Medicare 2026

Medicare in Dover: the Medigap vs. Advantage structure

DOVER, Del. — Every fall, people turning 65 in Delaware's capital face the same fork in the road: stay with Original Medicare and add a Medigap policy, or choose a Medicare Advantage plan instead. The two paths are built very differently, and understanding that structure — before comparing any specific plan — is the clearest way to make a choice you can live with.

With the Annual Enrollment Period running Oct. 15 through Dec. 7, Dover residents have a short window to weigh how each option is wired.

Two different structures, not two versions of the same thing

Original Medicare is the federal program itself — Part A (hospital) and Part B (medical). You can see any doctor or hospital in the country that accepts Medicare, and there is no network. But Original Medicare alone does not cap what you pay out of pocket in a year, and it does not include drug coverage.

That is where the add-ons come in. Most people on Original Medicare pair it with a stand-alone Part D drug plan, and many also buy a Medigap policy (also called Medicare Supplement Insurance) to help cover the deductibles and coinsurance Original Medicare leaves behind.

Medicare Advantage (Part C) is a different structure. Private insurers, under contract with Medicare, bundle Part A, Part B, and usually Part D into a single plan. These plans typically use provider networks (HMO or PPO) and often include extras Original Medicare does not cover, such as routine dental or vision. They also have a yearly out-of-pocket maximum for Part A and B services, which Original Medicare by itself does not.

What Medigap actually does

Medigap is not a replacement for Medicare — it sits on top of it. It is designed to pay some of the costs Original Medicare passes to you, like the Part A hospital deductible or the 20% coinsurance under Part B. Medigap plans are standardized by letter (Plan G, Plan N, and so on), which means the benefits inside "Plan G" are the same from one insurer to the next; only the price and the company differ.

There is an important timing rule. When you first enroll in Part B at age 65, you get a six-month Medigap Open Enrollment Period. During that window, insurers must sell you any Medigap policy they offer at their standard rate, regardless of your health. Outside that window, in most states, insurers can use medical underwriting — and can charge more or decline coverage.

What Medicare Advantage changes

Choosing Medicare Advantage does not mean you leave Medicare. You are still in the program; you are just receiving your benefits through a private plan. Because these plans manage care, they usually involve networks, referrals in some cases, and prior authorization for certain services. In return, they cap your yearly medical out-of-pocket costs and often fold prescription coverage into the same plan.

Dover is in Kent County, where a range of Medicare Advantage plans from multiple carriers are offered. The number and mix of plans in the county can change each year, which is one reason CMS encourages people to review their coverage during the Annual Enrollment Period even if they are happy with what they have.

The rules that apply either way in 2027

Some Medicare rules apply no matter which path you choose:

• Part D out-of-pocket cap: Your out-of-pocket spending on covered drugs is capped at $2,100 in 2026 and $2,400 in 2027, whether your drug coverage comes through a stand-alone Part D plan or is bundled into a Medicare Advantage plan.
• Part D deductible: The maximum allowed deductible is $615 in 2026 and $700 in 2027.
• No more coverage gap: As of 2025, the "donut hole" was eliminated. Part D now has three phases instead of four.
• Medicare Prescription Payment Plan: This optional program lets you spread your yearly drug costs into monthly payments instead of paying at the pharmacy counter.
• IRMAA: Higher-income beneficiaries pay an income-related surcharge on Part B and Part D premiums. For a single filer in 2026, IRMAA begins above $109,000 in income.

Key dates to keep in mind

• Oct. 15 – Dec. 7: Annual Enrollment Period. You can join, switch, or drop a Medicare Advantage plan or a Part D plan. Changes take effect Jan. 1.
• Jan. 1 – March 31: Medicare Advantage Open Enrollment Period. If you are already in a Medicare Advantage plan, you can switch to a different one or return to Original Medicare (and add a Part D plan).
• Your Medigap Open Enrollment Period: The six months that begin when you are 65 and enrolled in Part B. This is the easiest time to buy a Medigap policy.

How to think it through

There is no single right answer, and the best choice for your neighbor may not be the best choice for you. A few honest questions to ask yourself:

• Do I want the freedom to see any provider that accepts Medicare, or am I comfortable using a plan's network?
• How predictable do I need my costs to be month to month?
• Do I travel often, or spend part of the year outside Delaware?
• Am I still within my Medigap Open Enrollment Period, or would I need to go through medical underwriting?

Answering those first makes the plan-by-plan comparison much easier.