Original Medicare only
You have Part A and Part B. Here is what that leaves open.
Parts A and B are real coverage, and for most people they are the bulk of it. What they are not is finished. Original Medicare was built to split the cost of your care with you, and the half it leaves in your name has no ceiling on it.
What Original Medicare leaves in your name
Medicare pays its share of a covered service and hands you yours. On the Part B side of your coverage that share is a percentage, not a flat fee, which means it grows with the size of the bill rather than stopping at a number you were quoted.
Your share of a Part B service, after the annual deductible: 20% of approved amount
The most those shares can add up to in a year: No limit with Original Medicare alone
The second line is the one worth sitting with. A percentage is manageable when there is a number it stops at. Without one, your worst year is not a figure you can look up in advance. It is whatever that year turns out to be.
Where that shows up in practice
A hospital admission: The Part A inpatient deductible is charged per benefit period, not once per calendar year.
A rehab or skilled nursing stay: The first 20 days cost you nothing. From day 21 through day 100 there is a charge for every single day, arriving on top of whatever the hospital stay before it cost.
The prescriptions you take at home: Original Medicare does not cover them at all. That is Part D, and skipping it is not free: going without creditable drug coverage adds a late enrollment penalty of 1 percent for every month you wait, and it is permanent.
The 2026 dollar figures behind all three sit on what Medicare actually costs, and what each part does and does not cover is on Medicare basics.
Your two ways to close it
There are two, and an honest advisor will tell you neither one wins on paper. They solve the same problem from opposite directions, and the right answer depends on how you actually use care, not on which one sounds better.
Add a Medigap policy
Your Part A and Part B stay exactly where they are and a private policy sits behind them. Medicare pays first, then Medigap pays the remaining costs.
- Strongest at
- You keep the whole of Medicare's reach. Any doctor that accepts Medicare, anywhere in the country, with no network to check and no referral to chase.
- What you trade
- A monthly premium to a private insurer, in every month, on top of the Part B premium you already pay and whether you use care that month or not. Drug coverage is not part of it, so a Part D plan stays a separate decision.
Move to a Medicare Advantage plan
A private company approved and paid by Medicare takes over your benefits. Every Medicare Advantage plan sets an annual out-of-pocket maximum for covered in-network care, a protection Original Medicare alone does not have.
- Strongest at
- Many plans carry a $0 monthly premium, though you still pay your Part B premium to the government, and they usually bundle your drug coverage in. Many also include extras such as dental, vision, and hearing.
- What you trade
- These plans replace your Original Medicare, limiting your network and putting your coverage in the control of a private insurance company. And each year, carriers are allowed to change nearly every detail of the plan for the following plan year.
Medigap buys predictability and charges you for it every month. Advantage buys a lower premium and a firm annual cap, and charges you for it in network rules and yearly changes. Which trade you should take is a question about your doctors, your prescriptions and your tolerance for a surprise, which is exactly what a review is for.
Want the full feature by feature grid? Medigap versus Medicare Advantage, side by side. Or read each on its own: how Medigap works and Medicare Advantage, explained honestly.
Not sure whether your Medigap window is still open? One call tells you where you stand.
Why the two doors are not equally open
Waiting is itself a decision, because the two paths do not stay equally available. Medicare Advantage and Part D have enrollment windows that come back around every year. Medigap has one guaranteed window tied to when your Part B started, and once it closes only a handful of protected situations reopen a no-questions door.
After it closes, a Medigap policy is something you apply for rather than something you simply choose.
For some people the honest answer is still to leave things as they are, and an advisor worth talking to will say so. What matters is that it becomes a decision you made on purpose rather than one that made itself while the window closed.
What that means if your window has already passed
It is not automatically a no: Yes, carriers can decline you or exclude a condition based on your health history. Being declined will not affect your current coverage, so you have nothing to lose.
Your state may hand you another window: Some states run rules of their own that let you move between Medigap plans on a schedule instead of a health review. The current rule for every state sits on our by-state pages.
A few federal situations reopen the door: Federal rules protect a few specific circumstances, such as an Advantage plan leaving your area, and those create guaranteed-issue rights to buy certain Medigap plans with no health questions. Whether one applies to you is worth a call rather than a guess.
Advantage does not ask: A Medicare Advantage plan can be joined or switched during an enrollment period with no health questions at all. That asymmetry is the real reason timing matters here.
Deeper dives: does open enrollment apply to Medigap, what underwriting actually asks, and the switching rules in your state.
Questions people ask at this point
Original Medicare generally does not cover routine dental care, eyeglasses, or hearing aids. Many Medicare Advantage plans bundle some dental, vision, and hearing benefits, and standalone policies can add them alongside a Medigap plan. An advisor can show you what is actually available where you live.
Find out what closing the gap would actually cost you
Tell us where you live, the doctors you want to keep, and the prescriptions you take. A licensed advisor will walk both paths against your situation and tell you plainly if staying on Parts A and B alone is still the right call for now.
Two paths, one honest conversation
An advisor will walk both of them with you, including the case for leaving things as they are.
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