FIGURE IT OUT
Out-of-Pocket
Cost Estimator
The "$0 premium" in Medicare Advantage ads is real. But it is only one number in a much longer equation. This tool runs the math on a major medical event across three paths — so you can see the full picture before you choose.
No name or email required. Adjust the numbers to match your situation.
CHOOSE A SCENARIO TO START
OR ENTER YOUR OWN NUMBERS
YOUR ESTIMATED COSTS
| Cost Item |
Original Medicare Parts A + B only |
Original Medicare + Plan G Supplement |
Medicare Advantage with your MOOP |
|---|---|---|---|
| Part A deductible Per benefit period, 2026 | — | $0 | — |
| Part B deductible Annual, 2026 | $283 | $283 | $0 |
| Coinsurance / copays Part B: 20% uncapped (Original Medicare alone) | — | $0 | — |
| Total event cost What you pay for this medical event | — | — | — |
| Annual premium cost 12 months of plan premiums (Part B included in all) | $2,220 | — | $2,220 |
| True annual cost Event cost + 12 months of premiums | — | — | — |
Adjust the sliders above to see your estimate.
What assumptions does this tool use?
2026 CMS figures used in this tool:
- Part A deductible: $1,676 per benefit period (applies if you have a hospital stay)
- Part B deductible: $283 per year
- Part B coinsurance: 20% of Medicare-approved charges — uncapped for Original Medicare alone
- Standard Part B monthly premium: $202.90/mo (used in all three columns)
- Plan G covers: Part A deductible, Part A coinsurance, Part B coinsurance, skilled nursing coinsurance, foreign travel emergency (80%). It does not cover the Part B deductible ($283).
Simplifications:
- This tool assumes all charges are Medicare-approved (actual approved amounts are typically 20–40% lower than billed charges — this tool uses the charges you enter as the approved amount for simplicity)
- Medicare Advantage copays vary widely by plan and service type — this tool uses the MOOP as the ceiling for major events, which is the worst-case scenario
- Part A deductible applies only if you have an inpatient hospital stay; the tool applies it when charges exceed $5,000 as a proxy for likely hospitalization
- Drug costs (Part D) are not included in this estimate
- IRMAA surcharges are not included — use the IRMAA Calculator if your income may trigger them
This tool is for educational purposes only. It does not constitute financial, legal, or insurance advice. Figures change annually — verify current amounts at Medicare.gov or with a SHIP counselor before making any enrollment decision. The Clearing is not affiliated with CMS, SSA, or any government agency, and does not sell insurance or recommend specific plans or carriers.
Why the premium is only part of the story
Medicare Advantage plans advertise $0 premiums because the premium is genuinely $0 — that part is accurate. What the ads don't show is the Maximum Out-of-Pocket limit, which is the most you'd pay in a bad year. In 2026, the CMS-allowed ceiling for in-network MOOP is $9,350. Many plans set theirs between $4,000 and $7,000.
Original Medicare with Plan G has a different structure: you pay a monthly premium for the Supplement, but your exposure in a major event is capped at the Part B deductible ($283). Everything else is covered. The question is whether the premium savings from Advantage are worth the exposure difference in a bad year.
This tool doesn't answer that question for you — it just makes the math visible so you can answer it yourself.
A NOTE ON WHAT THIS TOOL DOESN'T COVER
This tool estimates medical cost-sharing. It does not include drug costs (Part D), dental, vision, hearing, or the value of extra benefits that Advantage plans may include. Those extras are real — and worth evaluating. But they're separate from the medical cost-sharing question.
If your income may trigger IRMAA surcharges, use the IRMAA Calculator separately. The surcharge applies to Part B and Part D premiums on all Medicare paths.
See all tools in Figure It Out →Research note: Studies on Medicare beneficiary decision-making consistently find that enrollees underweight future out-of-pocket exposure relative to current premium costs — a pattern sometimes called "premium bias." See: Abaluck & Gruber (2011), "Choice Inconsistencies Among the Elderly," American Economic Review; and CMS Medicare Current Beneficiary Survey data on plan switching behavior. Figures verified against CMS.gov 2026 Medicare & You handbook.
Want to think through the full picture?
The Medicare Fit Check looks at how you use healthcare, how you travel, and what matters most to you — not just the numbers. It takes about 3 minutes.