About the Medigap vs Medicare Advantage Calculator
This Medigap vs Medicare Advantage calculator compares the two main ways to fill Original Medicare’s gaps. On one side is a Medigap Plan G policy plus a stand-alone Part D drug plan, where you pay higher premiums but little at the doctor. On the other is a Medicare Advantage (Part C) plan, often with a low or $0 premium, but with copays and coinsurance up to the plan’s yearly in-network out-of-pocket maximum.
Enter your premiums, an estimate of how much medical care you will use (the Medicare-approved amount of your doctor visits, tests and hospital care) and the share of those costs an Advantage plan would leave to you. The calculator shows the expected cost of each option, the worst-case year if you get seriously ill, and the level of medical use at which the two break even.
Assumptions: both options pay the 2026 standard Part B premium of $202.90 a month; Plan G leaves you only the 2026 Part B deductible of $283; drug costs other than premiums are assumed similar under both and left out; and the Advantage plan is used in network. Advantage plans may add dental, vision or drug benefits that are not valued here, while Medigap lets you see any provider that accepts Medicare.
With the default inputs, the expected yearly savings with medicare advantage is $2,083.00. Change any value above to recalculate instantly.
How to use the medigap vs medicare advantage calculator
- 1Enter the Part B premium (or your IRMAA-adjusted amount).
- 2Enter the Medigap and stand-alone Part D premiums you were quoted.
- 3Enter the Advantage plan’s premium and in-network out-of-pocket maximum.
- 4Estimate your yearly medical use and the share an Advantage plan leaves to you.
- 5Compare expected and worst-case totals, and check the break-even level of use.
Formula and method
Both options start with the Part B premium. The Medigap side adds the Medigap and stand-alone Part D premiums plus the small cost-sharing the policy leaves you — for Plan G, just the yearly Part B deductible. The Advantage side adds its premium plus your copays and coinsurance, estimated as your share of the Medicare-approved cost of services and capped at the plan’s in-network out-of-pocket maximum.
The worst-case year assumes you hit each plan’s limit. The break-even level of medical use is the yearly approved cost at which the Advantage plan’s cost-sharing has grown enough to equal Medigap’s higher fixed premiums; above it Medigap is cheaper, below it Advantage is. Drug cost-sharing is treated as equal under both options.
- B, G, D
- Monthly Part B, Medigap and Part D premiums
- P_MA
- Monthly Medicare Advantage premium
- S, s
- Yearly approved cost of medical services and your MA cost-sharing share
- OOP_G, MOOP
- Medigap yearly cost-sharing and MA out-of-pocket maximum
Worked examples
Plan G at $160 vs a $0-premium Advantage plan
Part B costs $2,434.80 a year either way. Medigap adds $1,920 + $480 of premiums and the $283 deductible: $5,117.80. With $3,000 of care, 20% Advantage cost-sharing is $600, for $3,034.80 — about $2,083 cheaper. In a bad year, though, Advantage reaches $7,434.80, and Medigap wins once care exceeds about $13,415.
Heavy medical year
With $40,000 of care, 20% would be $8,000, but the Advantage plan stops at its $5,000 maximum, so it costs $7,434.80. Medigap still costs $5,117.80, about $2,317 less.
Advantage plan with a premium and lower maximum
Medigap now costs $2,434.80 + $2,400 + $480 + $283 = $5,597.80. The Advantage plan costs $2,434.80 + $600 of premiums + $600 of cost-sharing = $3,634.80, with a worst case of $6,534.80. Medigap becomes cheaper once care exceeds ($5,597.80 − $3,034.80) ÷ 20% = $12,815.
Frequently asked questions
Is Medigap or Medicare Advantage cheaper?+
Medicare Advantage is usually cheaper in years when you are healthy because premiums are low. Medigap usually costs less in years with heavy medical use, because Plan G leaves you only the Part B deductible while Advantage plans charge copays up to their out-of-pocket maximum.
What does Medigap Plan G cover?+
Plan G covers nearly all Original Medicare cost-sharing — Part A deductible and coinsurance, Part B coinsurance and excess charges — except the yearly Part B deductible, which is $283 in 2026.
What is the Medicare Advantage out-of-pocket maximum?+
Every Advantage plan must cap yearly in-network spending on Part A and B services. Each plan sets its own limit below the federal ceiling; it does not include premiums or Part D drug costs, which have their own $2,100 cap in 2026.
Can I switch from Medicare Advantage back to Medigap?+
You can leave Advantage during open enrollment, but outside your initial Medigap open enrollment period or a guaranteed-issue situation, insurers in most states can deny a Medigap policy or charge more based on your health.
Does Medicare Advantage restrict which doctors I can see?+
Most Advantage plans are HMOs or PPOs with provider networks and may require referrals or prior authorization. Medigap works with any doctor or hospital in the US that accepts Medicare.
Results are estimates for educational purposes and are not financial advice. Rates, fees and terms vary — confirm with your lender or a licensed advisor before making decisions.