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Medicare Advantage vs Medigap
Your premiums, your health year — the annual-cost verdict for 2026.
X VS Y COMPARISON · HEALTH · MEDICARE
Medicare Advantage vs Medigap: Which Wins?
Same Medicare, two very different bills. At the defaults — Plan G at $200/mo plus a $40/mo Part D plan against a $14/mo Advantage plan in a typical health year — Medigap costs $5,597.80 a year all-in while Advantage costs $4,102.80: Advantage wins by $1,495.00. But change one input — a bad health year that hits the $9,250 in-network cap — and the verdict flips: Medigap wins by $6,255.00. That flip is the whole decision. Below: the 2026 premiums that drive it, the worked example line by line, and the switching trap that makes this a one-way door in most states.
How the two paths price a year
Everyone pays the $202.90/mo Part B premium on both paths — that $2,434.80 a year is the floor, not the decision. The decision is what you stack on top:
| Side | Annual math (defaults) |
|---|---|
| Original Medicare + Medigap Plan G + Part D | ($202.90 + $200 + $40) × 12 + $283 deductible = $5,597.80 |
| Medicare Advantage (typical year) | ($202.90 + $14) × 12 + $1,500 cost-sharing = $4,102.80 |
Plan G covers everything except the $283 Part B deductible — the hospital deductible, the 20% coinsurance, the skilled-nursing coinsurance, all of it. So the Medigap total barely moves when you get sick: it is $5,597.80 in a healthy year and $5,597.80 in a terrible one. Advantage is the mirror image: cheap to hold ($2,602.80 in premiums), expensive to use — every copay and coinsurance counts up to the $9,250 in-network cap, which is where a bad year lands at $11,852.80.
The worked example: $1,495.00, line by line
Plan G $200/mo, Part D $40/mo, Advantage $14/mo, typical health year ($1,500 of MA cost-sharing):
Medigap path: $202.90 + $200 + $40 = $442.90/mo × 12 = $5,314.80 in premiums, plus the one bill Plan G does not cover — the $283 Part B deductible — for $5,597.80 all-in. Doctor visits, specialists, hospital stays: $0 at the point of care after January.
Advantage path: $202.90 + $14 = $216.90/mo × 12 = $2,602.80 in premiums, plus $1,500 of copays and coinsurance (a few specialist visits, some labs, an ER trip) for $4,102.80. Advantage wins by $1,495.00 — the premium savings minus the cost-sharing.
The flip: make it a bad year — surgery, a hospital stay, months of specialists — and the MA cost-sharing runs to the $9,250 cap: $2,602.80 + $9,250 = $11,852.80, while the Medigap side sits unchanged at $5,597.80. Medigap wins by $6,255.00. Same premiums, different year, opposite verdict — which is why this decision is really about how much uncertainty you want to buy off.
Output · formula · meaning
| Output | Formula | What it means |
|---|---|---|
| Medigap annual total | ($202.90 + Plan G + Part D) × 12 + $283 | $5,597.80 at the defaults — nearly immune to bad years. |
| Advantage annual total | ($202.90 + MA premium) × 12 + cost-sharing (capped at $9,250) | $4,102.80 at the defaults — cheap years cheap, bad years brutal. |
| The gap | | Medigap total − Advantage total | | $1,495.00 at the defaults — Advantage ahead in a typical year. |
Who uses this
- Turning-65 planners: the one decision where the first choice can be permanent — run it before the 6-month Medigap open enrollment closes.
- Open-enrollment switchers (Oct 15–Dec 7): weighing a $0-premium Advantage plan against Plan G — check the underwriting trap first.
- Adult children helping parents: the healthy-year math seduces everyone; the bad-year row is the one that matters.
- Advisors & educators: the one-way-door framing is the detail clients miss — cite it with the block below.
Accuracy & limitations
Uses 2026 national figures (CMS, Nov 2025): Part B $202.90/mo, $283 deductible, $9,250 MA in-network cap. Medigap premiums are illustrative — real Plan G prices run roughly $150–$300+/mo by age, ZIP, and insurer, and some states rate very differently. The MA cost-sharing input is your estimate; plans vary in copay schedules, and the cap covers in-network medical cost-sharing only (drugs have their own $2,100 cap; out-of-network care can exceed it). Ignores IRMAA (high earners pay more Part B on both paths), dental/vision/hearing extras, and quality-of-network differences no calculator can price. Not insurance advice — confirm with your State Health Insurance Assistance Program (SHIP), which is free.
Cite this calculatorBright Side Kit. “Medicare Advantage vs Medigap: Which Wins?.” brightoolbox.com, 2026.
Bright Side Kit. "Medicare Advantage vs Medigap: Which Wins?." https://brightoolbox.com/medicare-advantage-vs-medigap/ Accessed October 23, 2026.Frequently asked questions
Can I switch from Medicare Advantage back to Medigap later?
Sometimes — but in most states it is the trap door of this whole decision. Outside your first 6 months with Part B (the Medigap open enrollment) or your 12-month trial right (your first year on Advantage), insurers can use medical underwriting: they may deny you or charge more for heart disease, diabetes, cancer history, or arthritis. The exceptions: Connecticut, New York, Massachusetts, and Maine offer year-round or annual guaranteed-issue windows, and several states (CA, OR, WA, NV, ID, IL, KY, LA) have birthday rules for switching Medigap plans. Treat the age-65 choice as semi-permanent unless you live in one of those states.
What does Medigap Plan G actually cover?
Plan G is the most popular Medigap plan for new enrollees: it covers everything Original Medicare leaves behind except the $283 annual Part B deductible — the $1,736 Part A hospital deductible, the 20% Part B coinsurance (uncapped without it), skilled-nursing coinsurance, foreign-travel emergency care, all covered. Plan F (which also covered the Part B deductible) has been closed to new enrollees since January 2020; Plan G is its successor. Typical premiums run $150–$300+/mo depending on age, ZIP, and insurer.
Is the $9,250 Advantage cap really my worst case?
Almost. It caps your in-network medical deductibles, copays, and coinsurance — once you hit it, the plan pays 100% of covered in-network care for the rest of the year. What it does not cap: prescription drugs (separate $2,100 annual cap in 2026), out-of-network care (PPOs cap that separately, often much higher), and anything the plan does not cover. The median plan’s cap is actually around $5,900 — $9,250 is the legal maximum, and some plans set it lower.
Why is Medigap so expensive every month?
Because the insurer is absorbing the risk you are not: Original Medicare’s 20% coinsurance has no cap, so one bad year can mean tens of thousands in bills. Plan G’s premium — the calculator defaults to $200/mo — is the price of converting that open-ended risk into a fixed $283/yr exposure. Insurers price by age and ZIP (attained-age, issue-age, or community rating by state), which is why quotes vary so much.
Do I still pay the Part B premium with Medicare Advantage?
Yes — always. The $202.90/mo Part B premium is the floor under both paths: Medigap or Advantage, you pay it (it is usually deducted from your Social Security check). High earners pay more through IRMAA — up to $689.90/mo — on both paths too. Anyone quoting you a $0 Advantage plan means $0 on top of Part B, not $0 total.
What about prescription drugs on each path?
Most Advantage plans bundle Part D drug coverage (MAPD) — that is part of the premium bargain. Medigap pairs with a standalone Part D plan (the calculator defaults to $40/mo), and since 2025 the Inflation Reduction Act caps annual drug out-of-pocket at $2,100 on both paths. Price the Part D plan separately when you shop Medigap — it is a second premium people forget.
When can I change my Medicare coverage?
The fall open enrollment (October 15 – December 7) lets you switch between Advantage plans or return to Original Medicare for the next year. There is also a Medicare Advantage open enrollment (January 1 – March 31) for people already on Advantage to switch plans or drop back to Original Medicare. But remember the trap: leaving Advantage for Original Medicare is easy — getting a Medigap policy afterward usually requires passing underwriting outside a guaranteed-issue window.