Medicare 2026

Original Medicare + Medigap vs. Advantage: How to Choose

COEUR D'ALENE, Idaho — If you're turning 65 soon, or thinking about changing your Medicare coverage during this fall's Annual Enrollment Period, you'll quickly run into the biggest choice in Medicare: stay with Original Medicare and add a Medigap policy, or pick a Medicare Advantage plan instead.

The two paths can cover many of the same doctor visits and hospital stays, but they're built very differently. Understanding that structure — before you compare premiums or drug lists — is the clearest way to decide what fits your life.

Two different ways to get the same Medicare benefits

Original Medicare is the federal program itself. Part A covers hospital care, and Part B covers doctor visits and outpatient care. You can see any provider in the country that accepts Medicare, and there are no networks.

Medicare Advantage (Part C) is different. It's private insurance approved by Medicare. When you enroll, the plan takes over paying your Part A and Part B claims. You still have Medicare, but the private plan sets the rules — usually a network of doctors and hospitals, and often prior authorization for certain services.

Neither path is automatically better. They're just built on different foundations.

Where Medigap fits in

Original Medicare pays most of your covered costs, but not all. There's a Part A hospital deductible, a 20% coinsurance on most Part B services, and no yearly cap on what you might owe out of pocket.

That's the gap Medigap (also called Medicare Supplement Insurance) is designed to fill. Medigap policies are sold by private companies and are standardized by letter (Plan G, Plan N, and so on). Each lettered plan offers the same core benefits no matter which company sells it, though premiums vary.

A key point: Medigap only works with Original Medicare. You cannot use it with a Medicare Advantage plan. And if you want prescription drug coverage on the Original Medicare side, you add a stand-alone Part D plan.

How Medicare Advantage bundles things together

Most Medicare Advantage plans roll hospital, medical, and prescription drug coverage into one package. Many also include extras Original Medicare doesn't cover, like routine dental, vision, or hearing benefits.

The trade-off is structure. Advantage plans typically use HMO or PPO networks, so where you go for care matters. Every plan must have a yearly out-of-pocket maximum for Part A and Part B services, which Original Medicare alone does not have.

Coeur d'Alene is in Kootenai County, where a range of Medicare Advantage plans from several carriers was available for 2026. The exact number and mix change each year — the 2027 lineup is in each plan's Annual Notice of Change and on Medicare.gov's Plan Finder, which is the safest way to see what's actually offered.

The program figures worth knowing

A few program-wide 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 covered drug spending hits that amount, you pay nothing for covered prescriptions the rest of the year.
• Part D maximum deductible: $615 in 2026 and $700 in 2027.
• The coverage gap ("donut hole") is gone as of 2025. Part D now has three phases instead of four.
• Medicare Prescription Payment Plan: an optional way to spread your drug costs into level monthly payments across the plan year.
• IRMAA (higher-income surcharges) for Part B and Part D begin above $109,000 in income for a single filer in 2026.

These rules apply to Original Medicare and Medicare Advantage alike.

The Medigap timing rule that trips people up

Here's the part many people don't hear until it's too late. When you first sign up for Part B at 65, you get a six-month Medigap Open Enrollment Period. During that window, insurers must sell you any Medigap policy they offer at their best available rate, regardless of your health history.

After that window closes, in most states — Idaho included — Medigap insurers can use medical underwriting. That means they can charge more, or turn you down, based on your health.

Medicare Advantage doesn't work that way. You can switch during the Annual Enrollment Period (Oct. 15 – Dec. 7) or, if you're already in an Advantage plan, during the Medicare Advantage Open Enrollment Period (Jan. 1 – March 31). But moving from Advantage back to Original Medicare + Medigap later in life may require passing underwriting for the Medigap piece. That's a big reason to think carefully about the structure up front, not just one year's premium.

Questions readers in North Idaho are asking

Can I have both a Medigap plan and a Medicare Advantage plan? No. Medigap only works with Original Medicare. If you enroll in Medicare Advantage, a Medigap policy can't be used to pay your Advantage plan's costs.

Do I need a separate drug plan with Medicare Advantage? Usually not. Most Medicare Advantage plans include Part D prescription coverage. With Original Medicare + Medigap, you'd add a stand-alone Part D plan separately.

What if I travel or spend part of the year outside Idaho? Original Medicare travels with you nationwide to any provider that accepts Medicare. Medicare Advantage plans use networks, so out-of-area coverage varies — check each plan's rules for travel and for care outside the service area.

Where can I get help comparing without a sales pitch? Idaho's SHIBA program (the state's SHIP) offers free, unbiased Medicare counseling. You can also call 1-800-MEDICARE or use the Plan Finder at Medicare.gov.

Where to go next

The Annual Enrollment Period runs through December 7, so there's still time to think this through carefully rather than react to a mailer or a TV ad.

For plan-specific details, use the official Plan Finder at Medicare.gov. For personal questions about your situation, call 1-800-MEDICARE (1-800-633-4227), available 24/7, or contact Idaho SHIBA, the state's free Medicare counseling service, for one-on-one help.

The right structure for you depends on your doctors, your prescriptions, your travel habits, and your budget — not on which path sounds simpler in an ad.