As the “Silver Tsunami” continues to age into Medicare in 2026, the debate between Medicare Advantage (Part C) and Medicare Supplement (Medigap) has never been more intense. Both options aim to cover the “gaps” in Original Medicare (Part A and B), but they take fundamentally different approaches to your health and your wallet.
Medicare Advantage: The “All-in-One” Solution
Medicare Advantage plans are offered by private companies (like Humana, UnitedHealthcare, and Aetna). They replace your Original Medicare and often bundle in prescription drug coverage (Part D), vision, dental, and even gym memberships.
- The Appeal: Many Advantage plans have $0 monthly premiums. They offer a simplified, one-card experience.
- The Catch: You are generally restricted to a network of doctors (HMO or PPO). You often need “prior authorization” for specialists and expensive procedures. Your out-of-pocket costs can reach $8,000+ per year if you have a major health event.
Medigap: The “Freedom of Choice” Route
Medigap policies are supplemental. You keep your Original Medicare, and the Medigap plan pays for the 20% coinsurance that Medicare leaves behind.
- The Appeal: You can see any doctor in the US who accepts Medicare—no networks, no referrals. Your out-of-pocket costs are extremely low and predictable.
- The Catch: You pay a monthly premium (often $150–$300). You must buy a separate Part D plan for your prescriptions.
Key Changes in the 2026 Medicare Landscape
The “Inflation Reduction Act” of previous years has reached full implementation in 2026. This means:
- Out-of-Pocket Caps: All Part D plans now have a hard $2,000 cap on out-of-pocket drug costs. This has made Medicare Advantage plans even more competitive.
- Network Shrinkage: Some Advantage plans have tightened their networks in 2026 to control costs, making it harder to keep your favorite specialist.
- Increased Medigap Premiums: As healthcare labor costs have risen, Medigap premiums have seen a 5-8% increase in many states.
Who Should Choose What?
- Choose Medicare Advantage if: You are in relatively good health, prefer a low monthly cost, and don’t mind staying within a local network of doctors.
- Choose Medigap if: You travel frequently, have chronic health conditions that require frequent specialist visits, and want the peace of mind of knowing exactly what your medical costs will be each month.
The “One-Time” Window
The most important thing for 2026 retirees to remember is the Medigap Open Enrollment Period. This 6-month window starts when you are both 65 and enrolled in Part B. During this time, companies must sell you a Medigap policy at the best rate, regardless of your health. If you miss this window and choose Medicare Advantage first, you may be locked out of Medigap later if you develop health problems.