Medicare Open Enrollment: Weighing Original Medicare with Medigap vs. Medicare Advantage

The Medicare open enrollment period runs until December 7, offering beneficiaries the opportunity to reassess their coverage for 2026 amid changes in the Medicare Advantage (MA) market, which now features fewer plans and reduced extra benefits. Original Medicare (Parts A and B) remains a viable alternative, especially when paired with a Medicare Supplement (Medigap) plan, which helps cover out-of-pocket costs such as deductibles and copays. Unlike Medicare Advantage, Original Medicare does not restrict beneficiaries to specific provider networks, allowing broader access to hospitals and doctors nationwide without frequent prior authorization requirements. Original Medicare, however, lacks an annual out-of-pocket spending cap, making Medigap plans an attractive option for predictable healthcare expenses. Medigap is offered by private insurers and typically covers various cost-sharing elements, improving financial predictability for enrollees who prefer to avoid network restrictions or require consistent budgeting due to chronic conditions or travel needs. Importantly, Medigap plans do not provide additional benefits like vision or dental or include prescription drug coverage, which necessitates separate Part D enrollment. Transitioning from Medicare Advantage to Original Medicare with Medigap requires careful timing due to underwriting rules and eligibility windows. Beneficiaries who enroll in Medicare at age 65 have a six-month guaranteed-issue period for Medigap without medical underwriting. Additionally, individuals leaving an MA plan within the first year or experiencing plan cancellations may qualify for a special enrollment period ensuring access to Medigap without denial based on health status. This is particularly relevant during market exits by some MA insurers, which could be the only opportunity for some high-risk individuals to secure Medigap coverage. Medigap plans have standardized benefits across ten plan types (A through N), simplifying comparison primarily to focus on premium costs and insurer stability. Premiums vary widely by company and location, with discounts potentially available for women, non-smokers, married couples, or for leveraging payment methods such as automatic withdrawals. Analysis of premium rate history and customer service is crucial when selecting a carrier, as plan benefits do not differ by insurer. Choosing between Medicare Advantage and Original Medicare with Medigap hinges on personal healthcare needs, financial considerations, provider preferences, and coverage flexibility. The 2026 open enrollment period demands that beneficiaries weigh these tradeoffs carefully to optimize their healthcare spending and access. Professionals advising clients need to highlight these distinctions, regulatory guidelines, and coverage implications to facilitate informed decision-making.