Medicare 2026
Medicare Advantage or Medigap? Two Paths, One Choice
In Hilo, turning 65 often brings the same question: should you stick with Original Medicare and add a Medigap policy, or go with a Medicare Advantage plan? Both are legitimate paths, but they are built very differently. Understanding that structure — before you enroll — is the single best way to avoid a decision you later wish you could undo.
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Key takeaways
- Original Medicare plus Medigap and Medicare Advantage are two separate structures, not two flavors of the same plan.
- Medigap helps cover Original Medicare's out-of-pocket costs but does not include drug coverage, so most people add a stand-alone Part D plan.
- Medicare Advantage bundles Part A, Part B, and usually Part D through a private insurer, and typically uses a provider network.
- Key dates to remember: Annual Enrollment runs Oct. 15 – Dec. 7, and Medicare Advantage Open Enrollment runs Jan. 1 – March 31.
Path one: Original Medicare plus Medigap
Original Medicare is the federal program itself — Part A (hospital) and Part B (doctor and outpatient). You can see any provider in the country who accepts Medicare, and there is no network.
The trade-off is that Original Medicare alone has no out-of-pocket maximum. That is where Medigap (also called Medicare Supplement Insurance) comes in. Medigap is a private policy that helps pay the deductibles, coinsurance, and copays Original Medicare leaves behind. Plans are standardized and labeled by letter (Plan G, Plan N, and so on), so the benefits of a given letter are the same from one company to the next — only the price and the company differ.
Medigap does not include prescription drug coverage. If you take this path, you'll usually add a stand-alone Part D drug plan separately.
Path two: Medicare Advantage (Part C)
Medicare Advantage is a private plan that takes the place of Original Medicare for how your care is delivered. You still have Medicare, but a private insurer manages your Part A and Part B benefits, and most Advantage plans also include Part D drug coverage in the same package. Many include extras such as dental, vision, or hearing.
The structural difference: Advantage plans typically use provider networks (HMO or PPO), may require referrals or prior authorization, and have a yearly cap on in-network out-of-pocket costs. Rules, networks, and covered extras can change every year, which is why the fall review window matters.
What's the same either way
No matter which path you choose, the underlying Medicare rules and program figures still apply:
- The Part D out-of-pocket cap is $2,100 in 2026.
- The Part D maximum deductible is $615.
- The old coverage gap ("donut hole") was eliminated in 2025; Part D now has three phases.
- The Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly installments if you choose.
- IRMAA income-based surcharges on Part B and Part D begin above $109,000 for a single filer in 2026.
What's available around Hilo
Hilo is in Hawaii County, where residents have both routes available: enroll in Original Medicare and shop for a Medigap policy and a stand-alone Part D plan, or enroll in a Medicare Advantage plan offered in the county. The number of Advantage and Part D plans available is set at the county level and is updated each fall on Medicare.gov's Plan Finder.
Because Hawaii County spans a large area — from Hilo across to Kona and up to Waimea — provider networks matter. If you travel between islands or to the mainland, ask specifically how a plan handles out-of-area care before you enroll.
How to think through the decision
A few honest questions tend to cut through the noise:
- Do you want to keep specific doctors? Call their offices and ask which plans they accept.
- How often do you travel? Original Medicare travels with you nationwide; Advantage networks are usually regional.
- How predictable are your health needs? Medigap trades a higher monthly premium for fewer surprises; Advantage often has lower premiums but more variable out-of-pocket costs.
- When can you buy Medigap without medical underwriting? In most states, your best guaranteed window is the six months after your Part B starts. Rules for switching later vary — worth asking about before you commit.
Key enrollment windows
- Annual Enrollment Period: October 15 – December 7. You can join, switch, or drop a Medicare Advantage or Part D plan for coverage starting January 1.
- Medicare Advantage Open Enrollment: January 1 – March 31. If you're already in an Advantage plan, you get one chance to switch to another Advantage plan or return to Original Medicare.
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 Hawaii County
(MA penetration in Hawaii 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.
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.
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The parts of Medicare
Good to know
Frequently asked questions
Can I have both Medigap and Medicare Advantage at the same time?
If I choose Medicare Advantage now, can I switch to Medigap later?
Do I need a separate Part D plan with Medicare Advantage?
Where can I get unbiased help in Hilo?
- CMS — Medicare basics (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.
Also for Hilo
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This page was last updated: September 29, 2026.