In a Healthy Year, Medicare Advantage Saves You $2,640. In a Cancer Year, It Can Cost $9,250

In a Healthy Year, Medicare Advantage Saves You $2,640. In a Cancer Year, It Can Cost $9,250 Drew Wood Fri, June 19, 2026 at 9:40 PM GMT+7 6 min read Quick Read Medicare Advantage saves $2,200 annually in healthy years but can expose enrollees to $9,250 in out-of-pocket costs during a cancer year. Plan G enrollees face only the $283 Part B deductible during serious illness, saving up to $6,300 versus the federal Medicare Advantage cap. Switching from Medicare Advantage back to Medigap after a diagnosis triggers medical underwriting in most states, risking denial exactly when coverage matters most. A recent study identified one single habit that doubled Americans’ retirement savings and moved retirement from dream, to reality. Read more here. A 67-year-old in good health sees an obvious answer in her Medicare options. Original Medicare plus a Medigap Plan G runs about $220 a month on top of the Part B premium. A nearby Medicare Advantage plan charges $0. Her doctor is in network, prescription drug coverage is built in, and a gym membership comes with the package. Why pay an extra $2,640 a year? Then she receives a cancer diagnosis. Suddenly, network restrictions, prior authorization requirements, and out-of-pocket exposure matter more than the monthly premium. The comparison looks very different than it did when she was healthy. This article is for the reader weighing that exact decision: a relatively healthy person between ages 65 and 70 choosing initial Medicare coverage, or a current Medicare Advantage enrollee deciding whether to stay put during open enrollment. If you already have a chronic condition that requires frequent specialist care, the answer is often less straightforward. If your household income sits comfortably below the first IRMAA threshold of $109,000 for a single filer or $218,000 for a married couple filing jointly, IRMAA is not part of this decision. The question here is narrower: which structure costs less in a healthy year, and which one provides the strongest protection when healthcare needs become expensive. Read: Data Shows One Habit Doubles American’s Savings And Boosts Retirement Most Americans drastically underestimate how much they need to retire and overestimate how prepared they are. But data shows that people with one habit have more than double the savings of those who don’t. In a year where she sees her primary care doctor twice, gets a flu shot, and refills two generic prescriptions, the Advantage enrollee pays the standard $202.90 monthly Part B premium and almost nothing else. Copays for those office visits might run $0 to $40 apiece. The Original Medicare plus Plan G enrollee pays the same $202.90 Part B premium, plus the $220 Plan G premium, plus a standalone Part D drug plan. Plan G covers everything Original Medicare leaves behind except the $283 annual Part B deductible. Once she pays that deductible, her cost-sharing for the rest of the year is essentially zero. Healthy-year tally: the Advantage enrollee may save several thousand dollars a year in premiums and cost sharing compared with Original Medicare plus Plan G. The exact amount depends on local Medigap premiums, drug-plan costs, and the specific Advantage plan. Run the same comparison through a year with surgery, chemotherapy, imaging, and a five-day inpatient stay. The Medicare Advantage enrollee is exposed to the plan s out-of-pocket maximum. CMS sets the 2026 federal ceiling at $9,250 for in-network care and $13,900 for plans that include a combined in-network and out-of-network maximum. Most plans set lower limits. The enrollment-weighted average in-network maximum is $5,421 in 2026, although individual plans vary. Check the Evidence of Coverage for the number that applies to your plan. One important limitation: the in-network maximum does not include Part D drug spending. Network restrictions can also matter when a specialist, cancer center, or other provider is outside the plan s network. Depending on the plan structure, those situations can increase costs or limit access to care. The Original Medicare plus Plan G enrollee faces a different calculation. After paying the annual Part B deductible and monthly premiums, Plan G generally covers the Part A hospital deductible, Part B coinsurance, and most other Medicare-approved cost sharing. The result is highly predictable out-of-pocket exposure, even during an expensive year of treatment. In many high-cost medical scenarios, the combination of Original Medicare and Plan G produces lower out-of-pocket costs than a Medicare Advantage plan that reaches its maximum. The exact difference depends on the Advantage plan s cap, the Medigap premium, prescription drug costs, and whether specialized care requires out-of-network providers. The tradeoff comes down to how much value you place on protection against a bad year. A reader who expects relatively low healthcare utilization may spend less over time with a Medicare Advantage plan, particularly

In a Healthy Year, Medicare Advantage Saves You $2,640. In a Cancer Year, It Can Cost $9,250

Key takeaways

More in business