Medicare Advantage

Medicare in Spokane: How to Weigh Medigap vs. Advantage for 2026

People in Spokane can choose from 37 Medicare Advantage plans for 2027, against 59 this year. 21 of this year's plans are gone, 9 are new to Spokane County, and 28 that continue have changed something in their terms, 10 of them under a new name.

SPOKANE, Wash. — Every fall, thousands of people across Spokane sit down at their kitchen tables with a stack of Medicare mail and the same big question: Should I stick with Original Medicare and add a Medigap policy, or go with a Medicare Advantage plan?

Spokane seniors face a familiar fork in the road

Both paths are legal, both are common, and both are supported by the federal Medicare program. But they are built very differently. Getting the structure right — before you compare specific plans — is one of the best ways to avoid a costly mistake later.

Here's a plain-English look at how the two choices actually work, with 2027 numbers where they apply.

The two paths, side by side

Path 1: Original Medicare + a Medigap policy (and usually a stand-alone Part D drug plan). Original Medicare is the federal program: Part A (hospital) and Part B (doctor and outpatient). You can see any provider in the country that accepts Medicare, and you generally don't need referrals. Because Original Medicare has deductibles and coinsurance with no yearly out-of-pocket limit on its own, many people add a Medigap (Medicare Supplement) policy to help cover those cost-sharing pieces. Drug coverage is separate — you'd add a Part D plan.

Path 2: Medicare Advantage (Part C). Medicare Advantage plans are offered by private insurance companies approved by Medicare. When you enroll, the plan takes over paying your Part A and Part B claims. These plans usually use networks (HMO or PPO), often require referrals or prior authorization for certain services, and typically bundle in Part D drug coverage. They must include a yearly out-of-pocket maximum for in-network medical care.

Neither path is "better" in the abstract. They solve the same problem in different ways.

What availability looks like in Spokane

Medicare plan availability is set at the county level, not the city level. Spokane is in Spokane County, where residents can choose from a range of Medicare Advantage plans and stand-alone Part D drug plans offered by multiple carriers. Medigap policies in Washington are regulated by the state's insurance department and are sold by a number of private insurers.

For the current count of plans available in Spokane County, the plan finder at medicare.gov is the official source. It updates each year for the new plan year.

The trade-offs people most often miss

A few structural points trip readers up every year:

• Provider access. Original Medicare is accepted by most providers nationwide. Medicare Advantage plans use networks, which matter if you travel, spend winters elsewhere, or want a specific specialist or hospital.
• Referrals and prior authorization. Original Medicare generally doesn't require these. Many Advantage plans do, especially HMOs.
• Extra benefits. Advantage plans may include benefits Original Medicare doesn't cover, such as routine dental, vision, or hearing. Original Medicare + Medigap does not bundle those in.
• Medigap medical underwriting. This is the big one. When you first become eligible for Medicare, you have a one-time Medigap open enrollment window (typically six months after Part B starts) when insurers cannot turn you down or charge more for health reasons. Outside that window, in most states — Washington included — Medigap carriers can review your health when you apply. Washington has some consumer-friendly rules, but the timing still matters. Switching from Advantage back to Original Medicare + Medigap later isn't always as simple as people assume.

2027 drug coverage: the same rules on both paths

Whether your drug coverage comes through a stand-alone Part D plan or is built into a Medicare Advantage plan, the same federal rules apply for 2027:

• The Part D out-of-pocket cap is $2,100 in 2026 ($2,400 in 2027) for the year. Once you hit it, you pay $0 for covered drugs the rest of the year.
• The Part D deductible can't exceed $615 in 2026 and $700 in 2027 (plans can set it lower).
• The old coverage gap ("donut hole") is gone as of 2025. Part D now has three phases: deductible, initial coverage, and catastrophic.
• The Medicare Prescription Payment Plan lets you spread your drug out-of-pocket costs across the calendar year in monthly installments instead of paying big amounts at the pharmacy counter. It's optional and free to opt into.

Higher-income enrollees should also know that IRMAA surcharges on Part B and Part D premiums kick in above $109,000 in income for a single filer in 2026 (higher thresholds for joint filers), based on your tax return from two years earlier.

Key dates to keep on the calendar

• October 15 – December 7: Medicare Annual Enrollment Period. You can join, switch, or drop a Medicare Advantage or Part D plan. Changes take effect January 1.
• January 1 – March 31: Medicare Advantage Open Enrollment Period. If you're already in an Advantage plan, you can switch to a different Advantage plan or move back to Original Medicare (and pick up a Part D plan) once during this window.

Miss a window and you may be locked into your current coverage until the next one — a common and preventable mistake.