I picked the plan with the lowest premium, but now every doctor visit feels like a surprise bill. Should I have gone with a higher premium instead?

Question

Charise Karjala · Accepted Answer

Medica policies are very different from one another. You probably came up short with your needs analysis or listen to a friend who suggested their ““ Best” policy.

A careful needs analysis and consideration for finances is the most appropriate way to determine which policy is “best” for you.

If you’d like assistance with this analysis, please contact me for a free consultation at 760-831-2736.

Derrick Clevenger · Answer

There are many factors to consider when choosing your plan: network available in your geography, accessibility of providers & current health conditions. It’s not as easy to evaluate a plan based off premium unload. One needs to evaluate the big picture when choosing a plan.

Answered by Derrick Clevenger on April 7, 2025

Agent Licensed in NE, AZ, TN & TX

Answered by Derrick Clevenger Medicare Insurance Agent

Tasha Riggs · Answer

If I knew what you have I could understand what you have. 
If you got a supplemental with a high deductible then you will be paying 20% of your bills until you hit 2700.  
If you have a medicare advantage and it is no cost you should not have any surprise billing. It should only be the copay shown. I would have to look at your plan to understand what is happening

Robert Simm · Answer

That would be dependent on the medical service you received once you saw your provider and how that claim was coded to the insurance company and then if that claim was paid or not through the carrier. This is a perfect example of utilizing a health insurance broker experience when it comes to your medical expenses. I personally have been in this situation with my clients before and once we've done the investigation traditionally we find the doctor's office was at fault on submitting the CPT codes correctly to the insurance company. To answer your question, a higher premium doesn't always translate to lowering your cost on your medical expenses when you use the insurance and receiving medical treatment.

Answered by Robert Simm on April 7, 2025

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

Answered by Robert Simm Medicare Insurance Agent

Deborah Webster · Answer

We would need to look at what plan your on and compare. I am independent and work with lots of carriers and plan options.

Jerry Cohen · Answer

My first question is did you check to make certain that the providers you value are in the network of the plan you purchased. Second did you clearly understand the plan deductibles for in and out of network care. Were you clear on plan Co Pays in and out of network? Are you receiving services that are covered by Medicare?

Answered by Jerry Cohen on April 12, 2025

Broker Licensed in NY

Answered by Jerry Cohen Medicare Insurance Agent

Louanne Allison · Answer

This question must be for a Medicare Advantage plan which has a zero premium with specific copays for specialists. If a person needs to see their pain management specialist every month as some do, they are required to pay the copay which is generally about $50. There are plans with zero premium and specialist copays of $0-$30 available, but I have to check your zip code and doctor's names to see if they are in-network.

Answered by Louanne Allison on April 14, 2025

Agent Licensed in MI, FL, IL & OH, TN, TX & UT

Answered by Louanne Allison Medicare Insurance Agent

Chris Prang · Answer

What kind of plan did you pick? A Medicare Supplement or Medicare Advantage?

I'm guessing a Medicare Advantage plan. But you've provided too little information about the plan type and your needs for anyone to truly advise you well.

Regards,

Chris

Abigail Turner · Answer

This is definitely going to depend on the type of Medicare plan you've chosen and frequency of doctor visits. With Medicare supplement (also known as Medigap) plans, typically the higher the premium payment means greater coverage from plan letter to plan letter (such as Plan N costs more AND covers more than Plan A but Plan G costs more AND covers more than Plan N). So price can certainly determine coverage. 

With a Medicare Advantage plan, many are $0 premium per month but you WILL be billed or charged copays for any services rendered or doctor visits made.

I picked the plan with the lowest premium, but now every doctor visit feels like a surprise bill. Should I have gone with a higher premium instead?

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I picked the plan with the lowest premium, but now every doctor visit feels like a surprise bill. Should I have gone with a higher premium instead?

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