Medicare vs Medicare Advantage Calculator
Compare Original Medicare (Parts A+B) with Medicare Advantage plans. Factor in premiums, copays, drug coverage, and total annual costs.
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This calculator is for informational and educational purposes only. Results are estimates based on the information you provide and standard financial formulas. This is not financial advice. Consult a qualified financial advisor for decisions specific to your situation. Full Disclaimer
Advanced Medicare Comparison Analysis 2026 CMS
⌄Personalized Medicare cost analysis appears after you Calculate
The Core Trade-Off — Original Medicare + Medigap vs Medicare Advantage
Once you turn 65, you face a fork in the road. Original Medicare + Medigap gives you maximum provider choice, predictable costs, and works anywhere — but costs more in monthly premiums. Medicare Advantage (Part C) offers low or zero premiums and extra benefits like dental and vision, but limits you to network providers. The right choice depends on your health status, finances, and travel needs.
| Feature | Original Medicare + Medigap Plan G | Medicare Advantage (HMO/PPO) |
|---|---|---|
| Part B premium 2026 | $202.90/mo (everyone pays) | $202.90/mo (you still pay this) |
| Plan premium | $120-$300/mo Medigap (Plan G avg ~$170) | $0-$80/mo (many $0) |
| Part D drug premium | $30-$100/mo (separate) | Often included ($0-$40 add-on) |
| Provider network | Any provider that accepts Medicare | HMO: in-network only. PPO: in-network preferred |
| Travel coverage | Anywhere in US (some Medigap = international) | Limited to plan service area |
| Annual out-of-pocket max | ~$226 deductible (Plan G covers rest) | $9,350 in-network (2026 federal cap) |
| Referrals required? | No | HMO: yes. PPO: usually no |
| Prior authorization? | Rare | Common — can delay or deny care |
| Extra benefits (dental/vision/hearing/gym) | NOT included (buy separately) | Often included |
| Switching back if you don't like it | — | Annual Open Enrollment Oct 15-Dec 7 |
2026 premiums per CMS final notice (Nov 14, 2025). Medigap state-specific guaranteed-issue protections per Medicare.gov.
IRMAA — The Income Surcharge That Catches High Earners
IRMAA (Income-Related Monthly Adjustment Amount) is a Medicare surcharge based on your income from 2 years prior. For 2026, it's based on your 2024 tax return. If your 2024 MAGI exceeded $109K (single) or $218K (joint), expect a Part B premium increase of $81 to $487 per month per person — up to $6,936/year for high-income couples.
| 2024 MAGI Single / Joint | 2026 Part B Premium (per person) | 2026 Part D Surcharge |
|---|---|---|
| ≤ $109K / ≤ $218K | $202.90 (standard) | $0 |
| $109K-$137K / $218K-$274K | $284.10 (+$81.20) | +$14.50/mo |
| $137K-$171K / $274K-$342K | $405.80 (+$202.90) | +$37.50/mo |
| $171K-$205K / $342K-$410K | $527.50 (+$324.60) | +$60.50/mo |
| $205K-$500K / $410K-$750K | $649.20 (+$446.30) | +$83.40/mo |
| ≥ $500K / ≥ $750K | $689.90 (+$487.00) | +$91.00/mo |
SSA-44 — The IRMAA appeal most retirees miss
If a "life-changing event" caused your income to drop since 2024 — retirement, death of spouse, divorce, or work reduction — file Form SSA-44 to use more recent income. The approval rate for legitimate appeals is high, yet many retirees never file because they don't know it exists. If you retired in 2025 and IRMAA based on 2024 wages is hitting you in 2026, an SSA-44 with 2025 income documentation can eliminate or reduce the surcharge.
2026 IRMAA tiers per CMS. SSA-44 appeal form available at SSA.gov. MAGI calculation per IRC §1395r(i)(4): AGI + tax-exempt interest + excluded foreign earned income.
Medigap Plan Letters Decoded — Plan G vs Plan N vs High-Deductible G
Medigap plans are standardized by federal law into letters (A, B, C, D, F, G, K, L, M, N). Plan G is the most popular comprehensive plan for new Medicare enrollees in 2026 — it covers everything except the small Part B deductible. Plan F (which covers everything) is no longer available to new enrollees as of 2020.
| Plan | 2026 Premium (avg, age 65) | What You Still Pay | Best For |
|---|---|---|---|
| Plan G (most popular) | $130-$220/mo | $283 Part B deductible/yr | Predictable costs, comprehensive coverage |
| Plan N | $100-$170/mo | $283 deductible + $20 office copay + $50 ER copay | Lower premium, accept small copays |
| High-Deductible Plan G | $30-$60/mo | Up to $2,870 (2026) before benefits start | Healthy retirees, "catastrophic-only" coverage |
| Plan K | $60-$100/mo | 50% cost-share until $7,220 OOP cap | Cost-conscious, willing to risk OOP |
| Plan L | $80-$130/mo | 25% cost-share until $3,610 OOP cap | Middle-ground OOP coverage |
| Plan F | $160-$260/mo | $0 — covers everything | Pre-2020 enrollees only (closed to new) |
- Plan G: ~$50/mo more in premium, but no copays at doctor visits
- Plan N: ~$50/mo less premium, but $20 per office visit and $50 per ER visit
- Math: If you visit doctor 30+ times/year, Plan G saves money. Under 25 visits/year, Plan N typically saves money.
- Plan N caveat: Doesn't cover Part B "excess charges" — providers who don't accept Medicare assignment can charge up to 15% more. In states like NY, MA, MN, PA, and a few others, excess charges are banned anyway.
High-Deductible Plan G — the underrated option
High-Deductible G charges roughly $35-50/month — among the lowest premium Medigap options. You pay up to $2,870 in 2026 before Plan G benefits kick in. Effectively a "catastrophic only" Medigap: works well if you're healthy and want guaranteed-renewable coverage at low cost, with protection against major medical events. Combine with a $0 MA-style philosophy (lower premiums, accept some risk) but keep the freedom of Original Medicare provider choice.
Plan letters standardized per Medicare Improvement Patient and Provider Act of 2008 (MIPPA). Plan F closed to new enrollees as of Jan 1, 2020 per MACRA §401. Premium ranges vary significantly by state, age, gender, smoker status, and underwriting; always quote 5+ carriers.
Medicare Advantage — The "Free" Plans That Aren't Always Free
Medicare Advantage plans advertise "$0 premium" — and roughly 60% of MA plans do have $0 plan premium. But that doesn't mean Medicare is free. You still pay Part B ($202.90/mo in 2026) plus IRMAA if applicable. And the "free" plans rely on copays, coinsurance, and prior authorizations to control costs that Original Medicare + Medigap would simply pay outright.
| "Hidden" MA Cost | What It Looks Like in Practice | Annual Impact (typical) |
|---|---|---|
| Network restrictions | Specialist out-of-network = full cost or denied | $0-$10K+ if you need specific specialist |
| Prior authorization | 15% of MA prior auths denied initially (KFF 2024 study) | Care delays, sometimes weeks-to-months |
| Copays per service | $10-50 PCP, $40-80 specialist, $200-500 hospital/day | $1,000-$5,000/year for active users |
| Coinsurance for major care | 20% of Medicare-approved amount (chemo, cardiac care, etc.) | Up to MA OOP max of $9,350 in-network |
| Annual OOP max | $9,350 in-network (2026 federal cap) | Up to this if you have a serious illness year |
| Part D under "$0 plans" | Often has formulary restrictions, tier pricing | $200-$2,000/year depending on drugs |
When Medicare Advantage is genuinely the better choice
- Healthy retirees with limited budget — saves $150-$250/mo on premiums; OOP max protects against worst case
- Strong local network — if your trusted providers are all in the MA network
- Want "all-in-one" simplicity — one card, one bill, includes Part D and often dental/vision
- Subsidized through Medicaid (Dual-Eligible Special Needs Plans) — these MA plans are often free or near-free for low-income retirees
- Limited geographic mobility — if you stay in your service area year-round
MA prior authorization data per KFF 2024 analysis of CMS data. 2026 MA OOP cap per CMS final rule. ~52% of Medicare beneficiaries chose MA in 2025 per CMS enrollment data.
Decision Framework — Which One Fits Your Situation
No universal answer. The right Medicare path depends on your health, finances, providers, and travel patterns. Here's a structured framework based on your top 2-3 priorities.
Choose Original + Medigap if... →
You travel extensively (snowbirds, cross-country family). You have specialists at major academic centers (Mayo, Cleveland Clinic, MD Anderson). You expect significant healthcare needs (chronic conditions, family longevity, current diagnosis). You can afford $150-$250/mo more in premiums. You want zero prior-authorization friction.
Choose Medicare Advantage if... $
You're healthy with no chronic conditions and want to minimize current spending. Your local doctors are in the MA network. You stay in one geographic area year-round. You value extra benefits (dental/vision/hearing/gym/transportation/groceries). You're on Medicaid or qualify for Special Needs Plan (D-SNP/C-SNP).
Consider High-Deductible G if... $$
You want lower premium ($30-50/mo) AND keep Original Medicare's flexibility. You're healthy and willing to risk up to $2,870/year. You want guaranteed-renewable Medigap protection in case health changes.
The annual review you must do every fall
Medicare Open Enrollment runs October 15 - December 7 each year. During this window, you can switch between Original Medicare ↔ MA, change MA plans, change Part D plans, or add/drop drug coverage. Plans change every year — formularies update, providers leave networks, premiums shift. Reviewing your plan each fall is the single most important Medicare task. The 5-Star Special Enrollment Period also lets you switch to a 5-star MA or Part D plan once per year between Dec 8 - Nov 30.
Late enrollment penalties per Medicare Modernization Act 2003. SEP rules per CFR §422.62. Open Enrollment Period per Medicare.gov. Medicare Advantage Open Enrollment Period (MAOEP) Jan 1 - Mar 31 also allows MA-to-MA switching.
Continue your Medicare planning
Things to Know
Essential concepts for understanding your results
Original vs AdvantageWhat is the difference between Original Medicare and Medicare Advantage?
Original Medicare (Parts A+B): government-run, accepted by 99% of providers, no network restrictions. You pay 20% coinsurance with no out-of-pocket maximum (unless you buy supplemental Medigap). Medicare Advantage (Part C): private insurance replacing Parts A+B. Often includes dental, vision, hearing, and drug coverage. Lower out-of-pocket costs but restricted to plan networks. Advantage plans have out-of-pocket maximums ($3,000-7,500/year) that Original Medicare lacks.
Cost ComparisonWhich option costs less?
Advantage plans often have $0 premiums beyond the standard Part B premium ($174.70/month in 2026). Original Medicare + Medigap supplement costs $200-400/month additional. However, Advantage plans have higher per-service costs (copays, coinsurance) while Medigap covers most or all cost-sharing. For healthy seniors using few services: Advantage is cheaper. For those with chronic conditions needing frequent specialist visits: Original + Medigap provides more predictable costs and broader provider choice.
SwitchingCan you switch between Original and Advantage?
You can switch during the Annual Enrollment Period (Oct 15 - Dec 7) each year. Critical warning: if you switch from Original Medicare back to an Advantage plan after age 65, you may face medical underwriting for Medigap policies if you later want to switch back. Some states guarantee Medigap enrollment regardless, but most do not. This means switching to Advantage and then back to Original could leave you unable to get affordable supplemental coverage — a trap many seniors do not discover until it is too late.
Medicare vs Medicare Advantage Calculator: Compare Your Options
Choosing between Original Medicare (Parts A+B) with a Medigap supplement and Medicare Advantage (Part C) is one of the most important healthcare decisions for retirees. This calculator compares total annual costs, coverage differences, and out-of-pocket risk for each option based on your health status and usage patterns.
Enter your age, health status, prescription needs, and preferred providers above to see a side-by-side comparison of costs and coverage.
Original Medicare + Medigap vs Medicare Advantage
| Feature | Original Medicare + Medigap | Medicare Advantage (Part C) |
|---|---|---|
| Monthly premium | Part B ($185) + Medigap ($120-$300) + Part D ($30-$80) = $335-$565/mo | Part B ($185) + MA plan ($0-$150) = $185-$335/mo |
| Doctor choice | Any doctor accepting Medicare (93% of physicians) | Network only (HMO) or higher cost out-of-network (PPO) |
| Out-of-pocket maximum | None (Medigap G covers most costs) | $3,000-$8,300/year (capped by plan) |
| Referral needed for specialists | No | Often (HMO plans) |
| Extra benefits | None | Dental, vision, hearing, gym, OTC allowance |
| Prescription drugs | Separate Part D plan required | Usually included |
| Works nationwide | Yes | Usually local network only |
| Best for | Frequent travelers, multiple specialists, high healthcare users | Healthy retirees, budget-conscious, value extra benefits |
According to KFF, 54% of Medicare beneficiaries are now enrolled in Medicare Advantage (up from 33% in 2015). However, Original Medicare + Medigap provides more predictable costs for high-use patients because Medigap Plan G covers nearly all out-of-pocket costs after a $257 annual Part B deductible.
Total Annual Cost Comparison
Healthy retiree (few doctor visits, 2-3 prescriptions):
Original Medicare + Medigap G: $4,020-$6,780/year. Medicare Advantage ($0 premium plan): $2,220-$3,500/year. MA saves $1,500-$3,300/year for healthy users.
High-use retiree (specialists, procedures, 5+ prescriptions):
Original + Medigap G: $4,020-$6,780/year (Medigap covers most extra costs). Medicare Advantage: $2,220 + OOP costs up to $5,000-$8,300 = $7,220-$10,500/year. Original Medicare saves $1,000-$4,000/year for high-use patients because Medigap covers what MA charges as copays/coinsurance.
The crossover point: if your annual out-of-pocket medical costs would exceed $3,000-$4,000 under MA, Original Medicare + Medigap is cheaper despite higher premiums. Below $2,000 in OOP costs: MA wins on total cost.
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