Medigap vs Medicare Advantage Calculator 2026

How Medigap and Medicare Advantage Differ in 2026

Medigap (Medicare Supplement Insurance) and Medicare Advantage (Part C) are two competing approaches to filling the gaps in Original Medicare (Parts A and B). Medigap, paired with Original Medicare + a standalone Part D drug plan, generally provides broader provider access and predictable out-of-pocket costs but carries higher monthly premiums. Medicare Advantage replaces Original Medicare with a private plan, often at $0 premium, but uses provider networks and copay structures with higher variable out-of-pocket costs (source: medicare.gov).

For 2026, the standard Part B monthly premium is $185 and the annual Part B deductible is $257 per CMS announcements. The Medicare Advantage in-network maximum out-of-pocket (MOOP) is capped at $9,350 for 2026, with an out-of-network combined limit of $14,000 for PPO plans (source: cms.gov). Medigap Plan G — the most popular standardized plan for new enrollees — covers every Original Medicare cost-sharing element except the Part B deductible.

When Medigap (Plan G or N) Wins

Medigap wins when you travel frequently or live in multiple states, see specialists or use academic medical centers outside narrow networks, expect significant hospitalization, value rate stability over the long term, or want to avoid prior-authorization friction common in MA plans. With Plan G, your out-of-pocket exposure for any covered Medicare service is essentially the $257 Part B deductible plus your Part D drug costs — predictable and bounded. Premiums in 2026 run $100-300/month depending on state, age, and underwriting.

The big catch: switching FROM a Medicare Advantage plan back to Medigap later in life requires medical underwriting in most states. Pre-existing conditions can result in denial or rate-up. Four states (CT, MA, NY, ME) and some others guarantee community-rated Medigap year-round, but most states only have the 6-month initial enrollment guarantee plus narrow special situations.

When Medicare Advantage Wins

Medicare Advantage wins when you are healthy with predictable, light utilization, you live in an area with a strong, well-rated MA network, you want extras like dental, vision, hearing, transportation, gym memberships, or OTC allowances bundled in, or you simply cannot afford the $150+ monthly Medigap premium. The "$0 premium" headline is real for most plans, though you still pay the Part B premium ($185 in 2026). Copays for office visits typically run $0-30 primary care and $25-50 specialist, with hospital copays of $200-400/day for the first few days.

The downside: if you have a bad health year — major surgery, cancer treatment, multiple hospital stays — you can hit the $9,350 MOOP. Compare that to Plan G's $257 deductible. For about $1,500-2,500/year extra in Medigap premium, you eliminate the $9,000+ catastrophic exposure. The break-even depends heavily on health.

Star Ratings, Prior Auth, and Network Quality

Not all Medicare Advantage plans are equal. CMS publishes Star Ratings annually — pick a 4+ star plan whenever possible. Watch for plans with reputations for aggressive prior authorization or post-claim denials. The KFF and Commonwealth Fund have documented higher denial and appeal rates in MA than Original Medicare. For most retirees with chronic conditions or complex care needs, Medigap's broader access and lighter administrative burden is worth the premium difference.

For broader Medicare planning, see our Medicare IRMAA calculator for high-income premium surcharges, Plan G cost calculator for premium projections, and Medicaid spend-down calculator for long-term care planning.

Last updated April 2026. Sources: medicare.gov, cms.gov, kff.org.