Medicare Out-of-Pocket Cost Estimator (All Plans, 2025)
Estimate your total annual out-of-pocket costs under Original Medicare, Medicare Advantage, or Medigap, including premiums, deductibles, copays, and prescriptions.
| Category | Average Annual Cost | Notes |
|---|---|---|
| Part B Premium | $2,100 | $174.70/month |
| Medigap Plan G Premium | $2,160 | $180/month |
| Part D Premium | $480 | Avg. across regions |
| Average Deductibles | $226 | Part B |
| Max Out-of-Pocket (MA) | $8,850 | 2025 CMS limit |
| Typical Drug Copays | $300 | $15–$50 per script |
This estimator models total yearly healthcare costs for Medicare participants across all major plan types, Original Medicare (Parts A & B), Medicare Advantage (Part C), and Medigap (supplemental coverage). It combines real-world averages for premiums, copays, and prescription spending to give a clear cost picture.
| Plan | Description | Out-of-Pocket Exposure |
|---|---|---|
| Original Medicare (A & B) | Government-run, covers 80% of approved services | High |
| Medigap (Plan G, N, etc.) | Private supplement for the 20% gap | Low |
| Medicare Advantage (Part C) | Bundled private plans with caps | Moderate |
| Part D | Prescription drug coverage | Varies |
| Dual Enrollment (Medicaid) | For low-income beneficiaries | Low/none |
Age & Location
Costs differ by state and ZIP (especially Part D)
Health Status
More visits = higher variable costs
Plan Type
Advantage caps exposure; Medigap stabilizes costs
Income
Higher earners pay IRMAA surcharges on Part B/D premiums
Prescriptions
Drug tier and formulary significantly affect totals
Scenario 1 – Healthy Retiree (Age 67, CA)
Profile: Few doctor visits, low drug use
Recommended: Advantage plan
Annual Cost: $5,400/year
Scenario 2 – Moderate Needs (Age 72, TX)
Profile: Multiple prescriptions
Recommended: Medigap Plan G
Annual Cost: $7,800/year
Scenario 3 – High Medical Use (Age 80, FL)
Profile: Several hospitalizations
Recommended: Advantage plan
Annual Cost: $9,200/year
Q1: Does this include dental and vision costs?
Only Medicare Advantage plans may include these; Original Medicare does not.
Q2: How accurate are these estimates?
Values are based on CMS and insurance carrier averages for 2025.
Q3: What is the Max Out-of-Pocket (MOOP)?
It's the maximum you'll pay in a year for covered services under Medicare Advantage.
Q4: Do Medigap plans cap costs?
No hard cap, but coverage often eliminates most out-of-pocket expenses.
Q5: What is IRMAA?
Income-Related Monthly Adjustment Amount - higher-income beneficiaries pay more for Part B and D.
Q6: When can I change Medicare plans?
During Open Enrollment (Oct 15 - Dec 7) or during Special Enrollment Periods for qualifying events.