This tool is for education and planning. It does not replace Medicare.gov, Social Security, SHIP, legal advice, tax advice, or a plan-specific coverage check.
Key takeaway: Medicare Advantage usually costs less when you're healthy, but Original Medicare with Medigap Plan G typically costs less — or the same — once you have significant health needs, and it protects you from large unexpected bills.
What this helps you decide
- Whether the monthly premium savings from Medicare Advantage are worth the financial risk of higher out-of-pocket costs during a serious illness or surgery
- How the all-in annual cost of each option compares at different levels of healthcare use — healthy, moderate, and high
- Which plan structure matches your priorities: predictable fixed costs vs. lower premiums with variable cost-sharing
- What benefits like additional benefits not covered by Original Medicare (often included in MA) are actually worth compared to Medigap's nationwide access and no prior authorization requirements
Who this is for
- Someone new to Medicare who is trying to understand the real financial difference between these two approaches before making an enrollment decision
- A Medicare Advantage enrollee who is in good health now but wants to understand what switching to Medigap would cost — and whether they'll still be able to do so later
- Anyone who has gotten a quote for Medigap and thought the monthly premium seemed high, and wants to see when it actually pays off
- A person with chronic conditions or a family history of major health events who needs to plan for realistic worst-case costs
Example results
Example 1 — Healthy 66-year-old, few health events. Meet Carol. She's 66, takes one medication, sees her doctor twice a year, and feels great. Medicare plan networks, drug coverage, and costs can change each year. Before you enroll, check your doctors, prescriptions, pharmacies, and current plan documents.
Medicare plan networks, drug coverage, and costs can change each year. Before you enroll, check your doctors, prescriptions, pharmacies, and current plan documents. But her MA plan carries a maximum out-of-pocket limit up to $9,250. She's essentially self-insuring for that risk in exchange for the premium savings. That's a reasonable trade-off — as long as she has savings to cover a bad year.
Example 2 — 66-year-old needs knee replacement surgery. Same Carol, one year later. She needs a knee replacement, spends three days in the hospital, and goes through six weeks of rehab. Medicare plan networks, drug coverage, and costs can change each year. Before you enroll, check your doctors, prescriptions, pharmacies, and current plan documents.
Medicare plan networks, drug coverage, and costs can change each year. Before you enroll, check your doctors, prescriptions, pharmacies, and current plan documents. One surgery doesn't change her annual total. In this scenario, the Medigap route saved her $3,000–$5,000 compared to MA.
Example 3 — 70-year-old managing chronic conditions. Robert is 70, takes four medications, and sees two specialists regularly. Medicare plan networks, drug coverage, and costs can change each year. Before you enroll, check your doctors, prescriptions, pharmacies, and current plan documents.
At this level of use, the two options are very close in total cost. What tips the decision for Robert is access and convenience: Medigap gives him any doctor, any hospital, no network restrictions, and no prior authorization delays for specialist visits or procedures.
Sample scenarios
| Scenario | Input | Result |
|---|---|---|
| Healthy year, 66-year-old on MA ($0 premium) | 2 PCP visits, 1 specialist, 1 generic Rx | ~$2,935/yr — saves ~$2,255 vs. Medigap G, but carries $9,250 MOOP risk |
| Knee replacement surgery, MA plan | 3-day hospital stay, surgery, 6 weeks rehab | ~$8,000–$10,000/yr vs. ~$5,190/yr with Medigap G |
| Chronic conditions, 70-year-old, 4 Rx + 2 specialists | Monthly specialist visits, brand + generic drugs | MA ~$5,500/yr vs. Medigap G + Part D ~$5,800/yr — near parity |
| Worst-case year, MA plan hitting MOOP | Major illness, multiple hospitalizations | Up to $11,685/yr (Part B $2,435 + $9,250 MOOP) vs. ~$5,190 with Medigap G |
What to do next
- Get your actual Medigap premium quote. Medicare plan networks, drug coverage, and costs can change each year. Before you enroll, check your doctors, prescriptions, pharmacies, and current plan documents. Rates vary a lot by zip code — get real quotes before making any comparison.
- Check whether your doctors are in the MA network — and what happens if they leave. MA plans use networks, and a doctor who is in-network today may not be next year. If keeping your current doctors matters to you, that's a meaningful factor.
- Understand the Medigap enrollment window. You have a guaranteed right to buy Medigap during your 6-month open enrollment window that starts when you turn 65 and enroll in Part B. After that, insurers can decline you or charge more based on health history in most states. If you're considering Medigap, your timing matters.
- Decide whether you need the extras. Many MA plans include additional benefits not covered by Original Medicare benefits that Medigap doesn't cover. If you'd pay out of pocket for these anyway, factor that into your comparison — these benefits can be worth $500–$2,000/year depending on your needs.
Key facts
- Medicare plan networks, drug coverage, and costs can change each year. Before you enroll, check your doctors, prescriptions, pharmacies, and current plan documents.
- Medicare plan networks, drug coverage, and costs can change each year. Before you enroll, check your doctors, prescriptions, pharmacies, and current plan documents.
- Medicare plan networks, drug coverage, and costs can change each year. Before you enroll, check your doctors, prescriptions, pharmacies, and current plan documents.