Medicare Supplement

Medicare Advantage or Medigap? Charlotte's Two Paths for 2026

CHARLOTTE, N.C. — If you're new to Medicare, or rethinking your coverage during this year's Annual Enrollment Period, you've probably heard the same two terms over and over: Medicare Advantage and Medigap. They sound similar. They are not. Understanding how they're built — and why you generally choose one path or the other — is one of the most important decisions you'll make as a Medicare beneficiary.

Here's a plain-English guide to how the two paths work, and what's new for 2026.

Start with Original Medicare

Original Medicare is the federal program itself. It comes in two parts:

• Part A covers hospital stays, skilled nursing care, hospice, and some home health care.
• Part B covers doctor visits, outpatient care, preventive services, and durable medical equipment.

Original Medicare lets you see any doctor or hospital in the country that accepts Medicare. It does not, on its own, cap what you pay out of pocket each year, and it does not include prescription drug coverage. That's why most people add something on top.

That "something" is where the two paths split.

Path 1: Original Medicare + Medigap + a Part D drug plan

On this path, you keep Original Medicare and add:

• A Medigap policy (also called Medicare Supplement Insurance), sold by private insurers, that helps pay some of the out-of-pocket costs Original Medicare leaves behind — things like coinsurance and copayments.
• A stand-alone Part D plan for prescription drugs.

Medigap plans are standardized by letter (Plan G, Plan N, and so on), so a Plan G from one company covers the same core things as a Plan G from another. Premiums, though, can differ.

One important note: in most states, including North Carolina, insurers can use medical underwriting if you apply for Medigap outside your initial six-month Medigap Open Enrollment Period. That's why many people sign up for Medigap when they first become eligible.

Path 2: Medicare Advantage (Part C)

Medicare Advantage plans are offered by private insurers approved by Medicare. When you enroll in one, you're still in the Medicare program, but the plan takes over administering your Part A and Part B benefits. Most Medicare Advantage plans also include Part D drug coverage built in, and many bundle in extras Original Medicare doesn't cover.

Medicare Advantage plans usually work through networks — HMOs or PPOs — so which doctors and hospitals are in-network matters. Unlike Original Medicare, these plans do have an annual out-of-pocket maximum for covered Part A and B services.

Availability is set at the county level. Charlotte sits in Mecklenburg County, where the number of plans and carriers offered can shift from one year to the next. You can see the current lineup for your ZIP code using the Plan Finder at Medicare.gov.

What's actually new for 2026

A few program-level changes apply no matter which path you choose:

• Part D out-of-pocket cap: $2,100. Once your out-of-pocket spending on covered prescriptions hits that amount in 2026, you pay $0 for covered drugs the rest of the year.
• Part D maximum deductible: $615. Individual plans may set a lower deductible, but not higher.
• The coverage gap (the "donut hole") is gone. Since 2025, Part D has three phases instead of four.
• Medicare Prescription Payment Plan. This optional program lets you spread your out-of-pocket drug costs across the calendar year in monthly installments instead of paying at the pharmacy counter.
• IRMAA. Higher-income beneficiaries pay an extra amount on Part B and Part D premiums. In 2026, the surcharge begins above $109,000 in income for a single filer.

How to think about the choice

There's no universally right answer. A few honest questions to ask yourself:

• How important is provider flexibility? Original Medicare + Medigap generally lets you see any provider that accepts Medicare, nationwide. Medicare Advantage typically uses a network.
• How do you feel about predictable monthly costs vs. pay-as-you-go? Medigap tends to mean higher monthly premiums but fewer surprises when you use care. Medicare Advantage often has lower premiums but more cost-sharing at the point of service, up to the plan's out-of-pocket max.
• What are your prescriptions? Drug coverage varies plan by plan. Formularies matter.
• Do you travel or live part of the year elsewhere? That can affect which path fits.
• What's your timing? Your best window for Medigap without medical underwriting is usually when you first enroll in Part B.

Key dates to remember

• Annual Enrollment Period: October 15 – December 7. Anyone with Medicare can join, switch, or drop a Medicare Advantage or Part D plan. Changes take effect January 1.
• Medicare Advantage Open Enrollment Period: January 1 – March 31. If you're already in a Medicare Advantage plan, you can switch to a different one or return to Original Medicare (and pick up a Part D plan).