I had an MRI in June at a nearby hospital outpatient center.
When I log onto Medicare.gov/my/claims, I see the MRI code the hospital charged against, and the charge; $15,417.
Medicare allowed $446.50, and Medicare Part B paid 80%, leaving $89.30 to my BCBS Medigap plan. (Separate paperwork from them shows they paid the $89.30; I owed $0.)
So the hospital charge-to-fee schedule ratio was about 30X.
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The grammar is a little confusing. The hospital charged $15417, and the top part of the form says Medicare approved "$15417." However, further down, the actual payment appears, which is "Total Medicare paid the facility was $350.07" (80% of allowed.)
Medicare shows a remaining copay of $89.30 while BCBS paperwork shows $89.30 paid (but nothing about the total amounts).
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In round numbers, my traditional fee-for-service Medicare costs about $200 a month for Part B and another $200 a month for BCBS Medigap—roughly $4,800 a year. Apart from the annual Part B deductible, there is generally little or nothing more to pay during the year.
A Medicare Advantage plan does not eliminate the Part B premium, but it generally eliminates my $200-a-month Medigap premium, potentially saving about $2,400 a year. It may also throw in modest extras, such as a $50 eye exam and $100 toward glasses.
Less visibly, however, Medicare Advantage can bring a festival of copays throughout the year—for specialists, imaging, outpatient procedures, emergency care, hospital stays, rehabilitation, and other services. In 2026, plans may expose members to as much as $9,250 for in-network medical care, or $13,900 in combined in- and out-of-network spending under a PPO. Few members will experience such a train wreck. But by December, an MA member’s accumulated copays can easily consume much—or all—of the $2,400 initially “saved” by giving up Medigap. One M.A. copay average was quoted at $1400/year.
