Dorothy Chen
Most people shopping for Medicare coverage fixate on the monthly premium. I get it. That number shows up first, it’s easy to compare, and a $0 premium Medicare Advantage plan looks like an obvious winner against a Medigap Plan G that might run $140 a month or more. But here’s what I’ve seen trip up seniors over and over again in my two decades of doing this: the premium is almost the worst number to focus on. Total annual cost is what actually matters, and those two plans might end up costing you more or less the same, or wildly different, depending entirely on how much healthcare you use.
Let me walk you through what I actually found when I dug into this comparison recently, because a few things surprised even me.
The premium gap is real, but it’s not the whole story
| Scenario | Medicare Advantage | Medigap Plan G |
|---|---|---|
| Monthly Premium | Often $0 | $100-$200 (varies by state/insurer) |
| Part B Premium | Included | $185/month (separate) |
| Annual Premium Cost | $0 | $1,200-$2,400 |
| Deductible (2026) | Varies by plan | $257 (Part B only) |
| Out-of-Pocket Maximum (2026) | Up to $9,350 (in-network) | Essentially $0 after deductible |
| Copay Per Specialist Visit | Yes (varies) | $0 (after deductible) |
| Hospital Coinsurance | 20% typical | $0 (after deductible) |
| Network Restrictions | Yes | No (any Medicare-accepting provider) |
| Dental/Vision/Hearing | Often included | Not covered |
| Best For | Healthy, low healthcare use | Chronic conditions, frequent care |
| Worst-Case Annual Cost | Up to $11,750+ | $1,200-$2,400 |
Medicare Advantage (MA) plans, sometimes called Medicare Part C, bundle your hospital coverage (Part A), medical coverage (Part B), and usually prescription drugs into a single plan run by a private insurer. Medicare Supplement plans, also called Medigap, work alongside Original Medicare and pay costs that Medicare doesn’t cover, things like deductibles, copays, and coinsurance. They’re completely different structures, which makes comparing them tricky.
Right now, in 2026, many Medicare Advantage plans carry a $0 monthly premium, and some include dental, vision, and hearing benefits that Medigap doesn’t touch. That’s genuinely appealing. Meanwhile, a Medigap Plan G for a 65-year-old woman in a mid-sized city might run anywhere from $100 to $200 a month depending on the insurer and the state. Add the Part B premium (currently $185 a month for most people) and you’re looking at a real monthly outlay that a $0 MA plan doesn’t seem to require.
But here’s where the comparison gets complicated. Medicare Advantage plans have cost-sharing built in. That means copays every time you see a specialist, coinsurance when you’re admitted to a hospital, and an out-of-pocket maximum that can legally be as high as $9,350 for in-network services in 2026 (and higher still if you go out of network). Medigap Plan G, on the other hand, covers almost everything after the Part B deductible ($257 in 2026), meaning your exposure beyond that deductible is essentially zero once you’ve paid your monthly premiums.
So the real question isn’t “which plan has the lower premium?” It’s “what do I expect to spend in total this year, and what’s the worst-case scenario I can afford to absorb?”
Where Medigap wins, and who it wins for
Helpful resource: Withings Body+ Smart Scale with BMI and Body Composition is a top-rated option for this. (As an Amazon Associate this site earns from qualifying purchases.)
I’ll be honest: for people with serious, ongoing health conditions, heart disease, diabetes requiring regular specialist visits, cancer, anything that means frequent hospitalizations or outpatient procedures, a Medigap plan almost always comes out ahead on total cost. The math isn’t even close once you start adding up the per-visit copays and coinsurance on an MA plan.
A reader emailed me last month after her husband had a hip replacement. On a Medicare Advantage plan, they faced a $350 per-day hospital copay for days 1 through 5, plus 20% coinsurance on the surgical facility fees. Their out-of-pocket hit was over $4,000 for a single procedure. On a Medigap Plan G, after the Part B deductible, they would have owed essentially nothing beyond the monthly premiums they’d already paid. Even at $150 a month in Medigap premiums, a year of premiums is $1,800. The protection is clear.
What surprised me when I looked harder at this is how much the annual out-of-pocket maximum on MA plans has drifted upward over the past few years. Plans with $3,400 maximums aren’t gone, but the average is higher now, and many enrollees don’t realize their maximum applies only to in-network costs.
Medigap also gives you something that’s almost impossible to put a dollar value on: freedom. You can see any doctor in the country who accepts Medicare. No network restrictions, no referral requirements for specialists, no prior authorization for most services. For anyone who travels frequently, winters in a different state, or lives in a rural area with limited specialists, that flexibility is a real financial consideration, not just a lifestyle preference. Getting stuck out-of-network on an MA plan in the middle of a health event can be genuinely expensive.
The catch with Medigap is underwriting. If you miss your initial open enrollment window (the six months starting the month you turn 65 and enroll in Part B), insurers in most states can reject you or charge you more based on health history. So the person who “waits to see” and enrolls in a $0 MA plan at 65, then tries to switch to Medigap at 68 with new health conditions, may find themselves stuck. That’s one of the most consequential decisions in Medicare, and it doesn’t get enough attention.
Where Medicare Advantage wins, and who it wins for
Medicare Advantage vs. Medicare Supplements (Which is Better?) · Giardini Medicare on YouTube
Healthy people with limited healthcare needs and genuine financial constraints can do well with Medicare Advantage, and I don’t want to dismiss that.
If your total annual healthcare spending in a typical year is two or three primary care visits, one or two specialists, and a modest prescription regimen, an MA plan’s copays might cost you $600 to $1,200 a year out-of-pocket. Compare that to $1,500 to $2,400 in annual Medigap premiums (depending on your plan and location) plus a drug plan premium, and the MA plan actually is cheaper for you specifically.
The extra benefits matter too. I’ve seen MA plans cover $2,000 a year in dental benefits, gym memberships, and over-the-counter allowances. If you’re actually using those benefits, they have real dollar value that belongs in your total cost comparison.
Where I’d push back on the conventional wisdom is this: people overestimate how predictable their health will be. You can be perfectly healthy at 65 and have a stroke at 68. The $0 premium you saved over three years might not offset one serious hospitalization with MA cost-sharing. I’m not saying that to scare anyone. I’m saying that when you’re comparing these plans, the “worst case” scenario deserves as much attention as the “typical year” scenario.
The network issue also affects costs more than people expect. Prescription drug formularies on MA plans change annually. Your drug might be covered at a low tier in 2026 and shift to a higher tier next year, changing your monthly drug cost meaningfully. With Original Medicare and a standalone Part D drug plan (the setup Medigap users typically have), you have more flexibility to switch drug plans during open enrollment without disrupting your medical coverage.
How to actually compare the numbers
Here’s the process I walk people through, and it’s more useful than any chart.
Start with your own health history. Look at what you actually spent out-of-pocket last year, including copays, specialist visits, hospital stays, procedures, and drugs. If you don’t have records, your Explanation of Benefits (EOB) statements from your current insurer will have everything.
Then, for any MA plan you’re considering, map your actual usage onto that plan’s cost-sharing schedule. If you saw your cardiologist six times last year and the plan charges a $45 specialist copay, that’s $270 right there before anything else. Add hospitalizations, labs, imaging. Then add the drug plan costs for your specific medications using the plan’s formulary, which you can look up on Medicare.gov’s plan finder tool.
For Medigap, the math is simpler: annual premiums plus the Part B deductible (currently $257) is almost always your entire exposure for covered services. Add your standalone Part D premium and drug costs.
Compare your expected typical-year total and your realistic worst-case total for both options. That’s the comparison that matters.
The State Health Insurance Assistance Program (SHIP) offers free, unbiased counseling in every state, and their counselors can sit down with you and run these numbers using your actual medications and doctors. It’s genuinely one of the most underused resources in Medicare. Similarly, AARP’s Medicare resource center has solid comparison tools and plan guides that can help you think through these scenarios if you prefer to research independently first.
One more thing: get quotes from multiple Medigap insurers for the same plan letter. Plan G from one company is identical in benefits to Plan G from another company (that’s federal law), but premiums can vary by 40% or more between insurers for the same person. I’ve seen this catch people off guard.
This article is for informational purposes only. Medicare rules change annually. Always verify current plan details at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227). This site does not sell insurance or recommend specific plans.
Sources
- Withings Body+ Smart Scale with BMI and Body Composition
- The State Health Insurance Assistance Program (SHIP)
- AARP’s Medicare resource center
- Copper Compression Knee Support Sleeve
- OMRON Platinum Blood Pressure Monitor Upper Arm
Disclosure: As an Amazon Associate, we earn a small commission from qualifying purchases at no extra cost to you. We only recommend products that genuinely support the topics covered in this article.
- Medicare For Dummies (~$22), The definitive consumer guide to Medicare, enrollment windows, Part A/B/C/D, and supplement plans.
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Recommended Resources
Disclosure: As an Amazon Associate, we earn a small commission from qualifying purchases at no extra cost to you. We only recommend products that genuinely support the topics covered in this article.
- Medicare For Dummies (~$22), The definitive consumer guide to Medicare, enrollment windows, Part A/B/C/D, and supplement plans.
- Get What’s Yours for Medicare (~$17), Maximize your Medicare benefits and minimize out-of-pocket costs. Covers Part D drug coverage gaps and Medigap in depth.
