New Jersey Medigap vs Medicare Advantage Cost Calculator
Medicare Advantage often costs less in premiums. Medigap often costs less when you use a lot of care. Enter the premiums you were quoted, a rough idea of your medical copays and your drug costs, and this compares the two paths across a typical year and a heavy-use year. Medical and drug spending are kept apart, because an Advantage plan’s maximum out-of-pocket never includes prescriptions.
Estimates only. Figures on this page use published values and the details you enter. They are not a quote, an offer of coverage, or a determination of eligibility. Your premium and drug costs are confirmed by the plan you choose, and Medicare figures change each January. Everything is calculated in your browser; nothing you type is sent to us or anyone else.
How the two Medicare paths are costed side by side
The comparison builds a yearly total for each path from your figures, then repeats it for a year with heavy medical use. The Part B premium is left out because both paths pay it.
Medical and drug costs run on two separate tracks, as they do in Medicare. An Advantage plan’s in-network maximum out-of-pocket applies to basic benefits, the Part A and Part B services; Part D drug costs never count toward it (42 CFR 422.100(f)(4)). Prescriptions have their own yearly cap instead: $2,400 for 2027 plans, the threshold in the CMS CY2027 landscape file and the CY2027 Rate Announcement. That cap applies the same way to a stand-alone drug plan beside Medigap and to the drug coverage inside an Advantage plan.
Year labels: the plans you compare this fall are 2027 plans, so the drug cap is the 2027 figure. The Part B deductible is the 2026 figure, $283 (CMS), because CMS publishes the 2027 deductible around November 2026.
Both paths keep you in Medicare and both pay the Part B premium. What changes is who pays the claims and how: Medigap pays after Original Medicare, while an Advantage plan replaces Original Medicare’s claims processing with its own network rules.
- Drugs, both paths: the pharmacy copays and coinsurance you expect, capped at the 2027 Part D out-of-pocket limit. The same figure is added to each path.
- Advantage, typical year: twelve monthly premiums, plus the medical copays you expect capped at the plan’s in-network maximum out-of-pocket, plus drugs.
- Medigap, typical year: twelve months of Plan G plus a stand-alone drug plan, plus the $283 Part B deductible, normally the only medical bill Plan G leaves for Medicare-approved care, plus drugs.
- Advantage, heavy year: twelve premiums plus the full medical maximum out-of-pocket plus the full $2,400 drug cap.
- Medigap, heavy year: premiums and the Part B deductible as before, plus the full $2,400 drug cap, because Plan G pays the rest of approved medical costs.
- Difference: which path costs less in each year, and by how much. Because drug costs are the same on both sides, the gap comes from premiums and medical cost sharing.
Drugs = lesser of (expected drug copays, $2,400)Advantage typical = premium × 12 + lesser of (expected medical copays, MOOP) + drugsMedigap typical = (Plan G premium + drug plan premium) × 12 + $283 + drugsAdvantage heavy = premium × 12 + MOOP + $2,400Medigap heavy = (Plan G premium + drug plan premium) × 12 + $283 + $2,400 Worked example: a Camden County comparison with 2027 plan data
Hypothetical person, not a client, comparing paths for 2027. The Advantage inputs use real Camden County figures from the CMS 2027 landscape file: 24 of the county’s 41 plans have a $0 premium, and the median in-network maximum out-of-pocket is $9,400. The Medigap inputs are placeholders, $180 a month for Plan G and $20 for a drug plan, because Medigap rates depend on age, carrier and other factors. Use your own quotes.
Add $1,500 of expected medical copays and $600 of pharmacy copays for a few generics and one brand drug. Advantage totals $2,100 and Medigap $3,283: Advantage is $1,183 lower. The $600 of drug costs sits on both sides and is not capped by the Advantage medical maximum.
In a heavy year Advantage rises to $11,800: the $9,400 medical maximum plus the $2,400 drug cap, which are separate limits. Medigap rises only by the drug cap, to $5,083. Now Medigap is $6,717 lower.
Neither total is the answer alone. The real question is which year you want protection against, and whether your doctors are in the Advantage network.
The break-even point is where expected medical copays make the two typical-year totals equal. Here that is $2,683 of expected medical copays: below it Advantage costs less, above it Medigap does, and Advantage stops climbing at its $9,400 maximum. The $600 of drug copays is the same on both sides, so it does not move the break-even; counting it, both paths total $3,283 at that point.
| Year | Advantage | Medigap Plan G + drug plan |
|---|---|---|
| Typical year | $2,100 | $3,283 |
| Heavy-use year | $11,800 | $5,083 |
Illustration: a hypothetical example built from the rules and figures cited on this page, not a quote.
Errors that skew a Medigap versus Advantage comparison
- Comparing premiums only. A $0 premium plan still has copays up to its maximum; a heavy year changes the ranking.
- Using the in-network limit for out-of-network care. PPOs often carry a higher combined limit. If you travel or keep out-of-network doctors, model that figure.
- Leaving out the drug plan on the Medigap side. Medigap excludes prescriptions. New Jersey’s 2027 stand-alone drug plans run $5.30 to $217.90 a month.
- Deciding after the Medigap window closes. The six-month Medigap Open Enrollment Period is when insurers cannot use medical underwriting to refuse you (Medicare.gov). Switching later can mean health questions.
- Counting drug copays against the Advantage maximum. The in-network maximum out-of-pocket is for medical care. Prescriptions have their own $2,400 cap for 2027, so a heavy year on an Advantage plan can reach both limits.
- Overvaluing extras. Dental, vision and hearing benefits vary widely; count only what you would actually use.
- Assuming Medigap premiums stay flat. Rates usually rise with age and carrier filings. Ask each carrier about its rate history before choosing on price.
The Camden County and New Jersey picture for 2027
Camden County has 41 Medicare Advantage plans for 2027 outside Special Needs Plans, from 10 organizations: 25 PPOs, 1 regional PPO, 8 HMO-POS plans and 7 HMOs, with in-network maximums from $4,150 to $9,850 (CMS 2027 landscape file). 19 of them sit at the $9,850 top of that range.
Medigap plans in New Jersey are standardized: a Plan G from one carrier carries the same benefits as a Plan G from another, so price, rate history and service are what differ. Plans C and F can only be sold to people who were eligible for Medicare before January 1, 2020, so someone turning 65 now compares Plan G or Plan N (Medicare.gov, Choosing a Medigap Policy).
New Jersey also requires carriers to issue Medigap Plan D to people under 65 on Medicare because of a disability who apply within 12 months of starting Part B, with premiums tied to the age-65 rate (NJ Department of Banking and Insurance). Ask Jackie about the details for your situation.
Key terms: Medigap vs Advantage costs
- Maximum out-of-pocket (MOOP)
- The yearly ceiling on in-network costs for Medicare Advantage medical services.
- Plan G
- A standardized Medigap plan that pays nearly all Medicare-approved costs once you have met the Part B deductible.
- Network
- The physicians, hospitals and facilities contracted with a plan.
- Prior authorization
- Approval a plan requires before certain services, tests or procedures.
- Medical underwriting
- Health questions an insurer uses to accept, price or decline an application.
- Part B excess charges
- Amounts above the Medicare-approved rate that non-participating doctors may bill; Plan G covers them.
Information that sharpens the comparison
- Doctors, specialists and hospitals you want to keep.
- Prescriptions and your pharmacy.
- How many months a year you spend outside New Jersey.
- Plan G or Plan N quotes from more than one carrier.
What this assumes
- A comparison of figures you enter. It is not a quote, and it is not a recommendation on its own.
- The heavy-use Advantage year assumes you reach the plan’s in-network maximum out-of-pocket. Out-of-network care can cost more.
- That maximum covers medical care only. Drug costs are tracked separately on both paths and capped at the 2027 Part D out-of-pocket limit of $2,400, which the heavy-use year assumes you reach.
- The Medigap side is modelled on Plan G: after premiums, the Part B deductible is normally the only medical bill for approved services. The calculator uses the 2026 figure ($283) because CMS announces the 2027 amount around November 2026.
- The Medigap path adds a stand-alone Part D premium, which the comparison includes.
- Both paths still pay the Part B premium, so it is left out of the comparison.
- Dollars are only half the decision. Networks, referrals, travel and drug coverage differ too.
Where the figures come from
- CMS 2026 Medicare Part B premium, deductible and IRMAA amounts Centers for Medicare & Medicaid Services, 2026
- CMS CY2027 Medicare Advantage and Part D landscape file (New Jersey rows) Centers for Medicare & Medicaid Services, 2027
- CMS Announcement of CY2027 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies Centers for Medicare & Medicaid Services, 2027
- 42 CFR 422.100(f)(4): Medicare Advantage in-network maximum out-of-pocket limit U.S. Government Publishing Office (Code of Federal Regulations), 2025
- Medicare.gov: Medigap open enrollment and medical underwriting Centers for Medicare & Medicaid Services (Medicare.gov), 2026
- New Jersey Department of Banking and Insurance: Medicare Supplement coverage under 65 New Jersey Department of Banking and Insurance, 2026
What this comparison cannot weigh for you
- Networks: whether your doctors and hospitals take a plan.
- Referrals and prior authorization, common in HMOs.
- Travel: Medigap follows Original Medicare nationwide, while Advantage networks are local.
- Future Medigap rate increases, which vary by carrier.
- Drug costs that differ between the stand-alone drug plan and the Advantage plan’s drug coverage. The calculator uses one drug figure for both; run the Part D drug cost calculator or Medicare Plan Finder for each plan to refine it.
Bring Jackie your doctors, prescriptions and travel plans. She will check networks and price real Medigap and Advantage options for your ZIP code, so the comparison runs on actual quotes rather than placeholders.
Garden State Medicare Solutions is not connected with or endorsed by the United States government or the federal Medicare program. Medicare has neither endorsed nor reviewed this information.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
In clients' words
What working with Jackie looks like
Jackie provided amazing service, very helpful, and made me feel like I understood my options and assisted in the perfect choice.
Verbatim client reviews, as published on the agency's own website.
Common questions
Is Medigap or Medicare Advantage cheaper in New Jersey?
It depends on how much care you use. Advantage plans often have low premiums but you pay copays up to a yearly maximum. Medigap usually costs more each month but leaves few bills when you use a lot of care. This calculator compares both with your own figures.
What does Medigap Plan G leave me to pay?
For Medicare-approved services, usually just the Part B deductible: $283 in 2026. CMS announces the 2027 deductible around November 2026, so the calculator uses the 2026 figure until then. Plan G does not include drug coverage, so you add a Part D plan.
Can I switch from Medicare Advantage to Medigap later?
You can change your Medicare coverage in set periods, but outside your Medigap open enrollment a Medigap insurer can usually ask health questions and may decline you. That is why the first choice matters.
Do drug costs count toward the Medicare Advantage out-of-pocket maximum?
No. An Advantage plan’s maximum out-of-pocket covers medical (Part A and Part B) services only. Covered Part D drugs have their own yearly cap: $2,100 in 2026 and $2,400 for 2027 plans, on both stand-alone drug plans and Advantage plans with drug coverage. The calculator counts your drug costs separately and caps them at the 2027 figure, since 2027 plans are what you are choosing now.
Do you need a consultation?
Tell Jackie about your current situation. Telephone, Zoom or in person, at no cost to you. Call or text (856) 727-4221.
Serving South Jersey and all of New Jersey · (856) 727-4221
Content reviewed by Jackie Layser, Licensed Medicare Insurance Agent at Garden State Medicare Solutions, New Jersey, helping Medicare clients since 2008. How we source and review our content. Last updated .