Medigap vs Medicare Advantage in 2027: The Total-Cost Comparison That Decides It
By Rana — Editor, Elite Era Trends
If you are choosing Medicare coverage for 2027, you have probably already noticed the trap. One path advertises a $0 monthly premium. The other asks for roughly $150 a month before you use a single service. The $0 plan looks like the obvious winner — until you run the full year’s maths.
The honest comparison is not premium against premium. It is total yearly cost: premiums plus everything you pay when you actually need care, plus what happens in a bad year.
The decision deadline is Monday, December 7, 2026. Changes you make by then take effect January 1, 2027. Do nothing, and your current coverage renews on its 2027 terms.
Contents
- The short answer
- What each path actually costs in 2027
- The worst case: what a bad year costs
- Three worked examples: healthy, average, and bad years
- The five differences that are not about money
- The switching trap: the choice you may not get to remake
- How to decide in 15 minutes
- Frequently asked questions
- Sources
The short answer
Choose Original Medicare plus Medigap Plan G if you want predictable costs, any doctor who takes Medicare anywhere in the country, and no permission slips before treatment — and you can afford roughly $150 a month for the Medigap policy on top of your Part B premium.
Choose a Medicare Advantage plan if keeping the monthly bill low matters most right now, you are comfortable with a local network and prior authorization, and you can absorb several thousand dollars of cost-sharing in a bad year.
Neither choice is wrong. They protect against different risks: Medigap caps your surprises, Medicare Advantage caps your monthly bill.
| Original Medicare + Medigap Plan G + Part D | Medicare Advantage (with drug coverage) | |
|---|---|---|
| Monthly plan premium | ~$150 (Plan G, new 65-year-old, 2026 median); plus ~$36 Part D | $0–$12 typical; CMS average $12 in 2027 |
| Part B premium | $209.50/month (projected — CMS has not announced the final 2027 figure) | Same $209.50/month (projected) — everyone pays it |
| Doctor choice | Any doctor who takes Medicare, nationwide | Your plan’s network |
| Worst case, medical care | ~$292 (Part B deductible, projected) | Up to $9,850 in-network; $14,800 combined for PPOs |
| Worst case, drugs | $2,400 (Part D cap) | $2,400 (same Part D cap) |
| Prior authorization | No | Yes — ~53 million decisions in 2024 |
| Extra benefits | None | Often: dental, vision, hearing, gym |
| Switch later? | Only with medical underwriting in most states | Every year during open enrollment |
What each path actually costs in 2027
Start with the fixed costs — the money that leaves your account whether you see a doctor or not. Every projected number is labelled as projected.
Both paths pay the Part B premium. The 2026 Medicare Trustees Report projects the 2027 standard premium at $209.50 a month, up from $202.90 in 2026. CMS has not announced the final figure — checked November 14, 2026 — so treat $209.50 as the working number, not a bill. That is $2,514 a year on either path.
The Medigap path adds two more premiums. KFF reported in October 2026 that the average Plan G premium among current policyholders was $194 a month in 2025, but that blends people of every age. For a 65-year-old buying Plan G fresh in 2026, the median was about $150 a month. Premiums vary enormously by state — roughly $110 a month in low-cost states to more than $480 in New York — so get a quote for your ZIP code. Medigap never covers drugs, so you also need a stand-alone Part D plan: CMS projects the average at about $36 a month in 2027.
The Medicare Advantage path adds far less. CMS projected in September 2026 that the average Medicare Advantage premium falls to $12 a month in 2027, down from $14.37, and many plans charge $0. Drug coverage is usually built in, and the drug portion inside those plans averages about $7 a month after rebates. On a $0-premium Advantage plan, the fixed monthly bill is just the Part B premium.
| Fixed yearly cost | Original + Plan G + Part D | Medicare Advantage ($0 premium) |
|---|---|---|
| Part B premium | $2,514 (projected) | $2,514 (projected) |
| Plan G premium | $1,800 (at $150/month) | $0 |
| Part D premium | $432 (at $36/month) | $0 (included) |
| Fixed total | $4,746 | $2,514 |
The Medigap path costs $2,232 more a year before you use any care. That is the price of the certainty it buys.
The worst case: what a bad year costs
On Original Medicare alone, there is no ceiling at all. Part B leaves you paying 20% of doctor and outpatient bills with no yearly limit, and Part A leaves you a hospital deductible per benefit period. That is the gap Medigap exists to close. With Plan G, the only medical cost-sharing you pay all year is the Part B deductible — projected at $292 for 2027, not yet final. Plan G pays the Part A deductible, the 20% Part B coinsurance, and even Part B excess charges. Your worst case for medical care is $292.
On Medicare Advantage, the ceiling is the plan’s out-of-pocket maximum. CMS caps it for 2027 at $9,850 for in-network care, and $14,800 combined for PPO members who also use out-of-network care. Many plans set a lower limit — in Maricopa County, Arizona, 2027 plan limits run from $2,000 to $8,900 — but the ceiling is the number that matters in a bad year, and your plan’s figure is in your Annual Notice of Change. Premiums and drug costs do not count toward it; drug spending has its own separate cap of $2,400 for Part D in 2027.
| Worst case (medical care only) | Original + Plan G | Medicare Advantage |
|---|---|---|
| Healthy year | $292 | A few hundred in copays |
| Bad year (hospital + surgery) | $292 | Up to $9,850 in-network |
That $9,558 gap is the whole decision in one number.
Three worked examples: healthy, average, and bad years
These examples use the same 65-year-old: Part B at the projected $209.50 a month, Plan G at $150 a month, stand-alone Part D at $36 a month, and a $0-premium Medicare Advantage plan with drug coverage. Both paths pay the Part B premium, so it is included below to keep the totals real yearly bills.
Example 1: A healthy year
A few routine doctor visits, preventive care (free on both paths), one generic prescription.
| Original + Plan G + Part D | Medicare Advantage | |
|---|---|---|
| Fixed costs | $4,746 | $2,514 |
| Cost-sharing | $292 (Part B deductible) | ~$250 (copays) |
| Total | $5,038 | $2,764 |
Medicare Advantage wins by $2,274. In a year when little goes wrong, the $0 premium is genuinely cheaper.
Example 2: An average year
Several specialist visits, imaging, a short outpatient procedure, and a brand-name drug. Medicare Advantage cost-sharing comes to about $1,500.
| Original + Plan G + Part D | Medicare Advantage | |
|---|---|---|
| Fixed costs | $4,746 | $2,514 |
| Cost-sharing | $292 (Part B deductible) | $1,500 |
| Total | $5,038 | $4,014 |
Medicare Advantage still wins, by $1,024. This is the year most people actually have — and it is why more than half of Medicare beneficiaries, 54% in 2025 (about 34 million people), now choose Medicare Advantage, according to KFF.
Example 3: A bad year
A hospital stay, surgery, and rehabilitation. Medicare Advantage cost-sharing reaches $6,500 — well below the $9,850 ceiling, and realistic for a serious episode.
| Original + Plan G + Part D | Medicare Advantage | |
|---|---|---|
| Fixed costs | $4,746 | $2,514 |
| Cost-sharing | $292 (Part B deductible) | $6,500 |
| Drugs | $0 extra here | $1,200 |
| Total | $5,038 | $10,214 |
Medigap wins by $5,176. Note the shape of it: the Medigap total is the same $5,038 in all three examples. It never moves. The Medicare Advantage total moves from $2,764 to $10,214 depending on your health. That is the trade in plain terms — a lower bill in good years against a bill that can nearly quadruple in a bad one.
The break-even point is about $2,524 of Medicare Advantage cost-sharing in a year. Below that, Advantage is cheaper. Above it, Medigap is cheaper.
A cheaper middle path exists: high-deductible Plan G. It covers exactly the same benefits as standard Plan G, but you pay up to $3,050 of Medicare-covered costs yourself in 2027 before it starts paying. Premiums run about $30–$60 a month (around $52 on average in 2026). Fixed costs fall to about $3,570 a year, and the worst case is $3,570 + $3,050 = $6,620. We ran the full maths in our Plan G vs high-deductible Plan G comparison.
The five differences that are not about money
1. Networks. Medigap travels with you: any doctor or hospital that takes Medicare, in any state. Medicare Advantage plans have networks, and going outside them costs more — or, on an HMO, is not covered at all except in emergencies. Our Medicare Advantage HMO vs PPO guide explains the trade-off.
2. Prior authorization. Original Medicare with Medigap does not require your plan’s permission before treatment. Medicare Advantage plans do, for many services. KFF found insurers made nearly 53 million prior authorization determinations in 2024. Most are approved — but the delay and paperwork fall on you, at the worst possible time.
3. Drug coverage. Medigap never includes it; you buy a separate Part D plan and check its formulary every year. Most Medicare Advantage plans bundle drug coverage, which is simpler — but if your drug is not on the formulary, switching plans is the only fix. Stand-alone Part D premiums jump sharply in 2027 if you stay in the same plan, as our Part D premium guide explains.
4. Extra benefits. Medicare Advantage plans often include dental, vision, hearing, and gym memberships. Medigap includes none. They are real benefits — but they are also the marketing: a plan can offer free dental cleanings and still leave you a $9,850 hospital bill. Judge the medical coverage first.
5. Switching later. This is the difference that matters most — see the next section.
The switching trap: the choice you may not get to remake
You can switch Medicare Advantage plans every year. Each open enrollment (October 15 to December 7) you can change plans, and your new plan cannot refuse you or charge you more because you are sick. If your Advantage plan disappoints you in 2027, you can leave it for 2028 — and if you are in a Medicare Advantage plan on January 1, you also get a second chance during the Medicare Advantage Open Enrollment Period, January 1 to March 31.
You can usually only buy Medigap at full price once. Your guaranteed right to buy any Medigap policy at the standard price lasts for the six months after you turn 65 and enroll in Part B. After that window closes, insurers in most states can require medical underwriting — they can refuse you, or charge you more, because of your health. A few states (including New York, Connecticut, and Massachusetts) guarantee access year-round, but most do not. If you choose Medicare Advantage at 65, stay healthy for five years, then develop a condition and want Medigap, you may find the door closed. The reverse is not true: leaving Medigap for Medicare Advantage is always allowed during open enrollment.
One exception: if you try Medicare Advantage for the first time and leave within your first 12 months, you have a trial right to buy a Medigap policy without underwriting. We explain the timing in our guide to switching Medigap plans without underwriting.
The practical consequence: if you think you may ever want Medigap, the cheapest time to buy it is when you first turn 65. That is not a sales line — it is how the law is written.
How to decide in 15 minutes
- Check your doctors. Are they in the Medicare Advantage plan’s network? If your cardiologist or oncologist is out of network, the decision is made.
- Check your drugs. Run both options through Medicare’s Plan Finder with your exact prescriptions. Part D costs decide more real bills than premiums do.
- Find your plan’s out-of-pocket maximum. It is in your Annual Notice of Change. Could you pay that amount next year without borrowing? If not, Medigap’s fixed $292 worst case deserves a hard look.
- Weigh your health outlook. A planned surgery, a new diagnosis, or frequent specialist visits pushes the maths toward Medigap. A healthy year pushes it toward Advantage.
- Check your state’s Medigap rules. Past your six-month open enrollment window? Get a Medigap quote before assuming you can switch — underwriting may change the price or block the move.
- If money is tight, check the help programs. Your state may pay your Part B premium through a Medicare Savings Program, and Extra Help can cut drug costs to a few dollars per prescription. Both are free to apply for.
Whichever path you choose, do it before December 7, 2026. After that date, the choice locks in for 2027 — except for Medicare Advantage members, who get the January-to-March second chance.
Frequently asked questions
In a healthy year, Medicare Advantage is usually cheaper, because many plans charge a $0 premium while Medigap Plan G costs about $150 a month for a new 65-year-old. In a bad year with a hospital stay, Medigap is usually cheaper: your medical cost-sharing stops at the Part B deductible (projected $292), while an Advantage plan can charge up to its $9,850 out-of-pocket maximum.
No. Medigap policies never include prescription drug coverage, so you need a separate stand-alone Part D plan, which CMS projects will average about $36 a month in 2027. Most Medicare Advantage plans include drug coverage, which is one reason their monthly bill looks lower. Part D drug spending is capped at $2,400 in 2027 on either path.
You can switch during open enrollment, but in most states the Medigap insurer can require medical underwriting once your six-month window after turning 65 has passed. It can refuse you or charge more because of your health, except in states with year-round guaranteed issue such as New York, Connecticut, and Massachusetts. A 12-month trial right covers first-time Advantage users.
CMS caps it at $9,850 for in-network care in 2027, and $14,800 combined for PPO members who use out-of-network care. Many plans set a lower limit, so check your own plan’s figure in its Annual Notice of Change. Premiums and Part D drug costs do not count toward this maximum, and drug spending has its own separate $2,400 cap.
Yes. Everyone with Medicare pays the Part B premium, no matter which path they choose — the 2027 figure is projected at $209.50 a month, though CMS has not announced the final number as of November 14, 2026. A “$0 premium” plan means the plan itself charges nothing on top of Part B.
Original Medicare with Medigap is usually the better fit, because any doctor who takes Medicare anywhere in the country is covered, with no network and no prior authorization. Medicare Advantage plans are built around local networks, and care outside the network can cost far more or not be covered at all, except in emergencies. Snowbirds and frequent travellers should weigh this heavily before choosing an Advantage plan.
Sources
- Centers for Medicare & Medicaid Services, “Medicare Advantage and Medicare prescription drug programs expected to remain stable in 2027” (Sep 28, 2026) — average MA premium $12, average stand-alone Part D premium ~$36
- Centers for Medicare & Medicaid Services, CY 2027 Rate Announcement (Apr 6, 2026) — Part D deductible $700, out-of-pocket cap $2,400
- Centers for Medicare & Medicaid Services, CY 2027 MOOP limits — in-network maximum $9,850, combined PPO maximum $14,800
- 2026 Medicare Trustees Report (Jun 9, 2026) — 2027 Part B premium projected $209.50, deductible projected $292
- KFF, “Medicare Advantage in 2025: Enrollment Update and Key Trends” (Jul 2025) — 54% of eligible beneficiaries in MA; ~53 million prior authorization determinations in 2024
- KFF, Medigap enrollment findings (Oct 2026) — average Plan G premium $194/month among current policyholders
- United Medicare Advisors, Plan G/Plan N cost data (2026) — median $150/month for a new 65-year-old Plan G applicant
- Centers for Medicare & Medicaid Services, high-deductible Plan G amount for 2027 — $3,050
Figures checked against primary sources on November 14, 2026. The 2027 Part B premium ($209.50) and deductible ($292) are 2026 Medicare Trustees Report projections; CMS had not announced the final figures as of November 14, 2026.
Rana is the editor of Elite Era Trends, where he explains Medicare, Social Security and AI news for US readers in plain language — costs, deadlines and plan choices, checked against official sources.
