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

Derrick Clevenger · Accepted 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

Charise Karjala · 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.

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

Misty Bolt · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/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#misty-bolt

William Gray · Answer

You have not provided enough information. 

If you have original Medicare and chose a plan like the HDG - or the N plan or K / L there will be copays and deductibles. Medicare will pay after the deductible of 257$ 80/20. These plans all have different variations of copays so it will likely cost you different copays when you go to the dr. 

If you chose a Medicare Advantage plan you have replaced original Medicare with this plan and therefore you will have to read that plans summary of benefits to determine your copays and out of pocket costs. 

You can reach out to me if you need help understanding what you have and what costs you can expect.

John Budde · Answer

Higher premiums are not necessarily the answer. You have to work with a Medicare Broker who is willing to deep dive into your specific needs and doctors. The different Plans offered through carriers for Medicare Advantage have different benefits.

Answered by John Budde on May 29, 2025

Broker Licensed in IA, NE & SD

Answered by John Budde Medicare Insurance Agent

Misty Scaggs · Answer

When you say the word "premium" I am assuming that you currently have a Medicare Supplement that pays secondary to Orginal Medicare. If so can you please tell me what letter plan you have so I can know exactly what you cost would be for the doctor visits. It usually is printed on your ID Card. It could be "N", "G", "K"....etc.

Answered by Misty Scaggs on June 14, 2025

Broker Licensed in MO, FL & IL

Answered by Misty Scaggs Medicare Insurance Agent

Steven Bleicher · Answer

Yes. You know the expression: “You get what you pay for”. In the case of plans covering your health, the same thing applies. But, If you are still in the 1st year of Medicare, you are entitled to a benefit known as a “trial right”. This means that as long as you have yet to turn age 66, you can exercise that right (with no medical questions being asked) and acquire a Medicare Supplement or a Medigap plan with a monthly premium. When you were about to enter Medicare, I doubt that you spoke with more than one agent. If you had, you would have received lessons from 2 to 3 different agents, giving you a variety of rules which demonstrate the quirkiness of our illustrious healthcare system!

Answered by Steven Bleicher on May 23, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Steven Lovell · Answer

It depends if you're talking about a medicare.Advantage or a medicare supplement.A medicare supplement plan g would be a standard premium and then you would pay a deductible once and then there would be no surprises.All bills would be covered if you're having in copays every appointment you go to, then you may have a medicare advantage.Contact me and we can discuss further.

Answered by Steven Lovell on May 26, 2025

Broker Licensed in GA, CA, FL & 7 other states

Answered by Steven Lovell Medicare Insurance Agent

Rachel Armstrong · Answer

Picking a Medicare plan is very personal. It's not just about the premium - it's about how the plan fits your specific needs. The doctors you see and the medications you take can greatly affect your out-of-pocket costs. That's why it's so important to consider the prover network and the drug formulary before choosing a plan - there are the areas where unexpected bills often come from.

Answered by Rachel Armstrong on June 9, 2025

Broker Licensed in GA, AL & FL

Answered by Rachel Armstrong Medicare Insurance Agent

Mike Henry · Answer

Depends on the plan you chose. True supplement or advantage plan. Your agent should have told you which is better plan

Toni Chavez · Answer

Thanks for your question!

I can give you a yes or no response but what I can recommend is talking to a broker who represents the plans in your county.   They can compare plans, doctor ls and medications and recommend what is the best for your situation.

Most consumers don’t realize when you call an 800# you will only get the plans for that carrier.

As a broker our services are no cost, and our main job is to make sure we are doing a needs analysis with each client.  If you have an agent and they aren’t doing this yearly you have the wrong broker.  

Always remember if you sign up for a plan during annual  enrollment (Oct 15 - Dec 7) you can switch your MAPD during open enrollment (Jan 1 - Mar 31).  I always advise my client that switch plans to try it out for 60 days and if it’s not working we can switch you before March 31st.

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

Jaye Maxx Alexander II · Answer

The agent didn't ask the correct questions to put you on the proper plan. The entire process cannot be rushed to get a plan that will have lower out-of-pocket costs. You must make sure that your premiums are maxed out so that your out-of-pocket expenses are lower. AEP is Oct 15 - Dec 07, 2025, for the 2026 season.

Answered by Jaye Maxx Alexander II on May 14, 2025

Broker Licensed in NC, AK, AL & 47 other states

Answered by Jaye Maxx Alexander II Medicare Insurance Agent

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

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 & 15 other states

Answered by Robert Simm Medicare Insurance Agent

Glenn Soucek · Answer

Although you chose a low-premium plan, you may have been surprised by the bill after visiting the doctor. Your Medicare agent should have explained the co-payments associated with your doctor visits so that you wouldn't be caught off guard. You may be surprised by the bill because you haven't met your deductible. These are important questions that a consumer should ask their agent, and it is also the agent's responsibility to provide this education.

Answered by Glenn Soucek on June 17, 2025

Agent Licensed in IL

Answered by Glenn Soucek 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

Adam Ashby · Answer

Higher premiums are not necessarily the answer. You have to work with a Medicare Broker who is willing to deep dive into your specific needs and doctors. The different Plans offered through carriers for Medicare Advantage have different benefits. They will often soften some benefits in one area to make them more robust in another. The key is for you to communicate what your primary needs and concerns are and EXPECT your Broker to do the research to find the plan best for you.

Answered by Adam Ashby on May 19, 2025

Broker Licensed in CO, NE, UT, WA & WY

Answered by Adam Ashby Medicare Insurance Agent

Bud Griffin · Answer

Not necessarily. Premiums are not the only thing you should look at when comparing plans. Plan benefits vary from one plan to another. Comparing plans benefits available in your zip-code is important whan shopping for your chosen plan.

Answered by Bud Griffin on June 23, 2025

Broker Licensed in TX

Answered by Bud Griffin 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.

Robert Evans · Answer

Is this a Medicare Advantage plan or ACA plan? Please clarify so I can provide an accurate answer.

Richard Kozlowski · Answer

Not necessarily. You should review with your agent.

Crystal Cornett · Answer

I need to know what plan you picked, what state you’re located as well. A higher premium doesn’t mean the best coverage. Are you on a advantage plan or are you doing a gap with a plan D