I chose Original Medicare to keep my doctors, but now I'm drowning in bills. Should I have gone with Advantage instead?
Answered by 83 licensed agents
Basic Original Medicare by itself is just a starting point. It covers doctor visits and hospital stays. You usually pay a monthly Part B premium and must meet yearly deductibles. Original Medicare will then cover 80% of the approved amount, and you're responsible for the remaining 20% of the cost of your care. There is no limit to your out-of-pocket costs each year. Enrolling in a supplement plan is advisable if you want to keep your Original Medicare to cover your share of costs.
Medicare Advantage helps you control costs. The plans support your entire well-being so you can live a better, healthier life. In one package, the plans give you Part A and Part B coverage, plus Part C coverage, and many of them also include Part D prescription drug coverage and other benefits. The plans have limited out-of-pocket costs, more predictable co-pays, and a cap on your yearly out-of-pocket expenses.
If you are only on Original Medicare Part A & B, "Yes", you will have medical bills. Medicare is an 80-20 plan. For Medicare services, Medicare picks up 80%, and you are responsible for 20%. Having a Medicare Supplement or GAP plan, the insurance company picks up your 20% minus the Part B deductible. If you have a life-changing event on a Medicare Advantage plan, you would also be responsible for deductibles and co-payments.
Having Just Medicare A&B and not getting a program to help with the medical cost is not a good thing. In the hospital part B which covers surgery, emergency services Part B Alone will cost 20% of the entire bill which could be thousands of dollars. Simple open heart surgery can be at a minimum of 20-100 thousand dollars. Please this is why Medicare programs help people.
The difference between keeping original Medicare and going to an Advantage plan as far as copays is that they're both gonna have copays. But the difference is original Medicare has no maximum to it. So that means if you hit the wrong illness at the wrong time, you can have quite a bit out of pocket. An Advantage plan would give you a maximum out-of-pocket, meaning once you hit that threshold, you go to 100% coverage. So that is the difference between having original Medicare and an Advantage plan, and the reason why most people don't do original Medicare by itself. Hope this helps.
If you just turned 65 or are still within 6 months of turning 65 you can move to a Medicare Supplement plan that would cover all of your bills after a small deductible. If you have passed this period of time, a Medicare Advantage plan could definitely save you money and give you more benefits like dental, vision, hearing OTC and medications that are built into these types of plans in most cases. Things are changing a little for 2026 you would just need to compare plans for your county and see what all is available. You do have much better options than sticking with Original Medicare.
Not necessarily — Original Medicare offers broad doctor choice, but it can lead to higher out-of-pocket costs if you don’t have a Medigap plan to help cover the 20% coinsurance and deductibles. Medicare Advantage plans often have lower upfront costs, but they use networks, copays, and prior authorizations that can also add up depending on your care. The issue isn’t that Original Medicare was the wrong choice; it may be that your coverage isn’t complete. A review of your total costs, eligibility for Medigap, or timing for a plan change can help determine the best next step.
That can happen with Medicare . Original Medicare pays only 80 percent. That leaves you with 20 percent to pay. Medicare advantage can help with those bills. You may have some copays or deductible's. And with the right plan you can keep your doctors.
This is a nationwide question, and it reads: "I chose original Medicare to keep my doctors, but now I'm drowning in bills. Should I have gone with Advantage instead?" Well, what kind of bills are you drowning in? Is it that your premium for your supplemental policy has gone up? That's a fixed amount, so there shouldn't be a flood of those bills coming in unless you have something other than a G policy. With anything other than a G policy, you can end up with some very significant copays, coinsurance, and overage charges by physicians that don't accept Medicare as full and complete payment. The G policy is the only one that will pay for new Medicare beneficiaries. Obviously, if you aged in before 2020, you would have the F, which is the fabulous plan, but even at that, most of those F plans have gone into G for grades because, as a cost measure, the G is more efficient.
So, back to the question: Should you have gone with an Advantage plan instead? You could have done the research with your Advantage plan and determined that none of your doctors were included in that. The decision you made at that time would have been to keep your doctors. I think the concern here is perhaps you were ill-advised on your gap policy that you procured when you aged in or switched into after purchasing a Medicare policy. There's a lot of bad advice out there, and I want everyone to hear this lesson: Find a broker. Find somebody who's been doing this in your community for a long time or someone who has enough wits about them to understand the bigger picture and is willing to take an hour of their time to do a thorough needs analysis, because that's what needs to happen. We can't go backwards; we can only go forwards. So, gap people, use your birthday rule, find a good agent, and do a policy review. All right, take that one.
I need more information to answer this completely. Do you only have Original Medicare (Part A & Part B) that covers 80%? (Then you are responsible for the other 20% including deductibles.) Do you have a Medicare Supplement in addition to Part A & Part B, that helps cover the other 20%? If you have a Medicare Supplement plan, what Plan do you have? Various plans cover costs and co-pays differently. (You might pay for a Plan F, Plan G, Plan N, Plan L, Plan K, etc.)
Medicare Advantage plans also have various costs, coverage structures and copays, so I’m not sure of you would be better off having gone with a Medicare Advantage plan. Medicare Advantage plans are county specific according to your Primary residence.
Original Medicare and no other coverage is a major mistake because you will be on the hook for 20% of all outpatient charged services with no limit. Medicare Advantage plans are all different but one thing they have in common is something called an Out of Pocket Maximum which will limit your financial exposure every year.
If you went with original medicare only, you may be experiencing extra bills. With a medicare advantage you will still have bills to pay. A medicare supplement may be better for you when all other bills are covered 100% after your $283 annual deductible.
A medicare supplement plan can help cover many of the expenses original medicare does not cover. Just going with original medicare can leave you exposed to a high deductible $1676 for 2025 and 20% coinsurance.
An advantage plan offers services not covered by original medicare such as dental, vision, hearing and part D prescription drug coverage.
Possibly. The only time I recommend anyone to stay on original Medicare is if they are also on the State Medicaid program that will pay for your 20% co-insurance.
There is no maximum out of pocket amount with original Medicare. That means you will continue to pay your 20% with no limit.
If you chose a Medicare Advantage plan there would be a maximum out of pocket amount to help keep your costs under control. Choosing the right Advantage plan is very important. Getting help from a professional Medicare Insurance broker will help you see if your doctors accept Advantage Plans along with which ones they accept. It would also help cover your prescriptions premium because most Advantage plans include prescription drugs.
If keeping your doctors are the most important thing, and they don't accept Advantage plans, you might possibly qualify for a Medicare Supplement plan (Medigap) to help cover your costs.
It's common to be surprised by the costs not covered by Medicare alone. Many people pair Original Medicare with a Medigap policy to help manage those expenses. Others opt for a Medicare Advantage plan for its bundled benefits and cost protections, while accepting potential provider network limitations.
In summary, if you’re struggling with high out-of-pocket bills, it may be worthwhile to review Medigap and Medicare Advantage options during the next enrollment period. This could help you strike a better balance between provider choice and cost control.
If you’d like to explore your specific situation further, consider speaking with a licensed insurance advisor or your State Health Insurance Assistance Program (SHIP) for personalized guidance.
2 ways to reduce cost. 1) Getting a Medicare Supplement and a stand-alone Prescription Drug Plan or a Medicare Advantage Plan. A Medicare Advantage Plan will help lower out of pocket costs compared to Just Original Medicare...
If you went with a Medicare Advantage plan then that would be dependence on your area and what the insurance companies are offering on a Medicare Advantage plan. What I mean by this sentence is if you're on an original Medicare then after your deductible you will pay 20% of any outpatient medical expenses. That 20% could be more than a copayment tied to a Medicare Advantage plan. If you are using a tremendous amount of your health insurance then it would be advisable to compare original Medicare versus Medicare Advantage then if you can qualify for a supplemental plan then it might be worth it to take a look at that product as well to help reduce the cost of your medical expenses.
My advice is to talk to an agent who is well versed on Medicare Advantage and Medicare Supplement plans. With the right plan you should know what your expenses are going to be based on your services , no surprises. For some it’s is Medicare Advantage for others it is Medicare Supplements. Both have advantages and disadvantages. I always explain the fundamental differences between both types of coverages, so my clients make their decisions based on their specific needs.
The answer to this is based on what is most important to you. If you are in a situation where your Doctors were your primary need and expectation - then you made the right choice. The move to Medicare Advantage has the opportunity to limit your expense and definitely limits your exposure, but there are some things that you will have to give up - especially if you choose an HMO type plan. What is most important is that the Broker you work with is aware of your priority list and is helping you make decisions based on what you find to be the most important.
Many people choose Original Medicare (Parts A and B) so they can keep their doctors and avoid network restrictions. However, what often surprises new beneficiaries is that Original Medicare typically only covers about 80% of approved medical costs, leaving you responsible for the remaining 20% with no annual out-of-pocket maximum. That means outpatient procedures, tests, and specialist visits can quickly lead to unexpected bills if you don’t also have a Medicare Supplement (Medigap) plan to help cover those gaps. In contrast, Medicare Advantage plans (Part C) often bundle medical and prescription coverage together, include copays instead of percentage coinsurance, and have a yearly out-of-pocket limit—but they usually require you to use a provider network. If you’re feeling overwhelmed by medical bills, it doesn’t necessarily mean you made the wrong choice; it may simply mean your current coverage isn’t fully optimized for your healthcare needs. At Live Well Benefit Advisors, we help retirees compare Original Medicare, Medicare Supplement plans, and Medicare Advantage options so they can find coverage that protects both their doctors and their budget.
Yes i think you should have gone with a Medicare Advantage Plan. If you are new to Medicare you may still be within your 7 month window to start a Medicare Advantage plan.
if not, The Medicare Annual Enrollment Period (AEP), also known as the Annual Election Period or Fall Open Enrollment, runs from October 15 to December 7 annually. You can select a plan during this time to start for January 1st.
It all depends. While Original Medicare certainly provides access to more physicians and hospitals, it also comes with an unpredictable cost factor. Medicare Advantage is certainly one option to explore, but a good Medicare Supplement would be great for predictable cost without surprises. That's why I say you should always explore your options with a licensed broker like myself. We never charge a fee and we do this everyday.
You didn’t make a wrong choice; Original Medicare lets you keep your doctors, but without a Supplement you’re responsible for about 20% of costs with no cap, which is why bills add up.
A Medicare Advantage plan might lower upfront costs, or adding a Supplement could give you more predictable expenses—it’s just about finding the right fit for you now.
Many people don’t realize that Original Medicare is not complete coverage - it only covers part of whatever medical bill you incur, not all of it, and Original Medicare does not include prescription drug coverage either. Medicare Advantage will give you the additional medical coverage needed, and many policies also include the prescription drug coverage as well as additional benefits like basic dental and vision and hearing.
Without knowing the specifics, it is hard to say. If we are assuming that an Advantage Plan would cover all the same doctors/hospitals and approve all the procedures, then yes, because Original Medicare has no max out of pocket whereas an Advantage Plan does.
Having an advantage plan does not absolve you of bills unless you have Medicaid also. A solution, if you can be underwritten and approved, may be a Medicare Supplement, also known as Medigap. A supplement can pickup most if not all of the part that Medicare does not pay.
The decision to go with Original Medicare or Medicare Advantage is individual and based on several factors. The benefit of Medicare Advantage is having a maximum out of pocket, most plans do not have a deductible and most services are a copay instead of 20%. There are downsides to Medicare Advantage as well. The best way to decide is to meet with a local agent willing to go over your unique situation and determine if a Medicare Advantage plan could be right for you. You may be able to change plans at any time if you meet certain income or health criteria, so go ahead and meet with an agent now. They will let you know when the next enrollment period you qualify for will be.
1. Original Medicare with a Medicare supplement (medigap) plan to assist with the out of pockets in Medicare. You still have the freedom like you do with Medicare only, but with added coverage.
2. Medicare Advantage plan and making sure that your doctors / prescriptions are covered by the plan.
Original Medicare is great coverage when paired with a Medigap policy. Original Medicare Part A & B pays up to 80% of your medical bills. A Medigap policy will pick up the remaining 20% after a small annual deductible is met ($283 in 2026).
It makes me think that you do not have a secondary insurance such as Medigap. This would mean that you have up to 20% out of your own pocket.
With Medicare Advantage, you have out of pocket in the form of Co-pays for services. But it's not unlimited as there is a Maximum annual out of pocket for these plans. Once you hit it, then the plan typically pays all the medical costs after that.
Original Medicare paired with a Medigap policy is more comprehensive coverage for medical, but you have a separate premium to pay for the Medigap policy.
The Medicare Advantage plans can be $0/mo in some areas.
Nope. But you need to contact your agent who can explain what you bought at age 65. You also have a “Trial Right” before you turn age 66. This gives you the one-time chance to move over to an Medicare Supplement plan, at your discretion without having to answer any medical questions.
Sounds like when you went with original Medicare you didn’t add a Supplement which is a major mistake. Medicare only pays the first 80% but there is no cap on how much the 20% can be because there is no stop loss point. You either need a Medicare Supplement or Advantage plan , one or the other. If not you can incur great cost.
If keeping your doctors was your top priority, Original Medicare + a Medigap plan would have been the most protective combo (since Medigap pays most or all of those deductibles and coinsurance).
If cost protection was more important than provider freedom, Medicare Advantage would have limited your financial risk.
What You Can Do Now
Check if you can still switch:
You have certain periods (Annual Enrollment, Open Enrollment, or a Special Enrollment if you qualify) to move into Medicare Advantage or add a Medigap.
Timing matters, so your window may still be open depending on when you first enrolled.
Run the math:
Add up your typical out-of-pocket bills with Original Medicare.
Compare that with premiums + copays under a Medicare Advantage plan or Medigap. Sometimes the “expensive premium” is actually the cheaper move long-term.
Ask about networks:
If you lean toward Advantage, make sure your doctors and hospitals are in the network. That’s usually the dealbreaker.
Actually, a Medigap plan might have been a better fit for you. Once you have met your Part B deductible, you would be done paying for Medicare Approved services. However, now if you have certain pre-existing conditions, you may not be able to sign up for a Medigap plan.
I never recommend Original Medicare by itself. You either need a Medicare Supplement to go with it to pay the 20% coinsurance or you should take Medicare Advantage. Original Medicare alone has NO maximum out-of-pocket, so you will cost-share every claim with them in one way or another. Medicare Advantage will also cost-share many claims, but the difference is that it has maximum out-of-pocket protection so you’re not paying forever on large claims.
If you would meet with a LOCAL Senior Market Specialist they can show you different Medicare Supplemental plans available to you that cover those copays, coinsurance and deductibles
Original Medicare can bleed you dry. When you have a chance review your options with a broker, it's never too late to review your Medicare options as a supplement could work or Medicare advantage could work.
I always say to my clients not to just have Original Medicare since it will only cover at 80% plus a yearly deductible. Both Medicare Supplement and Medicare Advantage will help to reduce Medical bills vs a 20% co-insurance with Original Medicare.
If you are Outside of your 6 month Guaranteed Issue for Medicare Supplement - Check with a broker about qualifying with Underwriting Review. If this option is not within your budget then yes check to find out if Medicare Advantage is an option outside of the Annual Enrollment Period.
If you never signed up for Part D (RX plan) you may have a penalty so also talk to a local broker and find out about qualifying for any state programs to eliminate penalty.
The real question here is: Do you have a supplement to cover what Medicare doesn't cover. Did you know that Parts A and B only cover 80% of your medical? You will need a supplement to pick up the other 20% as well as a Part D, prescription drug plan. If you have all of these in place it is very reasonable to expect that your bills can be manageable and in many cases.
Depending on the types of medical services and the anticipated co-pays you will have, a Medicare Advantage or a mediab supplement plan maybe a good option for you. A Medicare Advantage plan may provide you with slightly lower copays under 20% and include several additional benefits for ancillary products and services. Whereas a Medicare supplement plan will act as a secondary to original Medicare and cover your 20% copays once in annual deductible is met. However the supplement plan does not usually include any additional benefits including prescription coverage so you would need at the very least to also enroll in a standalone Part D plan.
Either of these types of plans may help you to have lower overall costs.
Not necessarily. Advantage plans have "gaps" too, we call those co-pays, and co-insurance. I don't recommend that anyone choose Original Medicare alone, you need to pair with with a Medicare Supplement plan that will cover the gaps and protect your retirement income against those out of pocket costs.
In many cases, Original Medicare with a supplemental plan can offer a lower out of pocket than what you might find on an Advantage plan, while also giving you more freedom and flexibility.
The question assumes that the beneficiary does not have a Medicare Supplement as secondary coverage. The Medicare Advantage plan option would put a maximum out of pocket (MOOP) medical copays limit. These limits normally range from $3,000 to $7,000 in a calendar year. The Medicare Advantage plans typically have a flat copay or percentage of the approved Medicare amount.
If you enroll in a Medicare supplement, you would have minimal costs after your Medicare Part B deductible. With an Advantage plan, you have inpatient and outpatient copays.
Possibly. Original Medicare includes Part A - Hospital and Part B - Medical. In general, this takes care of 80 percent of normal healthcare costs. Original Medicare requires that you pay the remaining 20 percent. Should you require care that can be expensive, such as surgery, treatments, hospitalization, etc., your portion can get out of hand. On the plus side, Original Medicare does not restrict you from using any doctor or specialist you want. Not just locally, but all over the United States. That said, you might want to see if your doctors and specialists belong to any networks called Medicare Advantage Prescription Drug (MAPD) plans. Many doctors accept MAPDs. If you are able to find an MAPD plan that your doctors accept, you could minimize the 20 percent you are paying now. Also, these MAPD offer other benefits like Dental, Vision, Prescription Drug saving's and low copayments for office visits. Remember, under an HMO plan you must stay within your network. If you like, a PPO cost more but will have higher costs when using out of network doctors and specialists.
Medicare options and the direction people take depends heavily on their particular situation. If you only have traditional Medicare, then a Supplement plan is strongly encouraged to fill in the gaps of Medicare A/B alone. But if it's not affordable to pay additional premium for a Supplement plan, or you are outside of the window for guaranteed issue and your health has declined, then yes, a Medicare Advantage plan would be the better option.
I woul like to know what kind of bills are you drowning in? Original Medicare by itself is not good thing, because it has no cap. Did you pick up a Medigap plan to cover the 20% and deductibles? To me that would be the only reason you might be drowning in bills. I would not say that a Medicare Advantage plan is the way you should have gone, it all depends on your individual circumstance. Did you sign up when you were just turning 65? Do you have a lot of medical issues, if so then Original Medical with a Medigap plan might have been the best way. However, some people cannot afford a Medicap then a MAPD would be good way rather than just Original Medicare A & B.
And I want you to know you are not alone in this. This is one of the most common conversations I have, and it breaks my heart every time because it didn't have to happen this way.
Nobody sat down with you and showed you the full picture. That's not your fault. That's a failure of the system — and honestly, it's exactly the reason I do what I do.
Original Medicare lets you see almost any doctor, but the bills can add up fast since there’s no yearly limit. Medicare Advantage usually costs less out-of-pocket, but you have to stick with in-network doctors. The right choice depends on whether you care more about doctor choice or keeping costs predictable.
Medicare Advantage is one option to supplement Original Medicare. Fortunately, in the markets I work in there are options available with strong networks that allow beneficiaries to continue to see many providers in multiple medical groups. Medicare Supplement plans, also commonly called Medigap plans are a second option to protect Medicare beneficiaries from high out-of-pocket costs. I would be happy to discuss both options to see which one is the best solution for you.
Many people make this choice under the guidance of the staff at their doctor's office. Depending on your health and circumstances, you may be eligible for a Supplement plan that would have paid for many of the bills you are receiving. If you don't qualify, then yes an advantage plan may have helped with those bills, but you may not have gotten the same care. If your concern was keeping your doctors then an Advantage plan may or may not have been able to do that depending on networks available in your area. With a good agent you would have been able to review that scenario before having received care to help plan ahead.
Many providers like Original Medicare because there are no restrictions on the care they want to provide but they also fail to take into consideration the 20% that will be left for you to pay. Your needs, both medical and financial should be considered. Find a local agent in your area who may be able to see if you qualify for a Supplement (aka Medigap) or review Advantage options, depending on your circumstances.
If you're finding Original Medicare bills are overwhelming, a Medicare Advantage plan might be worth considering.
Original Medicare offers flexibility in choosing providers, BUT it lacks an out-of-pocket maximum which could lead to potentially higher costs for those with significant health needs.
Medicare Advantage (MA) plans often have lower premiums and include a limit on out-of-pocket (OOP) spending, thereby offering some financial protection. However, these plans typically have provider network restrictions and may require prior authorization for certain services, which might not be ideal if you need to see a specific doctor or travel frequently.
If you are drowning in bills, it sounds like you did not enroll in a Medicare supplement policy. Remember, Medicare pays 80% and you are responsible for the 20%, after you have paid the Part B deductible, which is $257 in 2025. If are are still within 6 months of your Part B enrollment date, you can sign up for a Medicare supplement policy and still be in a guaranteed issue timeframe, meaning you are not subject to health questions (most states). If you are past your Part B date, you still may qualify to enroll in a supplement. You need to speak with a qualified and experienced health insurance agent who focuses on Medicare and is local to you.
YES! Original Medicare can be very costly. At least on a Medicare Advantage plan you have a cap on costs. Always use a LOCAL LICENSED AGENT who brokers many different companies. BROKERS MAKE A DIFFERENCE!
You have 2 choices for coverage beyond original Medicare. Medigap is also commonly referred to as a Medicare supplement. Medigap plans do not have networks. Advantage plans do have networks. On Medigap, as long as your doctor is willing to bill Medicare, they will accept your Medigap plan and will lower costs like the Part A deductible. It will cover co-pays that you are currently paying on original Medicare. Work with a local reputable agent who can help guide you to appropriate plans and coverage.
If you kept original Medicare, you should’ve looked into a Medigap policy because it has a one time annual deductible and once you met that deductible it will cover the gaps that Medicare does not cover but if you only kept AMB then yes you’re going to have to pay 20% of all charges so I would suggest you contact a local agent which I am and I would be happy to come out and help you thank you
You should have spoken to a professional agent to guide you to making the proper decision for your overall healthcare. If you are attached to your doctors and the service providers, then a medicare advantage or Medicare Supplemental plan may make a better plan for you so that you are not getting hit with the 20% that original Medicare will not cover.
Maybe. All MedicareAdvantage plans have copays, deductibles and MOOP. (Maximum Out of Pocket costs). It is a different way to insure yourself. Both Original Medicare and Advantage plans have put of Pocket costs. It is good to speak with a knowledgeable agent to compare what is covered under each plan.
Well, if you're on original medicare and drowning in bills, it tells me you probably don't have a medicare supplement, and therefore, you're having to pay the unlimited 20% since original medicare has no cap. If you couldn't qualify for a Medicare supplement due to your health, then Medicare advantage could be better for you them original medicare because it at least will give you a cap, a Max out-of-pocket, a worst case scenario that you'd have out-of-pocket every year. If you stay on original medicare, there's an unlimited 20% you will be billed
Yes, either Medicare Advantage or Medicare Supplement (MedSup). In both choices, you may keep your doctors. A licensed agent can guide you through the best path to fulfill your particular needs. Between October 15 and December 7, you can apply for a new Medicare Advantage plan that will be effective on Jan/01/2026.
For MedSup, you have 6 months from the month you turn 65 and have Part B, during which you are guaranteed acceptance. After that, you'll be subject to underwriting and you're not guaranteed acceptance. MedSup also has a monthly premium, besides the Part B premium.
Maybe. There is no one-size-fits-all answer to this question. It is all a matter of budget and individual circumstances.
I have some customers with 10 million dollar houses in gated communities, and the gaps in Original Medicare, even in large claim scenarios, might put a slight dent in their finances.
For most of my middle class book of business, having to pay the gaps in Parts A and B, might spell financial ruin.
If you go with a Medicare Advantage substitute to Original Medicare, make sure to have your agent check your providers and medications first. If you can not find your providers, go to the next plan.
Another alternate is to keep Medicare as the primary payor and if your finances allow, think of purchasing a Medicare Supplement plan and pair it with a Prescription Drug Plan.
An Advantage may not (or possibly may depending on it's network) have allowed you to keep your doctors. Look into a Medicare Supplement (Medigap) plan which would allow you to keep all Medicare participating doctors and also limit your per visit, per procedure expenses.
You need to choose either a Medicare Advantage or Medicare supplement to cap your out of pocket costs. You need to confer with a seasoned medicare agent who can help you determine which is better for you.
Before switching over, look what parts of your actual plan works in your actual situation and have someone help you add supplemental coverage to minimize you financial exposure
Depending on the Medicare advantage plan your doctor may be in network that is one of the first things. A licensed agent should check for. Yes original Medicare covers 80% of the cost and you’re responsible for the other 20% with Medicare advantage plan you know what your cost are Whether they’re in network or out of network.
As you might know Original Medicare only pays 80% for any services rendered so you would then be responsible for the remaining 20%, which could be a lot depending upon what you needed to have done medically. Medicare Advantage would certainly help with the additional 20% costs but those plans do have copays, co-insurance and deductibles. They do offer additional benefits like drug coverage, hearing and dental. You can change from Original Medicare to a Medicare Advantage Plan during the Annual Enrollment Period October 15th to December 7th, and the plan will become effective January 1.
Yes going with advantage plans might reduce your out of pocket cost because advantage plans has maximum out of pocket not like original Medicare also original Medicare you are responsible for 20 percent they only cover 80 percent which can add up quite of bit to your cost.
If you chose original Medicare and are drowning in bills, it sounds like you have ONLY original Medicare, where Medicare pays roughly, 80% of the Part A hospital and Part B medical expenses. You could have went with a Medicare Supplement with a guaranteed issue the first year of turning 65, and paid a monthly premium (how much would depend on which Supplement Plan you chose, they start with the letter A and go to the letter N (some are no longer available)), or you could have chosen a Medicare Advantage Plan. If reviewed correctly, and you consider everything from networks, copays, etc., then you can make a well informed decision. October 15 to December 7 is the window to consider a Medicare Advantage plan. If you are still in your 65th year of age, you can get a Medicare supplement without any health questions. If you are drowning in bills, and are over 65, it could have a higher premium, or you may no longer be eligible for a supplement, it would need to be reviewed to be certain (did you delay enrolling into Part B for example). Reach out to a broker in your area to see how they can get you into a better position moving forward. We cannot change the past but we can try and help you make well informed decisions for the future.
It's possible. Medigap plans may have been a better option for you at the time. Your current situation, type of ailments, and your doctors play a key role in making a sound decision.
My professional opinion is: At the bare minimum please have a Medicare Advantage even if you are healthy and don't feel the need to attain any additional coverage outside of Original Medicare. Your health can be assessed at the time of enrollment and a recommendation can be provided by a licensed agent. You are under no obligation to enroll. This will protect you from having an unknown amount of medical expenses should "God, forbid" anything happens. Medicare is a federal benefit and is not an insurance. I would highly reccomend that you assess your specific needs at the time you initially enroll or during your Annual and Open Enrollments.
You didn’t necessarily make the wrong choice — you just chose the option that gives you the most freedom, but also the most exposure to out-of-pocket costs.
Why Original Medicare Feels Expensive
No cap on medical spending. With Part A and B alone, the bills keep coming — there’s no yearly limit to protect you.
20% coinsurance adds up fast. Especially if you have specialists, imaging, or ongoing treatments.
If you don’t have a Medigap plan, you’re paying the difference yourself.
Why Medicare Advantage might have helped
Lower monthly premiums (many plans are $0).
Built-in financial protection: Advantage plans have an annual max-out-of-pocket, so there’s a limit to how much you’ll spend in a year.
Extra benefits like dental, vision, hearing, and gym membership often included.
But here’s the trade-off
To get those savings, Advantage plans:
Use networks, meaning you may not be able to see all your doctors.
Require prior authorizations more often.
May treat out-of-network care as not covered.
So it’s not about regret — it’s about choosing what matters most:
🔹 Doctor freedom? → Original Medicare (preferably with a Medigap for protection).
🔹 Lower bills and cost protection? → Medicare Advantage.
What you can do right now
If you’re drowning in bills, you can look into:
A Medigap plan (if you qualify for an enrollment window).
Switching to a Medicare Advantage plan during an enrollment period if the network fits your doctors.
Programs that help with costs, such as Medicare Savings Programs or Extra Help.
You’re not stuck — you just need a plan that better matches your health and your budget
It’s understandable to feel overwhelmed, but you’re not alone in this situation.
Original Medicare (Parts A and B) gives you the freedom to see almost any doctor, but it doesn’t cover everything. You’re responsible for 20% of most medical costs after deductibles, and there’s no yearly limit on what you can spend.
Medicare Advantage (Part C) plans, by contrast, usually have fixed copays, an annual out-of-pocket limit, and often include drug, dental, and vision coverage — but they work within provider networks.
You don’t necessarily need to switch right away, but during the next enrollment period, it’s worth comparing plans to see if an Advantage option could better fit your medical needs and budget.
Of what use is keeping out-of-network doctors, hospitals and pharmacies, if a beneficiary can not afford the cost of their services and prescriptions? A thorough plan comparison done by a licensed agent, shows the relative cost-effectiveness of each plan in and out-of-network. Costs are generally lower when the providers, hospitals and pharmacies are in the same network. An in-network PCP also easily switches to an equivalent generic type of an expensive brand-name prescription drug as needed.
Most prescriptions written by an in-network provider would often qualify for true out-of-pocket cost if not on a plan carrier's formulary. It does not make sense to remain in plan that has just dropped Part B give back of about $185/month, which reduces deductions from SSA check, just to retain a provider. Conversely it will not make sense to drop an in-network provider who saves a beneficiary up to $5000/month in prescription and hospitalization costs to save $185/month Part B Giveback.
Possibly! I would recommend sitting with an agent and reviewing your options. Look to see how the plan works and what your usage is. If you are just covered by Original Medicare, you are responsible for deductibles and the 20% coinsurance for Part B, as well as the deductible and copays for Part A. Medicare does not have a cap, so you will not have that stop-loss that you would have with an Advantage Plan.
To help you determine whether a Medicare Advantage plan might better meet your needs, I would ask; Are your providers all in a Medicare Advantage Network? Do you typically incur high coinsurance amounts each year? Are you okay with referrals and prior-authorizations? Medicare Supplements allow you to see any doctor that accepts Medicare while Medicare advantage plans typically use a HMO/PPO network.
While Original Medicare can be a good options, it can definitely be costly without the proper supplement plan in place to offset some of the costs that you are experiencing. A Medicare Advantage does cap those out of pocket expenses in a calendar year, through co-pays, but it could give you some relief on the large out of pocket costs. I would suggest you sit down with a licensed broker who can provide you with both options so that you can make an informed decision about which direction works best for your particular situation.
