Medicare 2026

Medigap Letter Plans and Coverage in Des Plaines

# Original Medicare with a Medigap plan vs. Medicare Advantage: how to think it…

DES PLAINES, Ill. — If you're turning 65 soon, or thinking about switching during this year's enrollment window, you've probably run into the same fork in the road every Medicare shopper faces: stick with Original Medicare and add a Medigap policy, or go with a Medicare Advantage plan instead. They're built very differently, and the choice shapes how you'll see doctors, handle bills, and pay for prescriptions for years to come.

Here's a plain-language walk-through of how the two paths are put together, so you can decide which one fits your life.

Two very different structures

Original Medicare is the federal program itself. Part A covers hospital stays, and Part B covers doctor visits and outpatient care. You can use it with almost any provider in the country that accepts Medicare. It does not include prescription drug coverage, and it has no yearly cap on what you might owe out of pocket. That's why many people pair it with two extra pieces: a stand-alone Part D drug plan, and a Medigap (Medicare Supplement) policy sold by a private insurer that helps pay the deductibles and coinsurance Original Medicare leaves behind.

Medicare Advantage (Part C) is different. It's a private plan, approved by Medicare, that replaces the way you receive your Part A and Part B benefits. Most Advantage plans also bundle in Part D drug coverage and may include extras like dental, vision, or hearing. In exchange, you typically use a network of doctors and hospitals, and you may need referrals or prior approval for certain care. Advantage plans have a yearly out-of-pocket maximum for medical services, which Original Medicare alone does not.

You cannot use a Medigap policy with a Medicare Advantage plan. It's one path or the other.

How costs work on each path

On the Original Medicare + Medigap path, you generally pay the Part B premium, a Medigap premium, and a Part D premium. In return, once your Medigap is in place, most of your medical bills are predictable — the policy fills in a big share of what Medicare doesn't pay.

On the Medicare Advantage path, you still pay the Part B premium, and sometimes an additional plan premium. You'll typically pay copays as you use services, up to the plan's annual out-of-pocket limit for in-network care.

Neither path is automatically cheaper. It depends on how often you use care, which doctors you want to see, and which drugs you take.

The 2027 drug coverage rules that apply to both

Whether your drug coverage comes through a stand-alone Part D plan or is built into a Medicare Advantage plan, the same federal rules apply in 2027:

• Your out-of-pocket spending on covered drugs is capped at $2,100 in 2026 ($2,400 in 2027) for the year.
• The Part D deductible cannot be more than $615 in 2026 ($700 in 2027).
• The old "donut hole" coverage gap is gone — Part D now has three simpler phases.
• You can opt into the Medicare Prescription Payment Plan, which spreads your drug costs into level monthly payments instead of one big hit at the pharmacy counter.

Higher earners should also know that IRMAA surcharges on Part B and Part D begin above $109,000 in income for a single filer in 2026.

What's available around Des Plaines

Des Plaines is in Cook County, where residents have a wide range of Medicare Advantage and Part D options to compare, along with the standardized Medigap policies sold in Illinois. Because plan availability is set at the county level, two neighbors on the same block will see the same menu of choices — but the right choice for each of them can look very different.

Rather than shopping by brand name, it usually helps to start with three questions:

1. Which doctors and hospitals do I want to keep? Check whether they take Original Medicare (most do) or are in a specific Advantage plan's network. 2. What prescriptions do I take? Run them through the Plan Finder at Medicare.gov to see how each plan's formulary treats them. 3. How do I feel about predictability vs. flexibility? Medigap trades a steady monthly premium for fewer surprise bills. Advantage trades a lower (or no) extra premium for pay-as-you-go costs and network rules.

The Medigap timing trap most people don't hear about

This is the piece that quietly costs people the most. When you first enroll in 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 the best available rate for your age, regardless of your health history.

After that window closes, in most states — including Illinois — insurers can use medical underwriting. That means if you start on Medicare Advantage and later try to switch to Original Medicare with a Medigap, you may be turned down or charged more based on your health. It doesn't mean you can never switch. It just means the door is easier to walk through in one direction than the other.

Key dates to keep on the fridge

• Oct. 15 – Dec. 7: Medicare Annual Enrollment Period. You can join, drop, or change a Medicare Advantage or Part D plan for 2027.
• Jan. 1 – Mar. 31: Medicare Advantage Open Enrollment Period. If you're already in an Advantage plan, you get one chance to switch to a different Advantage plan or return to Original Medicare (and pick up a Part D plan).