What's your worst-case year?

What the Letter Leaves Out, part two. I am not an advisor. I am an engineer, and when engineers want to know whether something is safe, we ask what the worst case looks like. Your plan letter has a line for the maximum out-of-pocket amount, and that line is real. But it is one piece of a bad year, not the whole bill. Nowhere in the letter does it add the pieces together. So here is the arithmetic, with numbers you can check.

What goes into a worst-case year?

On an Advantage plan, four things. The plan's own monthly premium, times twelve. The Part B premium you still pay, times twelve: $202.90 a month for most people in 2026, more if your income triggers IRMAA, the income-related surcharge Medicare adds to Part B and Part D premiums, and the 2027 amount comes out later this fall. The plan's maximum out-of-pocket for covered medical care in its network. And the drug cap: once your out-of-pocket drug costs reach it, you pay nothing more for covered drugs that year, and it is $2,400 in 2027, up from $2,100 in 2026. The medical limit does not include drugs, and the drug cap does not include medical care, so in a truly bad year you can reach both.

What does that add up to?

Here is the math for a plan with a $0 plan premium, which some counties have and availability varies, using the median in-network limit across Maricopa County's 52 standard Advantage plans: $4,425 in 2026 and $4,825 in 2027. The 2027 column uses the 2026 Part B premium as a placeholder until the new one is announced.

Same kind of plan, same $0 premium, and the worst case went up $700, before any change to Part B. At the top of the range, the highest in-network limit among those 52 plans rose from $7,900 to $8,900. For illustration, before any plan premium, that limit makes the worst case $8,900 + $2,400 + $2,434.80 = $13,734.80. And if your plan is a PPO and you see doctors outside its network, there is a separate, higher combined limit on top of the in-network one.

What does the worst case look like on a Supplement?

The pieces change. With Original Medicare, a Supplement, and a drug plan, your worst case is the three premiums for the year, plus whatever your Supplement does not pay, plus the drug cap. With the popular Plan G, the gap Medicare's comparison chart leaves you is the Part B deductible, $283 in 2026. So the Supplement path usually has higher premiums and a smaller, steadier worst case, and the Advantage path usually has lower premiums and a larger worst case. Neither is better for everyone. They are two different answers to the same engineering question: how much risk do you want to pay for in advance?

How do I run my own numbers?

Take your plan's 2027 premium, its in-network maximum out-of-pocket, and the $2,400 drug cap, and add twelve months of Part B. Do the same for any plan you are considering. Then do the friendlier version too: your premiums plus what you expect to spend in a normal year on your own doctors and prescriptions. The worst case tells you how bad it can get. The normal year tells you what you will probably pay. You want to know both before October 15.

What a Certified Medicare Planner® does differently

They put the worst case and the expected case side by side, for your plan and for every plan you might switch to, using your doctors, your prescriptions, and your pharmacy. Then they ask the question no letter can: how much of that risk are you comfortable carrying? The advisors are at 602-281-3898.

Tomorrow in What the Letter Leaves Out: your drug plan. The letter can list changes to the drug list. It cannot tell you what your prescriptions will cost at your pharmacy next year.

Disclaimer: This article is for educational purposes only. It is not sponsored, endorsed, or otherwise representative of Medicare or the federal Medicare program. American Retirement Advisors is not a government agency. For official Medicare information, visit medicare.gov or call 1-800-MEDICARE (1-800-633-4227).