🩺 2025 Medicare Advantage vs Medigap
Costs, Coverage Gaps & 60-sec Calculator
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1. Why compare your Medicare options in 2025?
- Part B premium increase to $179.80/mo projected (CMS estimate).
- 43 % of Advantage plans will add max out-of-pocket ≥ $8 300.
- New CMS rule lets you switch to Medigap if your Advantage network shrank by >15 %.
2. Advantage vs Medigap – At-a-Glance
| Feature | Medicare Advantage | Medigap + Part D |
|---|---|---|
| Average Premium | $18/mo* | $155/mo* |
| Out-of-Pocket Max | $0–$8 300 | $0 (99 % coverage) |
| Networks | HMO/PPO regional | Any doctor nationwide |
| Extras | Dental, vision, OTC | — |
| Medical Underwriting** | No | Yes (after 6 mo) |
*2024 CMS data; **Varies by state.
3. Typical Costs in 2025
Advantage (HMO)
- Premium: $0–$35/mo
- Part B give-back: up to $75/mo
- MOOP: $4 500–$8 300
Medigap Plan G
- Premium: $120–$210/mo (65-yr)
- Part B deductible: $240
- MOOP: $0 after deductible
4. Annual Cost Calculator (60 sec)
Use $0 for expected OOP if you rarely visit doctors.
5. Enrollment Timeline & Tips
- OEP (Oct 15 – Dec 7): switch Advantage ↔ Original.
- MA-OEP (Jan 1 – Mar 31): one Advantage-to-Advantage switch.
- Guaranteed Issue: 6 mo window after Part B starts → no Medigap underwriting.
6. FAQ
Can I have both Advantage and Medigap?
No. CMS prohibits holding both simultaneously.
Do Advantage plans cover dental & vision?
About 97 % include preventive dental; 89 % include vision in 2025.
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