Medicare Part D

Medicare Advantage or Medigap? Two Paths for 2026

NORTH CHARLESTON, S.C. — With Medicare's Annual Enrollment Period running October 15 through December 7, people across the Lowcountry are staring down the same fork in the road: stay with Original Medicare and add a Medigap policy, or choose a Medicare Advantage plan instead.

Both paths are legitimate. Neither is "better" for everyone. But they work very differently, and understanding the structure now — before the December 7 deadline — can save you a lot of second-guessing later.

The two paths, in plain language

Original Medicare is the federal program most people picture when they think of Medicare. It has two main parts:

• Part A covers hospital stays, skilled nursing, hospice, and some home health.
• 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. But there is no yearly cap on what you might owe out of pocket. That is why many people add a Medigap (Medicare Supplement) policy to help pay the deductibles, coinsurance, and copays Original Medicare leaves behind. Drug coverage is separate — you'd sign up for a standalone Part D plan.

Medicare Advantage (Part C) is the other path. These are private plans approved by Medicare that bundle Part A and Part B together, and usually include Part D drug coverage. Advantage plans typically use provider networks (HMO or PPO), often require referrals or prior authorization, and set their own copays. By law, they must cover everything Original Medicare covers, and they must include a yearly out-of-pocket maximum for medical costs.

You cannot use a Medigap policy with a Medicare Advantage plan. It's one path or the other.

What's available around North Charleston

Plan availability in Medicare is set at the county level, not the city level. North Charleston sits in Charleston County, so the plans and carriers offered here are the same ones offered county-wide. If you want to see exactly how many Medicare Advantage plans and Part D plans are available in Charleston County this year, the Plan Finder at medicare.gov lets you enter your ZIP code and see the full list, side by side.

Program numbers worth knowing for 2027

A few program-level figures apply no matter which path you take:

• The Part D out-of-pocket cap is $2,100 in 2026. Once your covered drug spending hits that amount, you pay $0 for covered drugs the rest of the year.
• The Part D deductible can be no higher than $615 in 2026 (some plans set it lower).
• The old "donut hole" is gone. Since 2025, Part D has just three phases: deductible, initial coverage, and catastrophic.
• The Medicare Prescription Payment Plan is an optional program that lets you spread your drug costs across the calendar year in monthly installments, instead of paying a large amount at the pharmacy counter.
• IRMAA — the income-related surcharge on Part B and Part D premiums — begins for single filers with income above $109,000 in 2026 (based on your 2024 tax return).

How to think about the choice

There isn't a scorecard that picks a winner. But most people weigh a few things:

• Doctors and hospitals. If you have providers you want to keep, check whether they're in a plan's network before you enroll. Original Medicare's nationwide access is one reason some travelers and snowbirds prefer that path.
• Predictability vs. flexibility. Medigap tends to mean higher monthly premiums but fewer surprises at the doctor's office. Medicare Advantage often has lower premiums but more variable copays, and networks matter.
• Prescription drugs. Compare the actual drugs you take against each plan's formulary. Two plans can cover the same drug very differently.
• Extras. Many Advantage plans include benefits Original Medicare doesn't (like routine dental, vision, or hearing), but those benefits vary widely and change year to year.

Star Ratings — the 1-to-5 scale CMS publishes each fall — can give you a general sense of how members rate a plan's customer service, care coordination, and drug pricing. They're a data point, not a verdict.

Dates to circle

• October 15 – December 7: 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. If you're already in an Advantage plan, you get one chance to switch to a different Advantage plan or return to Original Medicare.

Medigap has its own rules. Your best window to buy a Medigap policy without medical underwriting is generally the six-month period that starts when you're 65 or older and enrolled in Part B. Outside that window, in most states, insurers can consider your health history. South Carolina follows the federal baseline here, so it's worth asking a licensed advisor or SHIP counselor how underwriting would affect you.