Medicare Supplement

Medigap and Medicare Advantage: the Lowell fork in the road

LOWELL, Mass. — Every year, thousands of people across the Merrimack Valley turn 65 or leave a job with health benefits and face the same fork in the road: stay with Original Medicare and add a Medigap policy, or enroll in a Medicare Advantage plan. Both are legal, both are common, and both are very different under the hood.

Lowell Faces the Same Big Medicare Choice in 2026

If you live in Lowell, understanding how these two paths actually work — before you compare any specific plans — is the single most useful thing you can do this fall.

Path One: Original Medicare + Medigap + a Part D Drug Plan

Original Medicare is the traditional federal program. It has two parts:

• Part A helps cover hospital stays, skilled nursing, hospice, and some home health care.
• Part B helps cover doctor visits, outpatient care, and preventive services.

Original Medicare pays a share of your covered costs, and you pay the rest. There's no yearly cap on what you might owe out of pocket, which is why many people add a Medigap (Medicare Supplement) policy. Medigap is sold by private insurers and helps pay some of the deductibles, copays, and coinsurance Original Medicare leaves behind.

Original Medicare does not include prescription drug coverage, so most people on this path also enroll in a stand-alone Part D plan.

The trade-off: with Original Medicare, you can generally see any provider in the U.S. that accepts Medicare — no network restrictions and no referrals. You'll typically pay a Part B premium, a Medigap premium, and a Part D premium.

Path Two: Medicare Advantage (Part C)

Medicare Advantage plans are offered by private insurers approved by Medicare. When you enroll, the plan takes over administering your Part A and Part B benefits, and most Advantage plans include Part D drug coverage in the same package.

Advantage plans usually use networks (HMO or PPO) and may require referrals or prior authorization for certain services. In exchange, they often bundle in extras Original Medicare doesn't cover, and — importantly — they include an annual out-of-pocket maximum for medical services, which Original Medicare alone does not.

Lowell is in Middlesex County, where residents typically have a wide range of Medicare Advantage and Part D options to compare each year. The exact plan list changes annually, and you can see the current lineup for your ZIP code at Medicare.gov.

What's the Same on Both Paths in 2026

No matter which path you choose, some 2026 rules apply across the board:

• Part D out-of-pocket cap: Your prescription drug costs are capped at $2,100 for the year.
• Part D deductible: Plans can charge up to $615, but not more.
• The "donut hole" is gone. As of 2025, Part D has three phases — deductible, initial coverage, and catastrophic — with no coverage gap.
• Medicare Prescription Payment Plan. You can choose to spread your drug costs into monthly payments across the year instead of paying at the pharmacy counter.
• IRMAA surcharges on Part B and Part D begin above $109,000 in income for a single filer in 2026 (higher for married couples filing jointly).

Key Dates to Circle

• 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 for the following year.
• Medicare Advantage Open Enrollment: January 1 – March 31. If you're already in an Advantage plan, you get one chance during this window to switch to a different Advantage plan or return to Original Medicare.

Medigap has its own rules. Your best guaranteed-issue window is usually the six months after you first enroll in Part B at age 65 or older. Outside that window, in most states, insurers can use medical underwriting.

How to Think About the Choice

There isn't a universally right answer — the honest question is which structure fits your life:

• Do you travel often or split time out of state? Network rules matter.
• Do you have doctors and specialists in Lowell, Chelmsford, or Boston you want to keep? Check whether they're in-network on any Advantage plan you consider.
• Do you take specific prescriptions? Every Part D and Advantage plan has its own formulary.
• How do you feel about predictable monthly premiums versus paying more only when you use care?

A licensed agent can walk you through options, but so can free, unbiased counselors — see below.