Medicare Cost Scenario Planner Tool

Key takeaway: Your total Medicare costs depend heavily on how much care you actually use — Original Medicare with Medigap costs about the same every year regardless of your health, while Medicare Advantage can be cheaper when you're healthy but expensive when something serious happens.

What this helps you decide

• Whether to choose Original Medicare (with or without Medigap) or Medicare Advantage based on your expected annual costs
• How much financial risk you're taking on with a low-premium plan versus a more predictable high-premium plan
• What your costs might look like in a worst-case health year — a surgery, a hospital stay, or a serious diagnosis
• Whether the monthly savings from a $0-premium Medicare Advantage plan are worth the potential out-of-pocket exposure

Who this is for

• Someone turning 65 who wants to compare all-in annual costs before picking a plan for the first time
• A current Medicare Advantage enrollee who had a big health event and is wondering whether Medigap would have saved money
• A retired couple trying to budget Medicare costs for the next several years on a fixed income
• Anyone who keeps seeing low advertised premiums and wants to understand what the actual total annual cost could be

Example results

Example 1 — Healthy year, few doctor visits. Say you're 66 and relatively healthy. You see your primary care doctor twice a year and maybe one specialist. If you're on a Medicare Advantage plan with a $0 monthly premium, your annual cost looks like this: Part B premium ($202.90 × 12 = $2,434.80) plus maybe $500 in copays and coinsurance for those visits. Total: around $2,935 for the year. That's pretty reasonable.

If you'd chosen Original Medicare plus Medigap Plan G instead, your total would run about $5,190 per year — that's your Part B premium ($2,434.80) plus Plan G premiums averaging about $165.85/month ($1,990.20/year) plus a Part D drug plan ($38.99/month average base premium = $467.88/year). But your additional out-of-pocket for those same doctor visits? Nearly zero after the $283 Part B deductible. The Medigap route costs more when you're healthy. That's just the tradeoff.

Example 2 — Moderate utilization, some specialists and prescriptions. Now you're seeing a specialist every couple of months, getting regular lab work, and taking two or three medications. On Medicare Advantage, your Part B premium stays the same ($2,434.80/year), but your copays and drug costs are adding up — maybe $2,500 in out-of-pocket costs over the year. Total: roughly $4,935.

On Original Medicare plus Medigap Plan G, your total stays about the same as always: around $5,190 per year. You're paying more in premiums upfront, but Medigap is covering most of your cost-sharing. At this level of utilization, the two options are roughly equivalent in total cost. This is the crossover zone.

Example 3 — High utilization, surgery or hospital stay. This is where the numbers get stark. Say you need knee replacement surgery, spend three days in the hospital, and go through rehab. On Medicare Advantage, your plan's maximum out-of-pocket limit (MOOP) can be as high as $9,250 in-network. Add that to your Part B premium and you could be looking at $11,685 or more for the year.

On Original Medicare plus Medigap Plan G, you still pay approximately $5,190 for the year — and that's it. Plan G covers your hospital coinsurance, skilled nursing coinsurance, and most other cost-sharing after your $283 Part B deductible. One surgery doesn't change your annual total. That predictability is what people are paying for when they choose Medigap.

Sample scenarios

Scenario	Input	Result
Healthy year, $0-premium MA plan	2 PCP visits, 1 specialist, no hospital, no drugs	~$2,935/yr (Part B $2,435 + $500 OOP)
Moderate year, MA plan	6 specialist visits, 3 prescriptions, labs	~$4,935/yr (Part B $2,435 + $2,500 OOP)
Surgery year, MA plan	Inpatient surgery, 3-day hospital, rehab	Up to $11,685/yr (Part B $2,435 + $9,250 MOOP)
Any year, Original Medicare + Medigap G + Part D	Any utilization level	~$5,100–$5,500/yr regardless of health events

What to do next

1. Estimate your typical annual health usage. Look at your last two years of doctor visits, hospital stays, and prescription costs. That pattern is your baseline for projecting Medicare costs.
2. Check whether your doctors take the plan you're considering. With Medicare Advantage, your network matters a lot. Use the plan's provider directory — don't assume your current doctors are included.
3. Compare drug coverage side by side. Use Medicare's Plan Finder tool at medicare.gov to enter your actual medications and see what each plan would cost for your specific drugs.
4. Think about worst-case risk, not just average-case cost. Ask yourself: if you had a major health event this year, could you afford up to $9,250 out of pocket? If not, the higher Medigap premium may be the right call.

Key facts

• The 2026 Medicare Part B premium is $202.90 per month ($2,434.80 per year), and everyone on Medicare pays this regardless of which plan type they choose.
• Medicare Advantage plans can cap your out-of-pocket costs at up to $9,250 per year (in-network) in 2026 — but you could hit that cap if you have a significant health event.
• Medigap Plan G averages about $165.85 per month in 2026 and covers most Medicare cost-sharing after the $283 Part B deductible, making annual costs highly predictable.

Related decisions

• Compare Medicare Advantage vs. Medigap costs side by side
• IRMAA calculator — see if your income raises your Part B or Part D premiums
• Part A premium calculator — find out what you'll pay for hospital coverage
• Medigap fit assessment — is Medigap the right choice for your situation?