Medicare Open Enrollment 2026: What One Fort Worth Family Learned Choosing Between Medigap and Medicare Advantage
The short answer
For most people in the Fort Worth area, Original Medicare paired with a Medigap plan and a Part D drug plan runs about $390–$460 a month but gives you nationwide access to any provider who accepts Medicare — including specialty centers like MD Anderson and UT Southwestern, with no referrals or prior authorization. Medicare Advantage plans often have a lower monthly premium, around $203–$217 a month — but that premium is only part of the picture. Once you actually use your benefits, copays and cost-sharing add up fast, and for anyone with more than occasional care needs, the total annual cost can catch up to — or pass — the Medigap route. Access to specific doctors and hospitals also depends on that plan’s network. These are 2026 estimates for the Fort Worth area — premiums, networks, and rules reset every year, so confirm current numbers before you decide.
Why Does a Physical Therapy Practice Care About Your Medicare Enrollment Choices?
It's a fair question — insurance decisions don't usually come up in a PT clinic. But we see the downstream effects of coverage choices every day: patients who can't get imaging approved, who hit a copay wall mid-treatment, or who simply didn't know what they'd signed up for until they needed it. And for us, it's personal too.
Twelve years ago, our founder, Denny Curnyn, was diagnosed with stage 4 colon cancer. At the time, only a handful of specialists in the country had real success treating it — and the team at MD Anderson in Houston was one of them. Because of the coverage he had, our family could choose to go there without asking permission first. Denny is still here today, and we don't take that for granted.
That experience changed how we think about insurance — for our own family, and for the coverage we choose for our employees here at the clinic. We won't select a plan for our team that isn't accepted at both MD Anderson and UT Southwestern, because we've seen firsthand what access to the right specialist can mean. So when Medicare Open Enrollment comes around each fall, we want our patients, friends, and neighbors in Fort Worth to walk in with the same kind of clarity — before a health scare forces the question.
Medigap vs. Medicare Advantage: The Basic Difference
Original Medicare covers roughly 80% of most outpatient and hospital costs. You choose how to cover the rest, and there are two paths.
A Medigap (Medicare Supplement) plan works alongside Original Medicare and pays those remaining gaps directly. You can see any provider nationwide who accepts Medicare, with no referral required.
A Medicare Advantage plan replaces Original Medicare with a private insurer's network and cost-sharing rules. Premiums are often lower, sometimes $0, but access to a specific hospital or specialist depends entirely on whether that plan has a contract with them — and those contracts can change year to year.
Where “Cheaper” Can Cost More
A 6-day hospital stay: with Medigap Plan G, that's typically $0 out-of-pocket after your premium. With a Medicare Advantage plan charging a per-day copay of around $440, six days can run up to $2,640 in copays alone.
Twelve weeks of chemotherapy or radiation: Medigap covers it at $0 once your Part B deductible is met. Advantage plans often charge a $25–$60 copay per visit — $300 to $720 over the course of treatment, plus any imaging or facility fees.
A genuinely bad year: with Medigap, your exposure is capped at your premiums plus the one-time $283 Part B deductible. With Medicare Advantage, you're exposed up to that plan's annual out-of-pocket maximum — averaging around $5,200–$6,100 for in-network care on Tarrant County plans in 2026, though it can run as high as the federal cap of $9,250.
These are 2026 examples specific to Tarrant County plans, not quotes — the point is how much the math can shift, not the exact numbers. Confirm actual costs for any plan you're considering before you enroll.
| Light year (routine visits only) | Heavy year (surgery, hospital stay, ongoing treatment) | |
|---|---|---|
| Original Medicare + Medigap Plan G + Part D | ~$4,900–$5,800/year — barely changes whether you use it or not |
~$4,900–$5,800/year — capped; Medigap absorbs nearly all the cost-sharing |
|
Medicare Advantage |
~$2,400–$2,600/year — low premium, minimal copays |
Up to ~$11,700–$11,900/year — premium plus hitting the plan's out-of-pocket max, which runs $5,200–$6,100 on average for Tarrant County plans and as high as the federal cap of $9,250 |
These are 2026 estimates for Tarrant County plans, meant to show how the math can shift — not a quote for any specific plan. Premiums, benefit designs, and out-of-pocket limits are set annually by CMS and individual carriers, and can change due to new legislation. Confirm current numbers for any plan you're considering before you enroll.
Questions to Ask Before You Enroll
Is my doctor, specialist, or hospital in-network — and will it still be next year?
Does this plan require prior authorization for tests, procedures, or hospital stays?
What's the annual out-of-pocket maximum, and could I actually afford it in a bad year?
If I travel, or a loved one lives out of state, am I covered there?
Is prescription drug coverage included, or will I need a separate Part D plan — and are my specific medications covered either way?
Do I need a referral to see a specialist?
Do Your Own Homework Before You Enroll
One thing we can't stress enough: verify everything for yourself before you sign anything. Premiums, network contracts, and coverage rules reset every year — sometimes mid-year — so what was true for a neighbor last enrollment season, or even what's written in this article, may not hold true for you today. Compare current plans at Medicare.gov, call to confirm your specific doctors, hospitals, and medications are covered, and talk with a licensed Medicare agent before you decide.
We're Here to Help You Navigate It
One of the ways we support our community and help our patients and their families live healthy, active lives is by helping them navigate the insurance side of care — because we've seen how daunting it can be, and we've lived what happens when the coverage isn't there for the moment you need it most. Y'all, ask the right questions this enrollment season and choose wisely. Here's to 30 more years of helping Fort Worth stay healthy.
Frequently Asked Questions
When is Medicare Open Enrollment in 2026?
Medicare's Annual Enrollment Period runs October 15 through December 7, 2026. Any changes take effect January 1, 2027.
What's the main difference between Medigap and Medicare Advantage?
Medigap works alongside Original Medicare and pays the gaps it leaves — copays, coinsurance, hospital cost-sharing — at any provider nationwide who accepts Medicare. Medicare Advantage replaces Original Medicare with a private plan that has its own network and often requires referrals, prior authorization, and copays.
Can Medicare Advantage patients see any specialist?
Not automatically. Access depends on whether that specific plan has a contract with the hospital or specialist, and those contracts can change from year to year.
Does Medigap cost more every month?
Usually, yes. In the Fort Worth area, Original Medicare plus a Medigap Plan G and Part D drug plan typically runs about $390–$460 a month, versus roughly $203–$217 a month for a Medicare Advantage plan. Medigap's higher premium buys predictable costs; Advantage's lower premium shifts more cost to the moment you actually need care.
How can Curnyn Physical Therapy help me choose?
We're not licensed insurance agents, but after 30 years in Fort Worth — and choosing coverage for our own team — we can share what we've learned and point you toward trusted, licensed help to compare your options.
This article is for general education only and isn't personalized insurance advice. Plan availability, networks, and costs change every year — before you enroll, confirm details with a licensed Medicare insurance agent .