Medicare Advantage vs Medicap Cost Calculator
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.
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. On a $0-premium Medicare Advantage plan, Carol's annual costs break down like this: Part B premium ($2,434.80) plus about $500 in copays and drug costs. Total: roughly $2,935 per year. On Original Medicare plus Medigap Plan G plus a Part D plan, Carol would pay: Part B ($2,434.80) plus Medigap G (about $165.85/month = $1,990.20/year) plus Part D (about $38.99/month average = $467.88/year). Total: about $4,893 — or roughly $5,190 when you include the $283 Part B deductible and some small remaining costs.
The MA plan saves Carol about $2,255 per year when she's healthy. 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. On Medicare Advantage, her costs for the year could run $8,000–$10,000 — hospital copays, specialist copays, rehab facility costs, and physical therapy copays add up fast, and many MA plans charge a per-day hospital copay. She could approach or hit the $9,250 MOOP.
If Carol had Medigap Plan G, she'd still pay approximately $5,190 for the year total — no matter how many days she spent in the hospital or how many rehab visits she needed. Plan G covers the Part A hospital deductible ($1,736), the daily hospital coinsurance for days 61–90 ($434/day in 2026), skilled nursing facility coinsurance, and the Part B coinsurance after the $283 deductible. 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. On Medicare Advantage, his copays (specialist visits often run $45–$60 each), drug costs, and lab work might total around $3,000–$3,500 in out-of-pocket spending, putting his annual total at roughly $5,500 (Part B $2,434.80 + OOP $3,000+). On Original Medicare plus Medigap G plus a Part D plan covering his four medications, his total might run about $5,800 per year — slightly higher, but it includes virtually unlimited specialist visits with no copays after the deductible, and he has access to any Medicare-accepting doctor in the country without needing referrals or prior authorizations.
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.
| 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 |
| Decision area | Tool | What it answers |
|---|---|---|
| Enrollment | Initial Enrollment Period Calculator | When your 7-month Medicare eligibility window begins and ends based on your 65th birthday |
| Enrollment | When Should I Sign Up for Medicare? | The best time to enroll based on your work status, other coverage, and age |
| Enrollment | Special Enrollment Period Checker | Whether a life event qualifies you for enrollment outside the standard windows |
| Enrollment | Late Enrollment Penalty Checker | How much extra you'll pay monthly if you missed your enrollment window |
| Enrollment | Part B Penalty Calculator | The exact 10%-per-year premium increase for delayed Part B enrollment |
| Enrollment | Part D Penalty Calculator | The 1%-per-month premium increase for gaps in creditable drug coverage |
| Costs | Cost Scenario Planner | Estimated annual spending across plan types at different health utilization levels |
| Costs | Advantage vs. Medigap Cost Comparison | True cost difference between Medicare Advantage and Original Medicare with Medigap |
| Costs | IRMAA Calculator | Whether your income triggers higher Part B and Part D premiums |
| Costs | Part A Premium Estimator | Your monthly Part A premium based on work history and quarters of coverage |
| Costs | M3P Calculator | How the Medicare Prescription Payment Plan smooths your drug costs into monthly payments |
| Coverage | Doctor & Drug Assessment | Whether your providers and prescriptions are covered by a specific plan |
| Coverage | Part D Shopping Tool | Which Part D plan has the lowest total annual cost for your specific medications |
| Coverage | Travel & Network Risk Assessment | How your coverage works outside your home area and which plan types travel best |
| Employer/COBRA | COBRA vs. Medicare | Why COBRA can trigger permanent Medicare penalties and how costs compare |
| Employer/COBRA | Employer Coverage vs. Medicare | Whether your employer plan or Medicare is primary and when to transition |
| Employer/COBRA | HSA & Medicare Compatibility | How Medicare enrollment affects HSA eligibility and what to do before enrolling |
| Planning | Caregiver Readiness Checklist | Whether you have everything in place to help a loved one with Medicare decisions |
| Planning | Document Gatherer | Which documents you need to have ready before enrolling or changing plans |
| Planning | Medigap Fit Assessment | Whether Medigap or Medicare Advantage is the better fit for how you use healthcare |
| Planning | Medigap Open Enrollment Window | Whether you're inside your one-time guaranteed issue window for Medigap |
| Planning | Medicare Savings Program Eligibility | Whether your income qualifies you for help paying Medicare premiums and cost-sharing |
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Data & Methodology for Research Articles: All provider, facility, quality star ratings, and enrollment data is sourced from primary CMS records (cms.gov), including the December 2025 CPSC Enrollment files and the January 2026 Provider Data Catalog. Calculations for patient-to-provider ratios are performed using indexed clinician and facility data. Everything on restingsycamore.com is for educational purposes and does not constitute an endorsement of any specific plan or provider.
Non-CMS Data Sources: Some specific data was obtained from https://opendata.gov