Overview: Abstract descriptions of cost-sharing become clear when you run the actual numbers. This section walks through a specific healthcare scenario under two different coverage paths using 2026 figures.

The Scenario

Maria, age 67, enrolled in Medicare at 65. She needs a total knee replacement this year, resulting in the following care: a 4-day inpatient hospital stay, 2 pre-operative specialist visits, 1 MRI, and 4 post-operative follow-up visits. It is her first medical care this calendar year (no deductibles have been met).

Assume the following Medicare-approved costs:

Hospital facility charges (Part A): triggers Part A benefit period
Physician and specialist fees (Part B): $3,000 total for all visits and the MRI

Path 1: Original Medicare + Medigap Plan G

Part B premium: $202.90/month
Medigap Plan G premium: approximately $150/month
Plan G covers 100% of all Medicare cost-sharing except the Part B deductible

Calculating Maria's costs:

Part A deductible: $0 (Plan G covers it)
Part B deductible: $283 (Maria pays this herself — Plan G does not cover the Part B deductible)
Remaining Part B bills: $3,000 − $283 = $2,717 subject to coinsurance
20% coinsurance: $0 (Plan G covers it)
Total point-of-service costs: $283

Path 2: Medicare Advantage ($0 premium plan)

Part B premium: $202.90/month
MA plan premium: $0/month
Plan cost-sharing: $350/day hospital copay (Days 1–5), $45 specialist visit copay, $200 MRI copay

Calculating Maria's costs:

Hospital (4 days × $350): $1,400
Pre-op specialist visits (2 × $45): $90
MRI: $200
Post-op visits (4 × $45): $180
Total point-of-service costs: $1,870

Annual comparison (including 12 months of premiums):

Medigap path: ($202.90 + $150) × 12 + $283 = $4,233.80 + $283 = $4,516.80 total
MA path: $202.90 × 12 + $1,870 = $2,434.80 + $1,870 = $4,304.80 total

For this moderate-utilization scenario, the Medicare Advantage path is slightly cheaper overall — but Maria paid $1,870 in medical bills when she received care. Under Medigap, she paid only $283 in medical bills regardless of how complex the surgery became.

The key insight: If Maria had developed complications requiring a 15-day hospital stay, the Medigap total would remain $4,516.80 (Plan G absorbs all additional Part A coinsurance). The Medicare Advantage total would increase because she would max out her 5-day hospital copay at $1,750 and continue incurring specialist copays — potentially exceeding the Medigap path depending on the plan's MOOP. Medigap offers cost certainty; Medicare Advantage offers lower premiums with exposure to point-of-service costs.