I picked a Medicare Advantage plan based on the low premium, but now I'm facing high copays. Did I make a mistake?

Question

Tony Capraro III · Accepted Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/medicare-advantage-low-premium-high-copays-mistake#tony-capraro

Nikki Rowland · Answer

Typically a Medicare Advantage plan does not cost a monthly premium but you do have Co-pays as you use the services. That is how these type of plans are designed. Without knowing specifics, it's hard to say if your choice was a mistake or was just not explained properly.

Answered by Nikki Rowland on April 16, 2025

Broker Licensed in SC & NC

Answered by Nikki Rowland Medicare Insurance Agent

David Bell · Answer

Probably not. Premiums are long term, co-pays are short term. The cost of Medicare Supplement premiums are often thousands per year and will always go up. You will always pay them, whether you use the plan or not. On the other hand,you will only have copays when you use the services, and servies are often not long term. Part B medications like chemotherapy often have a 20% copayment but it is short term. Durrable Medical Equipment like an oxygen concentrator would also be 20% and is probably long term, but it's about $30 per month.

When you join a Medicare Advantage plan with low premiums, I always suggest using your new savings on the cost of your prior health plan to build yourself a little savings account. If you have $2,000-4,000 saved, you will never worry about copayments. Planning and budget make all the difference. 

If you are really worried about the copays, talk to your agent about options to move to a Supplement. If you are healthy it is usually not a problem. There are also guaranteed acceptance plans if you are not healthy.

Andrew Bennett · Answer

I tell people that I truly believe that most everything inside Medicare is better than most everything outside of Medicare.  That being said I do think some decisions are better than others.  

Medicare Advantage plans do have disadvantages.  One disadvantage is that you have co-pays for every little thing that happens.  Most of the time those co-pays are pretty reasonable.  I'm not sure what part of the country you are in to know how your plan stacks up against others though...and what is a "high copay" to some might not be to others.

In general with Advantage you pay less each month, but you have to be ready to pay more when big things happen.  With traditional Medicare and a supplement you pay more monthly, but generally pay much of anything when you go to get care.

Marianne Engengro · Answer

Depending on how often you are using the plan benefits and/or if you are close to reaching the out of pocket maximum stated on your plan, is how to determine if a plan is cost effective for you.

Steven Bleicher · Answer

Seniors have been surveyed and THE most worrisome question from those who are about to become eligible for Medicare usually at age 65 is: Did I make the right decision?  Since there is absolutely no "cookie-cutter" plan which is perfect for everybody, there are many considerations to be aware of in making this extremely important decision. Here are many of the aspects of that decision: A) How is my current health and what is my family's health history?, B) What is my financial status?, C) Do I take multiple drugs and if so, are they mostly generic or Brand Name drugs?, D) Should I consider coverage for the more expensive aspects of Dental, Vision & Hearing which Medicare only covers the "routine aspects" of those 3 topics? 

So, since the Advantage plan should have been totally free since it is subsidized by the
Federal Government/Medicare, there is always a give & take with a free plan. Yes, there should have been a zero premium. But, in return the "take" is that every single Advantage plan contains a deductible. The average one in my State of AZ is around $3,000.00 or less. That means that if you were hospitalized, depending upon the rules of YOUR Advantage plan, there will be some out-of-pocket costs that you will have to bear. Then in the next calendar year, the deductible will start all over again.

However, if you are within the first 12 months of having joined Medicare, you should consider exercising "your Trial Right"!  This means that as long as you have yet to turn age 66, you can drop the Advantage plan in favor of the alternative or a Medicare Supplement plan which has a monthly premium but NO deductible (except for the 1-time per year Part B Ded'l.) whatsoever!  If you used a "Captive Agent" who can only offer an Advantage plan, that's where your error was, in not getting a 2nd & even 3rd opinion on your plan options.

Cleo Martin · Answer

That's the difference between z supplement and an advantage. Pay me now, supplement or pay me later, advantage. Th Advantage does have a maximum out of pocket, moop. But with a supplement you know exactly what your costs are for the year. The Part B deductible plus the premium for the supplement. With Advantage you aren't sure. You don't pay until you use it. There is the maximum for the year, but you feel like you are being tickled and dimed. The best way to describe it is---pay me know or pay me later. The now is the supplement every month. The later is the Advantage; which you pay as you use it. You have to decide which you are comfortable with. The consistency of the supplement payment or the surprises of co-payments when you use it.

Answered by Cleo Martin on May 1, 2025

Agent Licensed in SC, AL, FL & GA, MI, NC & TX

Answered by Cleo Martin Medicare Insurance Agent

Steve Brauer · Answer

There is never a "one size fits all" approach to picking a Medicare Advantage Plan. If you have high copays, you most likely have other benefits to that plan that maybe other plans do not have. The best part, is that you can switch your plan once, and sometimes twice, a year!

Answered by Steve Brauer on April 8, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Robert Simm · Answer

Maybe. There are zero premium plans in your market that could have lower co-payments and it would also depend on the use of your coverage and how many providers you're currently seeing at this time. I always recommend a second opinion on Medicare Advantage plans it is worth it to see if you can save some money on your medical expenses.

Answered by Robert Simm on April 7, 2025

Broker Licensed in NC, AL, AR & 15 other states

Answered by Robert Simm Medicare Insurance Agent

Rachael Metcalf · Answer

This is such a hard question to answer sometimes as an agent. It usually needs more conversation to say that. Or for me to ask questions to get to the bottom of why that is a good thing or not for you. But getting any form of coverage is not a mistake.....at least you have coverage right now.

Answered by Rachael Metcalf on April 17, 2025

Agent Licensed in TN, FL, GA & 5 other states

Answered by Rachael Metcalf Medicare Insurance Agent

Betty McCarty · Answer

Navigating Medicare options can be overwhelming, so we want to make sure you have clear and helpful information to guide your decision. Below, we’ve outlined key details about Medicare Supplement (Medigap) and Medicare Advantage plans, along with a few simple steps to help estimate your costs.

Medicare Supplement (Medigap):

•	Medigap plans typically have high monthly premiums.
•	However, they often provide reduced or no costs for care and services, giving you peace of mind when accessing healthcare.

Medicare Advantage:

•	These plans generally offer lower or no monthly premiums.
•	You may need to pay copays for certain care and services.
•	The good news is that preventive services are usually covered 100%.
Estimating Costs for Medicare Advantage Plans: If you're wondering whether your Medicare Advantage plan is the best option for you, here's a simple way to compare costs over time:

1.	Calculate Medigap Monthly Premiums and Deductibles: Add up the monthly premiums for a Medigap plan, including any deductibles, to get a clear picture of the total cost.

2.	Determine Drug Card Expenses: Find a drug card that best suits your needs and calculate the monthly expense, including deductibles. Be sure to check your drug tier levels and account for any drug card deductible.

3.	Assess Copay Expenses for Your Advantage Plan: Add up the copays for care and services covered under your Medicare Advantage plan. Don’t forget to include any drug deductibles you may be paying.

Since healthcare costs can vary from year to year, it’s helpful to project these expenses forward for a few years to understand the potential savings. For example, while you might pay $1,400 in copays for a hospital stay lasting 5+ days one year, you might not need hospital care the following year at all. These variations in cost are important to consider.
We hope this information helps you make a confident choice regarding your Medicare plan.

Kris Neupauer · Answer

You I haven't made a mistake but it's one of the trade offs that comes with not having a premium or having a very low premium. The important thing to do is make sure you're working with a agent or a broker who can provide you with multiple options and they review your plan with you annually making sure that if you're on an advantage plan and you might think that it is time to switch to a supplement, they will give you the best advice on the next steps, if eligible.

Answered by Kris Neupauer on May 1, 2025

Broker Licensed in MN, ND, SD & WI

Answered by Kris Neupauer Medicare Insurance Agent

Sophia Davis · Answer

There are many factors that go into ensuring you are on the correct plan for you. I would really need more information in order to answer this question. Please feel free to reach out to me Monday-Friday 9am-6pm (330) 967-5232.

Answered by Sophia Davis on April 21, 2025

Agent Licensed in OH

Answered by Sophia Davis Medicare Insurance Agent

Calvin Fritz · Answer

It sounds like you're experiencing one of the potential downsides of Medicare Advantage plans, where low premiums can be offset by high copays and other out-of-pocket costs. This can definitely feel like a mistake, especially if you expected more predictable costs.

Think Long-Term. Medicare Advantage plans can work well for some people, but if you expect to need frequent care or have specific providers in mind, it might be worth reconsidering whether Original Medicare with supplemental coverage might have been a better option. The key is finding a balance between premium, copays, and your healthcare needs.

Darla Anderson · Answer

The best way I can describe a Medicare Advantage plan is it is similar to pay-as-you-go. If you would like to see ways to avoid some of those larger costs, feel free to reach out. I can explain the differences between Original Medicare and Medicare Advantage and your options now.

Answered by Darla Anderson on April 17, 2025

Broker Licensed in NE, CO, FL & 5 other states

Answered by Darla Anderson Medicare Insurance Agent

Gene Page · Answer

Its a little bit like picking out  car, it all matters on your personal preferences. Any car will get you there but you have to consider all costs, like gas consumption, cost of repairs, comfort, how much you drive, and so forth. Not any one car fits everyones personal budget or preferences. 

Many people like the cost-free premium. Some plans may include cash back on your part B premium, healthy food allowance, Dental,Vision and Hearing benefits, no-referral networks, more inclusive Rx coverage, or many other possibilities. To afford all these additional benefits, your plan is likely to balance it with higher co-pays, higher out-of-pocket limits, and more exposure on hospital/day costs and other areas. Each plan is given a budget and they hope to customize it to be most attractive to potential members. A good agent will assist you in reviewing the areas of need you are most concerned with and help you make the best choice for those needs. Sometimes, needs or preferences change and during the Annual ebrollment each year, you will be able reasses what is a comfortable risk level for you.

Sometimes, you have other options as well. If you are within the first year of having an Advantage plan, you may wish to return to original medicare and purchase a Medicare Supplement plan. You will have a considerably higher monthly cost, but most things during the year will be covered. It will not have all the "extras" that an Advantage plan may offer, but it will cover your medical costs better.   You may also be able switch to a different Advantage plan mid-year if you meet certain cryteria. If you qualify for Medicaid, if you are going into or out of a care center, if your plan is not rated as 5-stars and there is a 5-star plan in your area, or maybe you have moved. 

Talk with a qualified agent. It will never cost you anything to use that service.

I picked a Medicare Advantage plan based on the low premium, but now I'm facing high copays. Did I make a mistake?

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I picked a Medicare Advantage plan based on the low premium, but now I'm facing high copays. Did I make a mistake?

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