Medicare Advantage vs. Medicare Supplement: Which Is Right for HNW Pre-Retirees in North County San Diego?

The short answer for most North County clients: Original Medicare paired with a Medicare Supplement (Medigap). UCSD Health and Scripps Health — the two tier-1 hospital systems most North County professionals already use — are not in the network of most Medicare Advantage plans serving this market. That single fact reshapes the entire conversation.

This is the same play Mayo Clinic uses on the national stage. If you want guaranteed access to a top-tier system, Original Medicare + Supplement is how you keep it. Medicare Advantage may save you on monthly premium, but it can quietly cost you the relationship you already have with a Scripps cardiologist in Carlsbad or a UC San Diego specialist in La Jolla.

That said — Medicare Advantage isn’t a bad product. For the right client, it’s the right answer. The job here is to put real numbers on both paths and pick the one that fits your medical life, not the one with the louder TV commercial.

The fundamentals first: A, B, C, D in plain English

Before we compare plans, draw a line in the sand. Parts A and B come from the federal government. Parts C and D come from private insurance companies. That distinction does most of the heavy lifting in this conversation.

• Part A — Hospital coverage. Inpatient stays, skilled nursing, hospice. Premium-free at 65 for most people, because you paid in through payroll taxes for at least 40 quarters.
• Part B — Doctor and outpatient coverage. Doctor visits, surgeries, lab work, imaging, durable medical equipment. The standard 2026 Part B premium is $202.90/month. For high-income households, IRMAA adds a surcharge — more on that in a minute.
• Part C — Medicare Advantage. A private insurance company takes over your A and B benefits and bundles them, usually with prescription drug coverage and extras like dental, vision, and gym memberships. You give up Original Medicare’s open architecture in exchange for a managed-care experience.
• Part D — Prescription drug coverage. A standalone private drug plan you pair with Original Medicare. Inside Medicare Advantage, drug coverage is usually built in.

That’s the whole map. Two products from the government, two products from insurance companies. Once you see it that way, the rest of this page is just math.

Why UCSD Health and Scripps Health change everything in North County

Here’s the part most national Medicare content misses: the network reality on the ground in North County San Diego.

UCSD Health (UC San Diego Health) and Scripps Health are the two tier-1 systems serving North County. They run the major hospitals, the cancer centers, the specialist clinics. Most of our clients — Carlsbad executives, Encinitas founders, Rancho Santa Fe wealth-holders, Del Mar and Solana Beach professionals — already see physicians inside one or both of these systems.

Most Medicare Advantage plans available in San Diego County do not include both Scripps Health and UCSD Health in their networks. Some include neither. The plans that do offer access often restrict you to specific medical groups, require referrals to see specialists, and can drop providers between plan years.

Original Medicare, by contrast, is accepted by both systems. Walk into any Scripps Clinic, UC San Diego Health center, or affiliated specialist office with Original Medicare + a Supplement, and you don’t think about networks. You don’t think about referrals. You don’t think about whether your oncologist is “in” or “out” this plan year.

This is the same logic that drives HNW clients to Mayo Clinic nationwide. Mayo only accepts Original Medicare. If you want access to the world’s best diagnosticians for a complex case, Medicare Advantage is the wrong door. Same play, scaled down to North County.

If you’ve spent twenty years building a relationship with a Scripps cardiologist or a UC San Diego neurologist, the conversation about Medicare Advantage is short.

What Original Medicare + Supplement actually feels like

Imagine your current PPO health plan. Now strip out the deductible. Strip out the copays. Strip out the network restrictions. Strip out the referrals. Strip out the prior authorizations. Add in roughly 96% of doctors and hospitals nationwide.

That’s Original Medicare with a Supplement (specifically Plan G or Plan N — we’ll cover the difference below). It’s going to look and feel like the sexiest PPO plan you’ve ever had.

The structure

• Part A covers hospital. Premium-free for most people.
• Part B covers doctors and outpatient. $202.90/month standard premium in 2026, more if IRMAA applies.
• Medigap Plan G picks up almost everything Original Medicare doesn’t pay. The only out-of-pocket you’ll see is the annual Part B deductible — $283 in 2026. After that, your covered medical costs run to zero.
• Part D drug plan covers prescriptions. Average plan premium is around $46/month in 2026, more or less depending on the drugs you take.

You can see any doctor, any specialist, anywhere in the country, no referral needed, as long as they accept Medicare. That’s open architecture. For HNW clients who don’t want to think about networks during retirement, the higher monthly premium is the cost of removing that anxiety. Most decide it’s a bargain.

G for great, N for nice — the two Supplement plans worth your attention

There used to be ten standardized Medigap plans. Today, two matter for most new enrollees: Plan G and Plan N.

Plan G — for great

Plan G covers everything Medicare Part A and B don’t pay, except the small annual Part B deductible ($283 in 2026). After you hit that deductible — usually one or two doctor visits in January — your covered medical costs for the rest of the year are zero. Surgery? Zero. MRI? Zero. Specialist visit? Zero. Hospital stay? Zero. Higher monthly premium, near-zero variability after the deductible.

Plan N — for nice

Plan N has the same architecture as Plan G, with slightly lower premium and slightly more skin in the game. You pay up to $20 per office visit and up to $50 per ER visit (waived if admitted). Plan N also doesn’t cover Part B excess charges, which matters in some states but rarely in California, where most providers accept Medicare assignment.

The math

Plan N typically runs $25-40/month less than Plan G. If you have fewer than 15-20 office visits a year, Plan N comes out ahead. If you have a complex condition with frequent specialist visits, Plan G wins.

For HNW clients valuing predictability over savings, Plan G is the default. Plan N is the right answer when monthly cash flow matters and the client expects light medical usage. Either way, both are widely available in San Diego County and underwriting rules in California give you flexibility to switch later.

When Medicare Advantage is actually the right answer

I don’t villainize Medicare Advantage. For the right client, it’s magnificent coverage.

Where Medicare Advantage wins

• Clients without an established relationship with a tier-1 hospital system
• Clients who don’t use concierge medicine and don’t anticipate complex specialist needs
• Clients who value zero monthly premium over network freedom
• Clients in markets where the major systems are in the MA network — Los Angeles County is a good example, with several MA plans there including UCLA Health and Cedars-Sinai

In LA County, I’ve placed clients into Medicare Advantage plans with no monthly premium, no deductible, $0 primary care, $0 specialist, $0 labs, $0 hospital. Magnificent coverage — as long as you’re okay using a primary care doctor in their network. The primary care doctor is the quarterback in that system. Without a quarterback, the play doesn’t run.

Where Medicare Advantage struggles for HNW North County clients

• UCSD Health and Scripps Health network gaps
• Prior authorization requirements that slow down complex care
• Annual network changes that can drop your specialist mid-year
• Maximum out-of-pocket exposure that can hit $9,350 in-network in 2026, higher when out-of-network care is involved

There isn’t a Goldilocks porridge in the middle here. Either you want open architecture and you pay for it, or you accept the network in exchange for a lower premium. Pick the side that matches your medical life.

Side-by-side: Original Medicare + Supplement vs. Medicare Advantage

The IRMAA reality for HNW pre-retirees

If you’re reading this in Rancho Santa Fe, Del Mar, or anywhere along the North County coast, IRMAA is part of your conversation.

The basics

The Income-Related Monthly Adjustment Amount is a Part B and Part D surcharge based on your modified adjusted gross income from two calendar years ago. For 2026 premiums, Social Security looks at your 2024 tax return. The average American pays $202.90 a month for Part B in 2026. At higher income brackets, you’ll pay the big pound of flesh.

2026 Part B brackets (single filer; double the income thresholds for married filing jointly)

• Up to $109,000: $202.90/month
• $109,001 – $137,000: $284.10/month
• $137,001 – $171,000: $405.80/month
• $171,001 – $205,000: $527.50/month
• $205,001 – $500,000: $649.20/month
• Above $500,000: $689.90/month

Part D IRMAA layers on top, ranging from $14.50 to $91.00/month depending on the bracket.

For a married couple in the top bracket, you’re looking at $1,379.80/month combined just for Part B. That’s before your Supplement premium, before Part D, before anything else.

Two key planning points

1. The two-year lookback. Social Security is always looking at your tax return from two calendar years ago. If you retire and your income drops, your IRMAA drops too — but with a two-year lag. Some clients file Form SSA-44 to request a “life-changing event” reconsideration when they retire, which can accelerate the relief.
2. HNW IRMAA never goes to zero. Even in retirement, with portfolio income, RMDs, capital gains, real estate income, deferred comp, and Roth conversion strategy — most HNW clients stay above the bottom bracket forever. We plan around it, not against it.

IRMAA is unpleasant. It’s also non-negotiable. The number is the number. We name it, we plan for it, we move on.

A real-world frame: The concierge medicine client

A client came to me last year with concierge primary care from a Pasadena physician — annual retainer plus per-visit fees, the whole structure. We walked through Medicare Advantage. The MA plan available in his market was extraordinary on paper: $0 premium, $0 most copays, dental, vision, gym membership. Magnificent coverage by any objective measure.

Then we asked the right question: does the concierge doctor accept Medicare Advantage?

He didn’t. He only accepted Original Medicare.

Once we put a number on what the client actually valued — the concierge relationship he’d built over a decade, the autonomy to pick specialists at any tier-1 system, the absence of prior authorization friction — Original Medicare + Supplement was the obvious answer. The higher monthly premium wasn’t a cost; it was the price of removing every network anxiety from his life for the next thirty years.

This same conversation happens every week with North County clients who already see Scripps or UCSD physicians. The math runs the same direction.

The Medicare Execution Process^®: how we get from question to plan

Here’s the sequence we walk every client through. Methodical, one step at a time, no skipping ahead.

1. Map your medical relationships. Which physicians do you see? Which systems? Concierge or traditional? Any complex conditions or active specialists? This determines whether networks matter for you.
2. Quantify your IRMAA exposure. Pull your most recent tax return. Model your retirement income picture. Identify which bracket you’ll land in and what that means for Part B and Part D premiums going forward.
3. Run the Supplement vs. Advantage analysis. Real numbers, both paths, in dollars per year. No hand-waving.
4. Choose the lane: Plan G, Plan N, or Medicare Advantage. Once the lane is picked, we shop the available carriers in San Diego County for the right combination of price and stability.
5. Place the plans — A, B, Supplement, D — in the right sequence. Part B enrollment timing matters. Supplement underwriting matters. Part D needs to align with your prescription list.
6. Annual review. Part D plans change every year. IRMAA brackets shift. Health changes. We rerun the analysis every fall during the Annual Enrollment Period.

That’s the process. 1,300+ HNW enrollments across 40+ states have been placed using this sequence.

Frequently asked questions

Can I switch from Medicare Advantage to a Medicare Supplement later?

Sometimes. Outside your initial enrollment window, switching from Medicare Advantage to a Medigap plan typically requires medical underwriting, and you can be declined for pre-existing conditions. California has stronger consumer protections than most states — the “California birthday rule” lets you switch between Supplement plans annually without underwriting — but moving from Advantage to Supplement after your initial 6-month Medigap open enrollment window is not guaranteed. This is why the decision at age 65 matters. It’s easier to start on Supplement and switch to Advantage later than the reverse.

Are Scripps Health and UCSD Health in any Medicare Advantage plans?

Some, but the network depth is limited and changes year to year. Even when one of these systems is “in network,” not every physician within the system, every specialist, or every facility may be available to you. Original Medicare gives you uniform access across both systems with no network parsing required.

Does Medicare Advantage actually save HNW clients money?

Rarely, when you account for total cost. The headline savings — zero or low plan premium — can get absorbed by maximum out-of-pocket exposure on a serious diagnosis, prior authorization friction, and the time-and-energy cost of working around network restrictions. For someone who never gets seriously sick, MA can save real dollars. For someone who has a heart event or a cancer diagnosis, the math can flip the other way fast.

What’s the IRMAA appeal process if my income drops?

File Form SSA-44 with documentation of a qualifying life-changing event — retirement, work reduction, loss of pension income, divorce, death of a spouse, loss of income-producing property. The Social Security Administration reviews the appeal and can adjust your IRMAA bracket prospectively, without waiting two years for the tax return cycle to catch up.

Do I have to enroll in Part B at 65 if I’m still working?

Not always. If you have creditable coverage through a large employer (20+ employees), you can usually delay Part B without a late enrollment penalty, with a Special Enrollment Period when employment ends. Smaller employers, COBRA, retiree-only plans, marketplace plans — these are different stories with different math. Bring the Summary of Benefits and we’ll quantify the right move.

How does the Medicare Execution Process^® work?

The Medicare Execution Process^® is a structured planning engagement: discovery on your medical relationships and income picture, IRMAA modeling, Supplement vs. Advantage analysis, plan placement, and ongoing annual review. Most North County clients book the initial 30-minute call to determine fit. There’s no cost to the planning conversation — Brian is compensated by carriers when plans are placed, at the same rate regardless of which carrier you choose.

What if I live in Carlsbad, Encinitas, Del Mar, Rancho Santa Fe, Escondido, or Oceanside?

Network availability varies block by block in North County. The Scripps Health and UCSD Health footprint runs differently in coastal Encinitas than it does inland in Escondido. We map each client’s actual physicians and facilities against each available plan’s network before placement.

Schedule a 30-minute Medicare planning call with Brian

Brian McArthur has placed 1,300+ HNW Medicare enrollments across 40+ states. He works with pre-retirees referred through financial advisor channels and through Design My Medicare^®’s North County practice.

The first call is structured: 30 minutes, no obligation, no slide deck. We’ll cover your medical relationships, your income picture, and the right product fit. If we’re not the right partner, you’ll know in the first 10 minutes.

Book a no-obligation review at go.designmymedicare.com/brian

Phone: 619-885-0556
Office: 20366 Elfin Forest Rd, Escondido, CA 92029

Brian McArthur is a licensed insurance agent. Design My Medicare^® and the Medicare Execution Process^® are registered trademarks. Premium figures cited are 2026 standard amounts published by CMS; individual premiums vary based on income (IRMAA), plan choice, and carrier. This page is for educational purposes and is not a solicitation for any specific insurance product. Not connected with or endorsed by the U.S. government or the federal Medicare program.