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?
Answered by 84 licensed agents
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.
Not necessarily! We are coming up to AEP from October 15 to December 7th. I would recommend meeting with a licensed Medicare agent who can help you navigate all the plans available in your area.
Hi, thanks for watching. So the question is, this person picked a plan with the lowest premium, but now every doctor visit feels like a surprise bill. Should that person have gone with a higher premium? Well, the great thing about Medicare Advantage is that you can switch it each year. If you get into a Medicare Advantage plan that has benefits that maybe don't align with what you need, at the end of the year, you can switch to another one. So it's not really about the higher premium or whatever. You have to pick the plan that you feel addresses your needs the best.
You should look at Traditional Medicare and a medi gap plan, you pay a monthly premium, but your only out of pocket is a $288 annual deductible, you pay a premium, but you have predictable costs and no surprizes
The premium may only be part of the issue. It sounds like the person who helped you did not take the time to properly explain the plan and how it works. Whether you chose an Advantage plan or a Medicare Supplement, you should be able to know what your bill will be before you ever have a procedure or visit a doctor. Always confirm with the provider what is going to be done and what it will cost ahead of time. Of course the occasional complication or emergency can arise at which time the provider may need to do something that was not foreseen. This however should be the exception and not the rule.
Lower-premium plans often come with higher out-of-pocket costs when you use services, which can lead to those surprise bills. A higher-premium plan might have given you lower copays and predictable costs — it’s all about finding the right balance between monthly payments and what you pay when you get care.
It depends on why you are getting a bill. There are a few factors that can cause this like for instance, if your plan is a PPO and your doctor is out of the network it would be more expensive to use them. Another example of why it might be more expensive could be because your copays or coinsurance is more on this plan than on the one you use to have.
The best thing to do is to talk with an agent that sells all or most of the plans in your area and make an appointment to review what you have, compared to other plans that may have a higher premium.
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
It is almost impossible to answer that question without knowing what type of plan you selected...a Medicare Supplement or a Medicare Advantage Plan? My guess is a Medicare Advantage plan. If you could confirm that i can answer more intelligently.
The rule of thumb is the less you pay per month for a plan, the more you pay when you use the services and vice versa. You will pay somewhere. Plans are all different and lowest price is not always the best choice.
Premium is definitely NOT the best way to get the best coverage for your personal needs. Make sure to check out all of the details inside of that plan to make sure the plan and network enables you to get your specific wants and needs. Fortunately, you will be able to make a change in plans in the fall, during the Annual Enrollment Period and also during the first quarter during Open Enrollment.
Maybe, selecting a zero dollar plan may not be the best. Also, selecting a plan that is $55 a month doesn't make it better. Find a Local Medicare agent to assist you. Look through your summary of benefits as well as have them compare other plans available in you area.
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Lets be honest though...I believe for the next 2 to 3 years, extra benefits aren't going to be an option so look at your co pays.
- Max out of pocket
- in patient hospital stay
- surgery co pay or co insurance big difference.
- MRI's and CT scans
Go over all of these in a one on one meeting with your LOCAL representative. Make sure to find one that does annual reviews each year. There shouldn't be any sunrises.
It depends if you're talking about a Medicare. Advantage or a Medicare supplement. A Medicare supplement plan g would be a standard premium and then you would pay a deductible once and then there would be no surprises. All bills would be covered if you're having in copays every appointment you go to, then you may have a Medicare advantage. Contact me and we can discuss further.
If I knew what you have I could understand what you have.
If you got a supplemental with a high deductible then you will be paying 20% of your bills until you hit 2700.
If you have a medicare advantage and it is no cost you should not have any surprise billing. It should only be the copay shown. I would have to look at your plan to understand what is happening
Hi, Medicare Misty is back with Medicare Minutes, and the question today is: I picked the plan with the lowest premium, but now every doctor visit feels like a surprise bill. Should I have gone with a higher premium instead?
So, yes, we may want to look at that. A higher premium usually means lower copays, so you'll pay more up front and less when you go. We can take a look at that, so give us a call.
If you have original Medicare and chose a plan like the HDG - or the N plan or K / L there will be copays and deductibles. Medicare will pay after the deductible of 257$ 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.
Sometimes picking the lowest plan can be more of a hassle when you start getting bills, then it is to pick a plan with a medium high monthly premium. With a high deductibles you must come up with the deductible before any of the 20% of me. With a monthly premium a little bit larger you generally only have to cover a small and will deductible instead.
You need to review your summary of benefits and evidence of coverage for your plan. Each plan is different its important to review these before you purchase the plan so you know what you are getting into.
Someone should have explained to you that when you choose a zero premium plan it is a pay as you go plan meaning you will have a co-pay every time you use the plan except for your annual exam. If you think you are getting nickel and dime, it may be time to look at a supplement plan Where you pay a higher premium upfront, but what you have to pay for at the time of expense is either zero or very low.
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.
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.
Hello, too many variables to answer definitively. A higher premium doesn’t always mean lower copay, unless you were choosing between Medicare Supplements only and did not consider multiple Medicare Advantage plans as well.
If you were only choosing between supplements, then you probably made that choice for a reason. If you were relatively healthy at the time of your enrollment you may have thought that you would be saving some money in lower premiums.
When it comes to Medicare Supplements, it’s safe to say that if you’d like the comfort of knowing that your doctor bill will always be $0, as long as the doctor is participating in Medicare, and you met your yearly deductible, you will pay for that comfort in higher premiums, which come every month, whether you see those doctors or not. Are you ok with that monthly commitment?
You may have opted for a high deductible supplement, in which case, once your deductible is met, you should no longer be getting “surprise” bills. However, you may have saved a significant amount in premiums and only incurred the bills when you needed to see a doctor.
Ultimately, I’d ask my client if they are comfortable with “prepaying” for the care they may or may not need vs assuming some of that risk personally. Many times healthier individuals are more inclined to choose lower premium plans with higher deductibles, copays and coinsurance while folks with chronic conditions or family history of serious diseases will opt for paying higher premiums for that extra peace of mind. Every case is unique and there is no standard answer.
Not necessarily. It is important to review your summary of benefits and associated co pays with the different plans that you are deciding between. Most Medicare Advantage plans have a $0 co pay for primary care visits and preventive care. Specialist co pays vary from plan to plan.
Hey, so looking at your question, you picked the plan with the lowest premium and you're getting surprise bills. Without more context, it's kind of hard to know whether you picked a Medicare Advantage plan or a Medicare supplement plan. I'll go on the supplement first. It sounds like you probably picked a high deductible Medicare supplement. They're generally very low premium, but you pay a deductible first.
Next year, we're looking at $2,800. Usually, I recommend those to people who are either very healthy and barely gonna use it at all but still want complete freedom and access, or people who could afford to pay a higher out-of-pocket. So it gives you freedom, access, choice—any doctor, anywhere, at any time. But you do have a rather large $2,800 plus deductible to satisfy before it kicks in 100% like a regular plan.
You would. It could be a Medicare Advantage plan as well. Many Medicare Advantage plans are a very low or no premium, but then you pay copays basically as you do everything other than usually primary care and lab work. So again, it's hard to know which one you have based on this information. But again, hierarchical plans we usually recommend to people who are healthier or at least a whole lot in the Medicare Advantage.
More good news is the type of shopping—you can pick a different plan. Or even if you're unhappy with your high deductible plan, annual normal is time period. We can shop those plans as well. I hope that was helpful and answered some questions for you.
The lowest premium does not equate to the lowest cost. What one should be concerned about is the maximum out of pocket costs on a Medicare Advantage Plan. The other area to pay attention to is the prescription deductible. If you are on a Medicare Supplement, then the most important thing to check for is the highest coverage. Each carrier uses different pricing on Medicare Supplements and in some cases you can get household discounts too. I would always consult to see what conditions you have and the services that you are expecting to use. Some people require more care because they do have chronic conditions and that should be assessed when purchasing a plan.
Lower premium plans often come with higher copays and out-of-pocket costs, sometimes paying a slightly higher premium gives you more stability and fewer surprise bills.
It is important to review your plan's summary of benefits and evidence of coverage in order to make an informed decision regarding which plan is right for you and your budget. For instance, Medicare Advantage Plans has co-pays and deductibles. You could also consider getting a hospital indemnity plan to offset some if not all the out of pocket expenses you're incurring.
Not necessarily. There are many factors involved here but that best thing to do would be to have a review performed to see why you are incurring so much billing. It is recommended you first speak with the providers office to see why this has been the case and then also review it with the current Medicare plan.
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.
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.
Medicare coverage is very personalized care. For this very reason I ask detailed questions that will allow me to know the speicific needs of my clients so that the understand the full scope of their coverage. A higher premium plan does not automatically mean as you state "no surprise bill".
I would love to help you find a personalized plan in the future that caters to your specific needs.
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!
It depends. It depends on what your health was at the time when you were reviewing Medicare Advantages plans. It seems you have Medicare Advantages coverage. If that is the case, & you were in good health & you had no knowledge of a major health outbreak for you before your purchased a Medicare Advantage plan then you made the decision best for you at the time.
Please use a Broker. Thank you.
Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
When evaluating plans there are several points to consider. One is the monthly premium. Two is looking at the copays for various benefits. Three is weighting the possible use volume for each benefit.
An example is a low premium might include a zero copay for a Primary care visit, but have a $30 copay for specialists. So if there are two primary care visits each year that represents a zero copay. If there are three specialists involved and each is visited twice per year that represents $180 in copays.
This should not be a surprise if your agent reviewed your personal medical situation and ran a few what if scenarios to help you understand how each plan works and that is one of the strengths of having a local agent over just some call center.
It depends on what plan you have and how it works. Did you check to make sure the doctor is in network. Or do you have a Medigap plan compared to a Medicare Advantage. If so this could mean the difference between paying for a higher premium plan.
This becomes complicated as premium doesn't always indicate what the plan covers or how well it's covered. There are many $0 premium Advantage plans that have excellent coverage, and there are Advantage plans that have a higher premium, that don't cover as much. So price does not always reflect quality.
That’s a common situation. Low-premium plans often have higher out of pocket costs, copays, coinsurance, and deductibles, which can make routine visits expensive.
Sometimes, a higher premium plan with lower cost-sharing ends up saving money if you see doctors or need prescriptions regularly. It’s all about matching the plan to your healthcare needs, not just the monthly cost.
There is not enough information provided to provide you with an accurate answer. Do you have a PPO Plan? Are you visiting doctors out of network? If it's and out of network doctor, are they charging you for Medicare allowed excess charges? Are there services you are having done that require a co-pay and your benefits were not properly explained to you? Do you have a copy of your Summary of Benefits with you that you can go over and match the medical service to the co-pay?
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.
In most cases the plans I recommend have no premium. I am surprised that usually doctor co pays and costs are in the benefit kit. If you did not receive it, you can usually look online. Every year plan benefits change, so you should review any annual change in benefits companies send every October. If you talk with an independent agent, they should be able to help you select the best plan for you in the area.
A plan with a lower monthly premium, which is the amount you pay just to have coverage, typically comes with a higher deductible. It sounds like the surprise bills you're receiving are the out-of-pocket costs from a high-deductible plan.
I suggest that you do the math. Look at the total cost of your Dr visits, plus the monthly cost of the plan, and compare that to a plan with a higher premium, i.e. the G or N plan. And think about it not for just 1 year, but 10 years. You will likely find the savings to be substantial for the lower premium plan.
If you are incurring more bills than you thought you would you may want to increase your coverage with a higher premium. You can figure this out by looking at your out of pocket expense compared to the difference in premium.
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.
I will answer your question assuming you have a High Deductible Suplement plan. You pay a monthly premium and a desuctible before your plan starts to cover. All Suplement companies have the same plans (G,N, etc) and these have the same coverage. Depending in your age and health it is still possible to revisit this decision.
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.
Whether a higher premium plan would have been better depends on your healthcare usage. Higher premium plans usually offer more predictable, lower costs per visit once the deductible is met.
The higher the premium the lower the deductible. But it all depends on your current health and whether you are willing to pay the higher premium or whether you want to keep your premium low and if you willing to pay out of pocket until you meet your deductible.
This is a difficult question to answer without knowing what type of plan you went with. If you went with a Supplement Plan, there are different levels some have co-pay some do not. If you went with an advantage plan same thing, however I would not be able to answer this question without speaking with you to review what you have. You can contact me, and I will be happy to help you.
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.
That is difficult to answer because I can’t see your benefit structure. Have you contacted the insurance company and ask them to review the benefit structure with you? Did you have a broker that signed you up?
Often, cheaper is not better and you find it’s actually costing you more than you anticipated. Having a licensed agent explain all of the options, benefits and associated costs is a better method to selecting your plan.
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?
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.
Not necessarily! It depends on how often you are going to the doctor. We would want to do the math to see if paying the higher premium (and subsequently having lower copays) makes financial sense than your current plan.
There is no exact right or wrong answer in regards to this. Folks that do not want as many surprises with their bills usually have original Medicare with a supplement and separate Part D plan. If choosing to stay with an advantage plan, the most important thing is your summary of benefits, which a good agent will review with you to ensure your understanding, hence less surprises.
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.
Getting a health insurance plan with a low premium, usually means you will have more out-of-pocket expenses. (think pay now or pay later). If you don't go to the doctor's often it might be adventitious for you to enroll on a low premium plan but if you have medical conditions or simply know that you'll need to see your primary care and/or specialists on a regular basis, then a plan that offers a higher premium with a lower deductible and lower overall out-of-pocket might be the better alternative.
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.
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.
The cheapest premium isn’t always the cheapest plan. You pay one way or the other—monthly or at the doctor’s office. A higher premium often buys predictability, stability, and fewer surprise bills.
Differences in your premium can affect your copays and deductibles. As your agent, I would explain that to you, so you can make an informed decision. You should always be informed as to what your plan includes, and the costs and differences that premiums can affect.
That depends on your area and what plans are offered. The agent that you worked with should have gone over what your copays would be with that plan and make sure you understood the out of pocket costs. If you don't see that many doctors then it may make sense for someone to have a low premium plan because it offsets the few times you see a doctor or hospital. I always look at the big picture with my clients and make sure they are saving the most money throughout the year and are covered exactly how they want to be and have the benefits that matter to them. Most part C medicare advantage plans are a $0 premium or a very low premium and depending on your area the plans with premiums may or may not be better. It also helps to work with a Medicare Broker that is licensed with multiple carriers/companies so you can be sure you are choosing the best one for yourself and your healthcare needs. Hope that helps, happy to review your coverage if you need! Have a blessed day.
It is likely you chose a plan that is Fee for Service or a PPO plan. This is where HMO plans have a slight advantage because HMO plans have contracted and negotiated costs of care. The only want to help you determine the best plan for you is to meet with a licensed Medicare Broker to assess your personal situation.
Sometimes, lower-premium Medicare plans can have higher out-of-pocket and pay-as-you-go costs, which can lead to this feeling if not carefully managed. Understanding your unique situation and selecting a plan based on your medical needs can prepare you for expenses you may face. Working with a licensed insurance agent can help you determine the plan that meets your needs most effectively.
This is a great question. With Medicare Advantage Plans, a doctor's visit should never feel like a surprise! When enrolling, it is the agent's duty to ensure they go over the entire scope of your policy. I would suggest that if you aren't sure what's happening with your plan, or your not aware of the costs associated with specialist visits, lab work, etc, you need to speak with a new Licensed Professional who will explain all plan details to you line by line. "I will be more than happy to do that for you at no cost". Lastly, if you don't want to speak to anyone else about your plan, you can call the insurance company or your broker and request a summary of benefits, which details all costs related to your plan. Feel free to reach out to me anytime.
It depends on your situation. Plans with lower premiums comes with higher deductibles. The higher premium plans would have saved you money with routine visits if it involved lower co pays or waived deductibles. Consider picking a plan based on how often you need to use your health plan in the future. Review your explanation of benefits and be sure to stay with doctors within your network to prevent any surprise bills later.
A qualified local agent should be able to advise you about your co-pays and maximum out-of pocket costs (MOOP) for any Medicare Advantage plan available in your county. The same is true for your estimated annual prescription drug costs under the Part D part of your plan. This is a good example of a reason to become acquainted with a local agent you trust.
There is no blanket statement for which plan is the best. And while premium is an important factor, that can't be the only factor. There are a lot of variables to making sure the plan you choose is right for you.
That depends on the plan. Is it a Medicare Supplement plan or a Medicare Advantage Plan? Just because the premium is lower doesn’t always warrant a bill from your doctor.
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
It depends of which plan you are enrolled, there are low premium or zero premium plans which also have no copays for drs visits, which health plan are you with?
The old adage “you get what you pay for” definitely applies here. A lower premium doesn’t always mean better overall coverage—cheaper plans often come with trade-offs like narrower networks, higher copays/coinsurance, or stricter rules that lead to surprise bills when you actually need care.
Choose coverage based on your medical needs, not just the monthly cost. If you have moderate to higher healthcare usage (frequent doctor visits, specialists, tests, etc.), a plan with a higher premium might save you money in the long run. When exploring new plans figure in you “near future” medical needs may be and calculate cost based on each plans coverages.
