Based on readers’ interest, huutri.org has decided to provide a detailed cost breakdown to help retirees clearly understand the potential financial differences between Medicare Advantage and Original Medicare with Medigap. By comparing a typical “normal year” and a “high-cost year,” this breakdown aims to guide retirees in choosing the plan that best fits their medical needs, budget, and long-term peace of mind.
Appendix: Cost Comparison Tables (Numerical)
This is an illustrative example of costs in a normal year and a high-cost medical year, helping retirees visualize the difference between Medicare Advantage and Original Medicare with Medigap.
Note: These are only average estimates. Actual costs may vary by region, plan choice, age, and health status.
Scenario 1: Normal Year (Moderate Medical Use)
Assumptions:
- Several doctor visits, routine lab tests
- One short hospitalization
- Some prescriptions
| Cost Component | Alice (Medicare Advantage) | Bob (Original Medicare + Medigap) |
|---|---|---|
| Part B Premium (monthly) | $185 × 12 = $2,220 | $2,220 |
| MA Plan Premium | $25/month → $300/year | — |
| Medigap Premium | — | ~$150/month → $1,800/year |
| Deductibles / Copays | ~$500–$2,000/year | Very low (most covered by Medigap) |
| Drug Costs | Within 2025 Part D $2,000 cap | Also within $2,000 cap |
Estimated Total:
- Alice (MA): $2,220 + $300 + ~$1,000 = ~$3,520
- Bob (Medigap): $2,220 + $1,800 + ~$300 = ~$4,320
In a low-use year, Medicare Advantage may cost less due to lower monthly premiums.
Scenario 2: High-Cost Year (Cancer Treatment, Multiple Hospital Stays, Surgeries)
Assumptions:
- Multiple hospital admissions
- Cancer treatment (radiation, chemo, surgery)
- Expensive medications
- Bob chooses to receive care at an out-of-state hospital (e.g., MD Anderson in Texas)
| Cost Component | Alice (Medicare Advantage) | Bob (Original Medicare + Medigap) |
|---|---|---|
| Part B Premium | $2,220 | $2,220 |
| MA / Medigap Premium | $300 | $1,800 |
| Deductibles & Cost Sharing | May hit the annual out-of-pocket maximum of $9,350 (for in-network services) | Medigap covers nearly all cost sharing, keeping expenses low |
| Drug Costs | $2,000 (2025 cap) | $2,000 |
| Out-of-Network Care (e.g. MD Anderson) | May be denied → full out-of-pocket cost (can be tens of thousands) | Covered if the facility accepts Medicare |
Estimated Total:
- Alice (MA): $2,220 + $300 + $9,350 + $2,000 = ~$13,870 (not counting any fully out-of-pocket costs for denied out-of-network care)
- Bob (Medigap): $2,220 + $1,800 + ~$2,000 = ~$8,020 (while still having freedom to choose where to receive treatment)
In a high-cost year, Medigap helps minimize financial risk and preserves provider choice.
Conclusion from the Cost Tables
- Medicare Advantage can save money in years with low medical usage, but carries greater financial risk if you need expensive or out-of-state care.
- Original Medicare + Medigap requires higher monthly premiums but provides predictability, stability, and nationwide choice for hospitals and specialists.
-Lê Nguyên Vũ-