Medicare Advantage vs Original Calculator
Compare costs of Medicare Advantage (Part C) versus Original Medicare with Medigap. Find the most cost-effective Medicare option for your needs.
Medicare Advantage vs Original Calculator
Calculator
Adjust values & calculateEnter your values below. Every result is computed in your browser — no data is sent to any server.
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.
What is the maximum out-of-pocket limit and why does it drive the worst-case column?
Every Medicare Advantage plan must set an annual maximum out-of-pocket, or MOOP, that caps what you can be charged in cost sharing for Part A and Part B services in a year; once you reach it the plan pays the rest. Original Medicare on its own has no such ceiling, because the Part B coinsurance keeps applying however large the bill grows. That asymmetry is why the worst-case figures here diverge so sharply, and it is the main reason people pairing Original Medicare with a supplement do so.
How do provider networks and prior authorisation change what I actually pay?
Medicare Advantage plans contract with a defined network inside a service area. An HMO generally covers only in-network care except emergencies and often requires a referral to see a specialist; a PPO covers out-of-network care but at higher cost sharing than Medicare Advantage vs Original Calculator's in-network copays assume. Many plans also require prior authorisation for imaging, elective surgery, skilled nursing stays and some drugs. Original Medicare has no network at all and imposes neither restriction for the great majority of services, though a limited set of items and services do carry prior authorisation; what matters instead is whether a provider accepts assignment, meaning they take the Medicare-approved amount as payment in full, which is worth real money if your specialists are scattered.
Why does the timing of buying Medigap matter so much?
Medigap has a one-time open enrolment window that opens once you are 65 or over and enrolled in Part B, during which insurers must sell you any policy they offer at their standard rate regardless of your health. Outside it, and outside a limited set of guaranteed-issue situations, most states let insurers medically underwrite, so an applicant with a chronic condition can be surcharged or refused. That is what makes a later return from Medicare Advantage to Original Medicare risky. Confirm the current window length and your state's rules before deciding.
Which option suits someone who travels or splits the year between two states?
Original Medicare is accepted by any participating provider anywhere in the country, so a snowbird can see doctors in both locations under the same coverage, and a Medigap policy follows. Medicare Advantage is built around a county-level service area, and routine care obtained outside it is usually treated as out-of-network or not covered at all, with emergency and urgent care the standard exception. Moving out of the service area permanently also creates a special enrolment period. Model the travelling case before assuming the lower Advantage premium wins.
Why does the cheaper option flip between a healthy year and a heavy-utilisation year?
The two designs load cost differently. Original Medicare with a supplement and a drug plan is premium-heavy: you pay a large fixed monthly amount and very little varies with usage. Medicare Advantage is usage-heavy, often with a low or zero plan premium on top of the Part B premium everyone still pays, but copays for every visit, hospital day and test. Below a certain volume of care the Advantage total is lower; above the break-even the copays accumulate toward the MOOP and the fixed-cost route wins.
References
Reviewed for accuracy by Daniel Agrici, Founder & Lead Developer · Editorial policy
Related Calculators
🧮Medicare Premium Calculator
Estimate Medicare Part B and Part D premiums based on income and IRMAA brackets.
🧮Medicare Supplement Cost Calculator
Compare Medigap supplement plan costs from plan type, age, gender, and location.
🧮Medicare Part D Cost Calculator
Estimate Medicare Part D prescription drug plan costs from medications and pharmacy.
🧮Nursing Home Cost Calculator
Estimate nursing home costs from care level, shared vs private room, and state averages.
🧮Funeral Cost Calculator
Estimate funeral costs from service type, casket, burial vs cremation, and location.
🧮Retirement Income Calculator
Calculate total retirement income from Social Security, pension, 401k, and investment withdrawals.
🧮Retirement Relocation Calculator
Compare cost of living in retirement-friendly cities and states with tax implications.
🧮Assisted Living Cost Calculator
Estimate assisted living facility costs from care level, location, and room type.