-sharing rules.

You cannot mix and match every combination. Medigap pairs with Original Medicare, not with Medicare Advantage. That single fork in the road drives most of your cost math.

The program numbers that anchor your 2027 budget

A few program-level figures are worth memorizing because they apply no matter which plan you eventually choose:

• Part D out-of-pocket cap: $2,100 in 2026 and $2,400 in 2027. Once your covered drug spending hits that amount in a calendar year, you pay nothing for covered drugs the rest of the year.
• Part D deductible ceiling: $615 in 2026 ($700 in 2027). A plan can charge less, but not more.
• Three drug-payment phases, not four. The coverage gap was eliminated in 2025, so 2026 and 2027 both have just deductible, initial coverage, and catastrophic (where the cap kicks in).
• Medicare Prescription Payment Plan. If your drug bills are lumpy, you can ask to spread them across the calendar year in level monthly payments. It doesn’t lower the total — it smooths it.
• IRMAA: Higher-income beneficiaries pay a surcharge on Part B and Part D. In 2026, it begins above $109,000 for a single filer (higher for joint filers), based on your tax return from two years earlier.

How the two paths compare on cost structure

Think of it as a trade-off, not a winner.

Original Medicare + Part D (+ often Medigap) tends to have higher predictable monthly costs (the Medigap premium, the Part D premium) in exchange for lower and steadier costs when you actually use care. Original Medicare by itself has no annual out-of-pocket maximum on Parts A and B, which is why many people add Medigap.

Medicare Advantage typically has a lower plan premium but shifts more cost to the moments you use care — copays for visits, coinsurance for certain services, and an annual out-of-pocket maximum set by the plan. You still pay the Part B premium either way.

Neither path is cheaper in the abstract. The right question is: given your prescriptions, your doctors, and how often you expect to use care, which cost pattern fits your budget?

What Missoula-area availability looks like

Plan availability is set at the county level. Missoula is in Missoula County, where the 2026 CMS landscape files show 16 Medicare Advantage plans offered and 2 carriers offering Medicare Advantage with drug coverage (MA-PD). For stand-alone drug coverage, Montana has 11 stand-alone Part D plans for 2026, sold statewide, and anyone in the county with Original Medicare can join one of them — confirm current options on medicare.gov before you decide, since details can update. The 2027 lineup will appear in each plan's Annual Notice of Change and on the Medicare.gov Plan Finder.

Also in the 2026 county data: under CMS's 2026 Star Ratings, 1 contract rated 4 stars or higher. Star Ratings are Medicare's scorecard on plan quality and service; they're one input among many and shouldn't be the only thing you look at.

With roughly 20,683 residents 65 and older in the county, you’re not making this decision alone — and there is free local help (see below).

A simple order of operations

1. Confirm your Part A and Part B start dates. Your Initial Enrollment Period is a seven-month window around your 65th birthday. 2. List your prescriptions and your doctors. These drive drug-plan and network decisions more than anything else. 3. Decide the path first: Original Medicare (with or without Medigap and Part D) or Medicare Advantage. Switching paths later is possible but has rules. 4. Then compare specific plans on medicare.gov’s Plan Finder, where you can enter your drugs and see personalized cost estimates. 5. Note the deadlines. Annual Enrollment is Oct. 15–Dec. 7. Medicare Advantage Open Enrollment is Jan. 1–March 31 for people already in an Advantage plan.