Medicare Part B vs. Medicare Advantage: What Patients Need to Know (and What It May Cost You
- manchesterphysical
- 1 hour ago
- 4 min read
With major changes coming to Medicare Advantage plans in Vermont—including the loss of United Healthcare and Blue Cross Blue Shield Medicare Advantage—many patients are now deciding between:
Original Medicare (Part A + Part B)
A Medicare Advantage plan (Part C), often through Humana
This decision matters—especially if you use services like physical therapy, imaging, or specialty care. Below is a simple breakdown of how these options work, what they typically cost, and why some patients with Medicare and a Medigap plan may end up paying little or nothing for covered care after a certain point.
Quick Definitions
Original Medicare (Part A + Part B)
Run by the federal government
Same rules nationwide
You can see any provider who accepts Medicare
Predictable costs
Optional add-ons:
Part D (prescription drug coverage)
Medigap (supplemental insurance)
Medicare Advantage (Part C)
Run by private insurance companies
Combines Part A, Part B, and usually Part D
Often includes extras (dental, vision, hearing, gym memberships)
Uses networks, copays, and prior authorizations
Costs and benefits vary widely by plan and can change every year
Monthly Premiums: What Patients Typically Pay
Coverage Type | Typical Monthly Cost |
Original Medicare (Part B only) | ~$185 |
Original Medicare + Medigap | ~$275–$365 |
Medicare Advantage | ~$185–$202 (many plans are $0 extra) |
Medicare Advantage often looks cheaper upfront—but monthly premiums are only part of the story.
The Medicare Part B Deductible (This Is the Missing Piece Most People Don’t Hear About)
Medicare Part B has an annual deductible.
2025 Medicare Part B Deductible
$240 per year
Paid once per calendar year
Applies to outpatient care (doctor visits, physical therapy, imaging, etc.)
Once this deductible is met, Medicare begins paying its share of covered services.
Why Some Medicare Patients Pay $0 After the Deductible
Original Medicare + Medigap
Many Medigap plans are designed to cover:
The Part B coinsurance
Most remaining out-of-pocket costs after the deductible
👉 Once the $240 deductible is met, many patients with Medigap pay little—or nothing—for covered services for the rest of the year.
Example
January–February: you pay the first $240 for doctor visits or therapy
After that:
Doctor visits may cost $0
Physical therapy visits may cost $0
Imaging may cost $0
As long as the service is Medicare-covered and the provider accepts Medicare.
Medicare Advantage: No Deductible, But Ongoing Copays
Medicare Advantage plans often advertise:
“No deductible”
“$0 premium plans”
While this can be true, it works differently:
You usually pay something every time you receive care
Copays continue all year
Costs vary by plan
Costs add up as care increases
Cost Comparison Chart: How the Deductible Changes What You Pay
After the Part B Deductible Is Met
Service | Medicare + Medigap | Medicare Advantage |
Primary care visit | $0 | $0–$30 copay |
Specialist visit | $0 | $20–$60 copay |
Physical therapy visit | $0 | $10–$45 per visit |
X-ray | $0 | $10–$50 |
MRI | $0 | $100–$350 |
Ongoing therapy visits | $0 | Copay every visit |
Physical Therapy: A Major Difference for Many Patients
Original Medicare + Medigap
Any PT clinic that accepts Medicare
No network restrictions
No prior authorization
No visit limits
After deductible: often $0 per visit
Medicare Advantage
In-network only
Prior authorization common
Visit limits possible
Copays every visit
Benefits may change annually
For patients needing ongoing therapy (arthritis, Parkinson’s, balance issues, post-surgical rehab), this difference is huge.
Real-World Cost Scenarios (Annual Estimates)
Low-Use Patient
Few doctor visits
No therapy
Plan Type | Estimated Annual Cost |
Medicare + Medigap | $4,000–$5,500 |
Medicare Advantage | $2,500–$3,500 |
Plan Type | Estimated Annual Cost |
Medicare + Medigap | $4,000–$5,500 |
Medicare Advantage | $2,500–$3,500 |
Moderate-Use Patient
Regular doctor visits
Occasional therapy or imaging
Annual Cost | |
Medicare + Medigap | $4,000–$5,500 |
Medicare Advantage | $2,500–$3,500 |
Moderate-Use Patient
Regular doctor visits
Occasional therapy or imaging
Plan Type | Estimated Annual Cost |
Medicare + Medigap | $3,500–$5,000 |
Medicare Advantage | $3,000–$4,500 |
High-Use / Chronic Care Patient
Regular physical therapy
Multiple specialists
Imaging or hospital stays
Plan Type | Estimated Annual Cost |
Medicare + Medigap | $4,500–$6,000 (predictable) |
Medicare Advantage | $7,000–$10,000 (in heavy-use years) |
Original Medicare + Medigap (Why Costs Cluster Together)
Patient Type | Annual Premiums (Mostly Fixed) | Estimated Out-of-Pocket Care Costs | Estimated Total Annual Cost |
Low-use | $3,000–$4,200 | $0–$200 | $3,200–$4,400 |
Moderate-use | $3,000–$4,200 | $0–$300 | $3,200–$4,500 |
High-use | $3,000–$4,200 | $200–$1,000 | $3,500–$5,200 |
What This Shows Clearly:
Premiums are the main driver
Low and moderate users pay about the same
High users may pay slightly more
Costs are predictable and stable
Why Medicare Advantage Looks Different
For Medicare Advantage:
Premiums are lower
Usage drives cost
Copays add up with each visit
So the spread looks like this:
Patient Type | Estimated Total Annual Cost (MA) |
Low-use | $2,500–$3,500 |
Moderate-use | $3,000–$4,500 |
High-use | $7,000–$10,000 (in heavy-use years) |
What This Means for Vermont Patients in 2026
With fewer Medicare Advantage plans available:
Networks may be smaller
Copays may be higher
Access to preferred providers may change
Understanding the Part B deductible helps patients see why:
Medicare + Medigap costs more monthly
But can lead to very low or $0 costs for care after the deductible
Bottom Line
Part B deductible: ~$240/year
After it’s met:
Medicare pays its share
Medigap often covers the rest
Many patients with Medigap pay $0 for covered outpatient care for much of the year
This is one of the biggest differences between predictable Medicare + Medigap and copay-based Medicare Advantage plans.
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