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Medicare Advantage vs Medigap Plan G
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Medicare Advantage vs. Medigap Plan G: The Essential Copay and Cost Comparison

Medicare Advantage (Part C) vs. Medigap Plan G: A Head-to-Head Cost Comparison

The choice between a Medicare Advantage (MA) plan and Original Medicare paired with a Medicare Supplement (Medigap) Plan G is one of the most critical financial decisions in retirement healthcare. While Medicare Advantage offers lower monthly premiums and often includes extra benefits, Medigap Plan G provides highly predictable, near-zero costs at the time of service.

We break down the critical difference: your out-of-pocket cost for care (copays and deductibles).

Copay Comparison: Medicare Advantage vs. Medigap Plan G (Est. 2026)

This chart directly compares the typical costs you pay when you receive common medical services under both plan types. The figures for Original Medicare costs (like deductibles) are based on estimated 2026 amounts.

Service/Cost Type Typical Medicare Advantage (Part C) Cost Medigap Plan G (with Original Medicare) Cost
Monthly Premium Low or $0 (You still pay your Part B premium) Higher Premium (This secures your cost predictability) + separate Part D premium
Primary Care Visit $0 - $30 copay per visit $0 (Plan G covers the 20% coinsurance)
Specialist Visit $30 - $65 copay per visit $0 (Plan G covers the 20% coinsurance)
Annual Deductible (Part B) $0 (The plan may have its own deductible) You Pay the annual Part B deductible ($283 in 2026)
Inpatient Hospital Stay $200 - $450 copay per day (for the first 4-7 days) $0 (Plan G covers the entire Part A deductible, $1,736 in 2026)
Skilled Nursing Facility (SNF) $0 for days 1-20, then $25 - $100 copay for days 21-100. $0 (Plan G covers the coinsurance for days 21-100)
Out-of-Pocket Maximum (MOOP) Yes. A mandated yearly limit (e.g., up to avg. $5,900 for in-network care). Copays stop once this is hit. Minimal. Your annual cost is limited to the single Part B deductible (approx. $283).

Understanding the Cost Structure Difference

The decision between these two options is a choice between two distinct financial philosophies:

The Medicare Advantage Financial Model (Pay-as-You-Go)

Medicare Advantage plans offer the attractive benefit of a low or zero dollar monthly premium. However, this is balanced by cost-sharing at the point of service. You will pay a copay for nearly every visit, test, and procedure until you meet your plan's annual Out-of-Pocket Maximum (MOOP).

  • Pros: Low monthly budget; includes extra benefits such as dental, eyewear, fitness memberships, and over-the-counter allowances.

  • Cons: High financial exposure (up to the MOOP) if you have a serious illness; requires network adherence.

The Medigap Plan G Financial Model (Predictable Protection)

Plan G is the most popular Medigap plan because it provides comprehensive financial insulation. Once you satisfy the small annual Part B deductible (approx. $\$283$), Plan G covers the remaining $20\%$ coinsurance, the Part A deductible, and all copays for Medicare-approved services.

  • Pros: Highly predictable annual costs; near-zero costs for major health events; nationwide network access.

  • Cons: Higher monthly premium; requires a separate Part D plan.

Network and Administrative Control: A Critical Difference

Beyond copays, the type of plan dictates your access to doctors and your freedom from administrative hurdles:

  • Medicare Advantage (MA): Most plans operate with HMO or PPO networks. To keep costs low, you must use in-network doctors. These plans also frequently require prior authorizations and referrals for non-emergency services.

  • Medigap Plan G: Since Plan G works with Original Medicare, you can see any doctor or hospital in the U.S. that accepts Medicare. Referrals and prior authorizations are rare and limited to only a small list of specific items/procedures mandated by Medicare.

Disclaimer: The figures provided are estimates for the 2026 plan year. Medicare Advantage and Medigap premiums vary widely based on your ZIP code, age, and carrier. This information is for educational purposes only and is not a specific plan quote or offer to enroll.