Medicare Part D
Medigap or Medicare Advantage in 2026? How to Decide
MORGANTOWN, W.Va. — Every fall, people sitting at kitchen tables across north-central West Virginia face the same fork in the road: stick with Original Medicare and add a Medigap policy, or move to a Medicare Advantage plan. Both are legitimate paths. They just work very differently, and mixing them up is one of the most common — and costly — mistakes new enrollees make.
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Key takeaways
- Original Medicare (Part A and Part B) lets you see any provider that accepts Medicare and doesn't require referrals, but it has no yearly out-of-pocket limit on its own.
- Medicare Advantage (Part C) plans usually bundle Parts A, B, and D, typically use provider networks, may require prior authorization, and do have an annual out-of-pocket maximum for medical care.
- You can only be in one system at a time, meaning you cannot have Medigap and Medicare Advantage together.
- The one-time Medigap Open Enrollment Period lasts six months starting when you turn 65 and enroll in Part B, and after that window closes, insurers in most states, including West Virginia, can use medical underwriting to deny coverage or charge more based on your health.
Here's a plain-English guide to how the two structures differ, what changes for 2027, and where to get help you can trust.
Two different roads, not two versions of the same thing
Original Medicare is the federal program itself — Part A (hospital) and Part B (doctors and outpatient care). You can see any provider in the country that accepts Medicare, and you don't need referrals. But Original Medicare has no yearly out-of-pocket limit on its own. That's why many people add:
- A Medigap (Medicare Supplement) policy, sold by private insurers, which helps pay the deductibles and coinsurance Original Medicare leaves behind, and
- A stand-alone Part D prescription drug plan.
Medicare Advantage (Part C) is different. You're still in Medicare, but a private plan takes over the job of paying your claims. These plans usually bundle Parts A, B, and D together, and often add extras. In exchange, they typically use provider networks and may require prior authorization or referrals. They do have an annual out-of-pocket maximum for medical care.
You can only be in one system at a time. You cannot have Medigap and Medicare Advantage together.
What's available around Morgantown
Morgantown is in Monongalia County, where Medicare plan availability is set at the county level — not the city level. That means two neighbors on the same street will see the same menu of plans, but a friend across the state line in Pennsylvania may see something completely different.
If you want to know exactly how many Medicare Advantage or Part D plans serve Monongalia County, the plan finder at Medicare.gov lets you enter your ZIP code and see the current count and options for your address. The 2027 lineup is also described in each plan's Annual Notice of Change.
The Part D numbers everyone should know for 2027
A few program-level figures apply no matter which path you choose:
- Part D out-of-pocket cap: $2,100 in 2026 and $2,400 in 2027. Once your drug spending reaches that amount, you pay nothing for covered drugs the rest of the year.
- Part D maximum deductible: $615 in 2026 and $700 in 2027 (plans can charge less).
- The old "donut hole" coverage gap is gone as of 2025. Part D now has three phases instead of four.
- Medicare Prescription Payment Plan: an optional program that lets you spread your drug costs across the calendar year in monthly installments instead of paying at the pharmacy counter.
- IRMAA (higher-income surcharges) begin above $109,000 in income for a single filer in 2026. If that's you, budget for it — it applies to Part B and Part D premiums regardless of which path you pick.
The mistakes people most want to avoid
1. Assuming you can switch back to Medigap anytime. This is the big one. When you first become eligible for Medicare, you have a one-time Medigap Open Enrollment Period — six months starting when you're 65 and enrolled in Part B — during which insurers must sell you a policy regardless of health history. After that window closes, in most states insurers can use medical underwriting. That means if you choose Medicare Advantage first and later try to move to Original Medicare + Medigap, you may be denied a Medigap policy or charged more based on your health. West Virginia does not have a broad "guaranteed issue" law that overrides this, so the choice you make at 65 matters.
2. Not checking whether your doctors and hospitals are in-network. Original Medicare works anywhere Medicare is accepted. Medicare Advantage plans have networks. Before you enroll in any Advantage plan, confirm that WVU Medicine, Mon Health, your primary care doctor, and any specialists you rely on are in that plan's network.
3. Forgetting about prescriptions. If you go with Original Medicare, you'll almost always want a stand-alone Part D plan. Skipping drug coverage when you first become eligible can trigger a late enrollment penalty that follows you for life.
4. Missing the enrollment windows.
- Annual Enrollment Period: October 15 – December 7. This is when anyone with Medicare can join, switch, or drop a Medicare Advantage or Part D plan.
- Medicare Advantage Open Enrollment: January 1 – March 31. If you're already in an Advantage plan, you get one chance to switch to a different Advantage plan or return to Original Medicare.
How to think it through
Ask yourself a few honest questions:
- Do I travel often, or split time between states? Original Medicare's nationwide access may matter more to you.
- Do I have a chronic condition and want predictable, comprehensive cost-sharing? Medigap is designed for that, but the premium is a monthly commitment.
- Am I generally healthy and comfortable with networks and prior authorization in exchange for a lower monthly premium and extra benefits? Medicare Advantage may fit.
- What are my prescriptions, and what does each option's drug coverage look like for those specific medications?
There is no universally "right" answer. There is only the right answer for your health, your budget, and your comfort with risk.
By the numbers
Medicare Part B premium, 2006–2026
The standard monthly Part B premium has climbed from $88.50 in 2006 to $202.90 in 2026. Hover any point for that year’s premium.
Source: CMS. Standard premium shown; in some hold-harmless years many existing enrollees paid less. Confirm at Medicare.gov.
By the numbers
How people get Medicare in Monongalia County
(MA penetration in Monongalia County)
MA penetration from CMS enrollment data; Medigap share is an estimate. U.S. average is about 54% Medicare Advantage. These are area-level figures, not plan-specific.
Try it
How the 2026 Part D drug cap works
Slide to your estimated yearly prescription costs and see how the new $2,100 out-of-pocket cap protects you. This illustrates the standard Part D benefit; your plan may structure costs differently.
Once your out-of-pocket spending on covered drugs reaches $2,100, you pay nothing more for the rest of 2026. Confirm details at Medicare.gov.
Explore
When can you enroll? An interactive year
Enrollment windows are federal and the same nationwide. Confirm your personal dates at Medicare.gov or 1-800-MEDICARE.
Good to know
Frequently asked questions
Q: Can I have both Medigap and Medicare Advantage?
Q: If I pick Medicare Advantage now, can I switch to Medigap later?
Q: Do Star Ratings tell me which plan to pick?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.