Medicare Advantage Vs Original Calculator
Compare costs of Medicare Advantage (Part C) versus Original Medicare with Medigap. Enter values for instant results with step-by-step formulas.
Reviewed for accuracy by Daniel Agrici, Founder & Lead Developer
Medicare Advantage Vs Original Calculator
Calculator
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Formula: Total Annual Cost = (Monthly Premiums x 12) + Deductibles + Copays/Coinsurance + Drug Costs
Additional inputs: Doctor Copay ($), Specialist Copay ($).
Worked example — Medicare Advantage saves $2,860/year for this healthy beneficiary
Formula
Total Annual Cost = (Monthly Premiums x 12) + Deductibles + Copays/Coinsurance + Drug Costs
Each option is calculated by summing all premiums, deductibles, and expected out-of-pocket costs. Medicare Advantage costs are capped at the plan Maximum Out-of-Pocket (MOOP) limit, while Original Medicare with Medigap has predictable costs due to supplemental coverage.
Worked Examples
Example 1: Healthy Retiree Comparison
Problem:A 67-year-old with 8 doctor visits/year, no hospital stays, and $100/month in prescriptions compares Original Medicare + Plan G Medigap ($200/mo) + Part D ($35/mo) vs. a $0-premium MA plan with $25 copays.
Solution:Original Medicare: Premiums = ($174.70 + $200 + $35) x 12 = $4,916.40 Part B deductible = $240 Rx costs = $100 x 12 = $1,200 Total = $6,356.40 Medicare Advantage: Premiums = $174.70 x 12 = $2,096.40 Doctor copays = 8 x $25 = $200 Rx costs = $1,200 Total = $3,496.40
Result:Medicare Advantage saves $2,860/year for this healthy beneficiary
Example 2: High-Utilization Comparison
Problem:A 75-year-old with chronic conditions expects 15 doctor visits, 5 hospital days, and $400/month in prescriptions.
Solution:Original Medicare + Medigap: Premiums = ($174.70 + $250 + $45) x 12 = $5,636.40 Part A deductible = $1,632 Part B deductible = $240 Rx = $4,800 Total = $12,308.40 Medicare Advantage ($8,300 MOOP): Premiums = $174.70 x 12 = $2,096.40 OOP costs capped at $8,300 Total = up to $10,396.40
Result:Original Medicare costs more in premiums but Medigap provides predictable costs
Frequently Asked Questions
What is the difference between Original Medicare and Medicare Advantage?
Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance) provided directly by the federal government. It offers broad provider networks since most doctors accept Medicare, but it has no annual out-of-pocket maximum and covers only about 80% of approved costs after deductibles. Medicare Advantage (Part C) is offered through private insurance companies contracted with Medicare. These plans must cover everything Original Medicare covers but often add extra benefits like dental, vision, hearing, and fitness programs. However, Medicare Advantage plans typically use restricted provider networks (HMO or PPO), require referrals for specialists, and may have prior authorization requirements. The tradeoff is between freedom of choice with Original Medicare and potential cost savings and extra benefits with Medicare Advantage.
What is Medigap and why might I need it with Original Medicare?
Medigap, also known as Medicare Supplement Insurance, is a private insurance policy designed to fill the gaps in Original Medicare coverage. Original Medicare only pays 80% of Part B-approved charges, leaving beneficiaries responsible for 20% coinsurance with no cap on out-of-pocket expenses. A serious illness or extended hospital stay could result in tens of thousands of dollars in costs. Medigap policies cover some or all of these gaps, including the Part A and Part B deductibles, the 20% coinsurance, and excess charges. There are ten standardized Medigap plans labeled A through N, each offering a different level of coverage. Plan G is currently the most popular, covering almost all gaps except the Part B deductible. Medigap premiums typically range from $100 to $300 monthly depending on location and age.
Can I switch between Medicare Advantage and Original Medicare?
Yes, but timing matters significantly. You can switch during specific enrollment periods. The Annual Election Period runs from October 15 to December 7 each year, allowing you to switch from Original Medicare to Medicare Advantage or vice versa. The Medicare Advantage Open Enrollment Period from January 1 to March 31 allows Medicare Advantage enrollees to switch to a different Advantage plan or return to Original Medicare. However, there is a critical caveat regarding Medigap. If you leave Original Medicare for Medicare Advantage and later want to return, you may face medical underwriting for Medigap policies in most states. This means pre-existing conditions could result in higher premiums or denial of coverage, potentially making the switch back financially impractical.
How do prescription drug costs compare between the two options?
With Original Medicare, you must purchase a separate Part D prescription drug plan from a private insurer, adding another monthly premium typically ranging from $15 to $80. Most Medicare Advantage plans include prescription drug coverage (called MA-PD plans) within their plan at no additional premium cost. Both Part D and MA-PD plans use formulary tiers that determine your copay or coinsurance for each medication. The Inflation Reduction Act capped insulin costs at $35 per month for Medicare beneficiaries and introduced a $2,000 annual out-of-pocket cap on Part D drug costs starting in 2025. When comparing plans, always check that your specific medications are covered and at what tier level, as this can dramatically affect your actual annual drug spending.
What extra benefits does Medicare Advantage typically offer?
Medicare Advantage plans frequently offer benefits not covered by Original Medicare, making them attractive to many beneficiaries. Common additional benefits include routine dental care such as cleanings, fillings, and sometimes dentures, routine vision exams and eyewear allowances, hearing exams and hearing aid coverage, Silver Sneakers or similar fitness program memberships, over-the-counter medication allowances of $25 to $200 quarterly, transportation to medical appointments, meal delivery after hospital stays, and telehealth services. Some plans even offer supplemental benefits for the chronically ill, including non-medical transportation, pest control, and home modifications. However, the value of these extras must be weighed against the network restrictions and potential for higher costs during serious medical events.
References
Reviewed for accuracy by Daniel Agrici, Founder & Lead Developer · Editorial policy
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