I chose Original Medicare to keep my doctors, but now I'm drowning in bills. Should I have gone with Advantage instead?

Question

Clarence &quot;Mark&quot; Christiansen · Accepted Answer

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.

Answered by Clarence "Mark" Christiansen on April 4, 2025

Agent Licensed in WI, AZ, CA & 16 other states

Answered by Clarence "Mark" Christiansen Medicare Insurance Agent

Jolynn Allen · Answer

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.

Answered by Jolynn Allen on April 21, 2025

Agent Licensed in CO

Answered by Jolynn Allen Medicare Insurance Agent

Marie Terhune · Answer

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.

Answered by Marie Terhune on April 14, 2025

Broker Licensed in NH

Answered by Marie Terhune Medicare Insurance Agent

Sandra Teel · Answer

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.

Leslie Helene Sussman · Answer

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.

Michael Pyers · Answer

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.

Answered by Michael Pyers on April 14, 2025

Broker Licensed in OH & MI

Answered by Michael Pyers Medicare Insurance Agent

DeeDee Whitlock · Answer

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

Robert Simm · Answer

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.

Answered by Robert Simm on April 8, 2025

Broker Licensed in NC, AL, AR & 14 other states

Answered by Robert Simm Medicare Insurance Agent

Fred Manas · Answer

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.

I chose Original Medicare to keep my doctors, but now I'm drowning in bills. Should I have gone with Advantage instead?

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I chose Original Medicare to keep my doctors, but now I'm drowning in bills. Should I have gone with Advantage instead?

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