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

Question

Comfort Olude · Accepted Answer

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.

Charise Karjala · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/i-chose-original-medicare-to-keep-my-doctors-but-now-im-drowning-in-bills-should-i-have-gone-with-advantage-instead#charise-karjala

Clarence &quot;Mark&quot; Christiansen · 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

Gary Church · Answer

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.

Answered by Gary Church on May 19, 2025

Broker Licensed in Ca, AZ, NV & TX

Answered by Gary Church Medicare Insurance Agent

William Lawler · Answer

Yes. Advantage plans cover a lot of the costs that original Medicare does not. Your agent should find an Advantage plan that your doctor accepts.

Robert Moore · Answer

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.

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.

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

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

Steven Bleicher · Answer

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.

Answered by Steven Bleicher on May 20, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

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

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.

Yasmery Vargas · Answer

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.

Answered by Yasmery Vargas on May 15, 2025

Agent Licensed in PA

Answered by Yasmery Vargas 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

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.

Carol Thompson · Answer

That depends on your finances; Medicare Advantage can lessened your cost in medical bills as you will not be paying 20% cost sharing on most things.

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 & 15 other states

Answered by Robert Simm Medicare Insurance Agent

Donnie Vermillion · Answer

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.

Albert Smith · Answer

In my Opinion, Yes, if it is the only option available to you. Supplemental insurance is another option if you can afford the cost.

Kimberly Hargis · Answer

Yessss.  Original Medicare has NO max out of pocket meaning you could go broke with the 80/20 split.

Duane Boebel · Answer

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.

Answered by Duane Boebel on May 27, 2025

Broker Licensed in AL, AZ, FL & 12 other states

Answered by Duane Boebel Medicare Insurance Agent

Melody Manthey · Answer

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.

Answered by Melody Manthey on May 25, 2025

Broker Licensed in MN

Answered by Melody Manthey Medicare Insurance Agent

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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