Medicare 2026

Grand Rapids Medicare: how the two coverage paths are built

GRAND RAPIDS, Mich. — If you are weighing Original Medicare with a Medigap policy against a Medicare Advantage plan, the calendar matters almost as much as the coverage itself. The two paths are built differently, and the enrollment windows that govern them do not line up. Miss the wrong date, and your options can narrow for years.

Here in Kent County, where Grand Rapids sits, the choice between these two structures is one many people revisit each fall. This guide focuses on the timing side of that decision — when the doors open, when they close, and what happens if you walk through the wrong one.

The two structures, in one minute

Original Medicare is the federal program: Part A (hospital) and Part B (doctor and outpatient). You can add a stand-alone Part D drug plan and a Medigap policy, which is private insurance that helps pay the out-of-pocket costs Original Medicare leaves behind.

Medicare Advantage (Part C) is different. A private plan, approved by Medicare, delivers your Part A and Part B benefits — usually with drug coverage built in — often through a network of doctors and hospitals. You cannot use a Medigap policy with a Medicare Advantage plan.

That structural fork is why the enrollment dates matter so much: the rules for getting into (and out of) each side are not the same.

The one Medigap window you should not miss

The single most important date for anyone leaning toward Original Medicare plus Medigap is the start of your Medigap Open Enrollment Period. It begins the month you are 65 and enrolled in Part B, and it lasts six months.

During that window, insurers in Michigan must sell you any Medigap policy they offer at their standard price. They cannot turn you down or charge more because of your health history.

After those six months end, that protection generally goes away. You can still apply for a Medigap plan later, but in most cases the insurer can use medical underwriting — reviewing your health — and can decline you or charge more. This is the piece that catches people off guard, especially those who try Medicare Advantage first and later want to switch back to Original Medicare with a Medigap.

There are limited "guaranteed issue" situations (for example, if a plan leaves your area), but they are exceptions, not the rule. Full details are on medicare.gov.

The fall window: Oct. 15 – Dec. 7

The Annual Enrollment Period (AEP) runs from Oct. 15 through Dec. 7 every year. During AEP you can:

• Join, switch, or drop a Medicare Advantage plan.
• Join, switch, or drop a Part D drug plan.
• Move from Medicare Advantage back to Original Medicare (and pick up a Part D plan).

Changes made during AEP take effect Jan. 1. AEP does not guarantee you a Medigap policy — that is a separate process governed by the underwriting rules above.

If you are happy with your current setup, you do not have to do anything. But AEP is the right time to check that your drug list, doctors, and pharmacy still fit whatever plan you are in.

The early-year window: Jan. 1 – March 31

The Medicare Advantage Open Enrollment Period runs Jan. 1 through March 31. It is narrower than AEP and applies only if you are already in a Medicare Advantage plan. During this window you can:

• Switch to a different Medicare Advantage plan, or
• Drop your Medicare Advantage plan and return to Original Medicare (and add a Part D plan).

Again — returning to Original Medicare here does not by itself guarantee you a Medigap policy. If you are past your original six-month Medigap window, insurers in most cases can still underwrite. This is why the "I'll just try Advantage and switch later" plan can go sideways.

What changes for 2027

A few program-level facts to keep in mind as you compare:

• Part D out-of-pocket spending is capped at $2,100 in 2026.
• The Part D deductible cannot be higher than $615 in 2026 ($700 in 2027).
• The coverage gap (the old "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 payments instead of paying at the pharmacy counter.
• IRMAA surcharges on Part B and Part D begin above $109,000 in income for a single filer (2026).

These apply whether you go with Original Medicare plus a stand-alone Part D plan, or a Medicare Advantage plan that includes drug coverage.

What's available around Grand Rapids

Grand Rapids is in Kent County, where CMS sets Medicare Advantage and Part D plan availability. The specific number of plans and carriers changes each year. To see the current lineup for your ZIP code, use the Plan Finder at medicare.gov or call 1-800-MEDICARE.