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

I picked a Medicare Advantage plan based on a low premium, but now I'm facing high co-pays. Did I make a mistake? We hear that all the time. You wanna work with someone like me who can offer both Medicare supplement and Medicare Advantage to tell you all the good and bad, all the pros and cons about Medicare Advantage and Medicare supplement. The Medicare Advantage commercials, the 1-800 numbers, all of that, they make a ton of money from the government for selling those plans. Don't get me wrong, we offer those too, but in the right situations, they fit perfectly. You should know the differences between Medicare supplement and Medicare Advantage. The Medicare Advantage plans blind you with the low premiums or zero premiums, and then on the back end, out-of-pocket costs can be anywhere from $4,000 to $10,000 a year. I saw one of those Friday, $10,000 a year maximum out-of-pocket with a zero premium. So if you have health issues or you're going to the hospital, seeing doctors on a regular basis, or God forbid you have cancer or a heart condition, you're gonna hit that $4,000 or $10,000 out-of-pocket with a Medicare Advantage plan every year. So work with someone like me who can offer both. Good luck.

Gary Church · Answer

When selecting a health insurance plan. It’s very important to work with a Medicare agent, who will take the time to understand your needs to review your options for the year. The cost is important but being able to get the care you need is as important. You’ll have to keep your current plan until the end of the year. Your opportunity to change is October 15 until December 7 for a January 1 start date. I hope this answers your question.
Bay Area Health solutions 
Gary

Steve and Sue 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 and Sue Brauer on April 8, 2025

Broker Licensed in AZ & CA

Answered by Steve and Sue Brauer Medicare Insurance Agent

Mike Alexander · Answer

The needs of everyone is different  so its important to have a trusted advisor to do a needs assesment to be sure the plan you pick meets your needs.
You do have options if you selected the wrong plans and you may have some options to change plans.

Daniel Brechin · Answer

If you purchased a MA plan.  It was not explained?
I would like to set down with you and see if I can Help you.
If I can help you 
Daniel Brechin
Contact me.

Norman Smith · Answer

Medicare Advantage plans are front loaded for what you will see as savings. Problem is when you come across needing major issues you will easily reach your MOOP (Maximum Out of Pocket). And if you should need something major, it can be rejected or delayed. For example you may be told you need to have a stint or a bypass, but the directors of the MA Plan may require you to do another stress test or blood work before they agree that it’s a necessary procedure. And if you do, they will tell you where to go - you have no choice. So MA plans limit your freedom of choice. And now with the cutbacks in MA plans acceptance and allowances, the availability of a qualified medical professional may be harder to find.
With Open Enrollment coming, I would encourage you to explore going back to Original Medicare and taking an acceptable Medigap plan. The price now may be a little more than a MA Plan , but in the long run, you will have better control and options for your health, and may pay less in the long run!

Terri Reagin · Answer

Not Necessarily. New plans are being released every year between Oct 15-Dec 7. Contact your local agent to make sure you are on the right plan for you!

Pamela Masters · Answer

It depends. The best way to choose a plan is decide the 3-5 most important things you want in a plan, then with the agent helping you, look at the plans and also check medications and doctors. Make sure you give the agent at least an hour and a half to go over your plan choices. . When they are done you should have a very clear understanding of the plan. If not keep asking questions

Answered by Pamela Masters on September 27, 2025

Broker Licensed in NC

Answered by Pamela Masters Medicare Insurance Agent

Charise Karjala · Answer

The question is, I picked a Medicare Advantage plan based on the low premium, but now I'm facing high copays. Did I make a mistake? Buyer's remorse, right? I don't know. Honestly, if your primary objective was to have a low premium or a zero premium, then perhaps that's fine. If you were tricked into getting a policy based on a low premium and now you have high copays, that's unfortunate. This is part of the challenge of having Medicare agents going out and selling in a community and only representing one product.

Compare that to people like me. We're brokers, and we work for multiple carriers. We have the opportunity to do a needs analysis, which involves 12 variables. Then I can go through my available products, which are around 75, and make a recommendation for maybe three or four that would meet your needs. That's why you want to work with a broker and avoid going to the selling events. They can be kind of fun if you're going with your friends and having coffee, but if you want a very good fit and no buyer's remorse, contact an agent who has access to lots of different carriers.

We are called brokers. There are two things I want to tell you, and I'm not sure if I'm going to have enough time. Number one, the Medicare Advantage annual election period is stated as being from October to December. I want you to know that there's also an open enrollment from January until March 31st, which is a much quieter and saner period to be making changes. So I invite you to take the pressure off and contact one of the wonderful agents through this hub. Ask them who they represent and be satisfied that you're not being sold, so you won't have buyer's remorse.

Edward Smith, ChFC, CRPS, AIF · Answer

Not necessarily. I think you must look at, what is the chance I am going to have ongoing health issues? Are you going to have to pay these co-pays every year? And also, even if you do, Will these copays equal more than the monthly premium, I would have paid for a Medicare supplement and a standalone PDP plan? You may consider buying a hospital indemnity plan. These policies help with out-of-pocket copays and still cost less than Medicare supplements. You can use them in conjunction with your Medicare Advantage plan.

Answered by Edward Smith, ChFC, CRPS, AIF on June 23, 2025

Broker Licensed in OH, GA, IN, KY & TN

Answered by Edward Smith, ChFC, CRPS, AIF Medicare Insurance Agent

Lynn C Shurtleff · Answer

The rule of thumb is the less you pay per month the more you pay when you use the services and vice versa. If you pay $0 per month for a plan, you will pay somewhere and usually that is higher copays for things like out patient surgeries and in patient hospitalization. The Annual Enrollment Period and the Open Enrollment Period January through March offer you the opportunity to change your plan which might be recommended in your situation.

Answered by Lynn C Shurtleff on November 14, 2025

Broker Licensed in TN, AR, CO & 6 other states

Answered by Lynn C Shurtleff Medicare Insurance Agent

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

Justin Doherty · Answer

Perhaps. If you're in a "season" where you have frequent health needs, you will certainly pay more out-of-pocket costs. However, if your year-after-year health is consistently healthy, you may still spend less with your Medicare Advantage plan. That being said, if your health is costing you high copays and you anticipate continued healthcare needs, you may want to consider switching to a Medigap policy if you're able. Either way, you're going to pay, you just have to decide which way fits your needs best.

Answered by Justin Doherty on August 25, 2025

Broker Licensed in PA, CO, CT & 11 other states

Answered by Justin Doherty Medicare Insurance Agent

Michael Denniston · Answer

When choosing a Medicare Advantage plan the best thing to do is list the Dr's. you need, the prescriptions you take also the hospitals and clinics you would use. Number one, find out if all of your must have Doctors are covered in any plan and network you chose. Make sure your drugs are covered then compare co- pays and total out of pocket for the year. Each year you can change plans during AEP (annual enrollment period) if you find yourself on the wrong plan. It does happen to a lot of people who join without guidance. You may also qualify for an SEP (special enrollment period) you are un aware of. Call us today if you find yourself in this position.

Answered by Michael Denniston on June 8, 2025

Agent Licensed in FL, AL, AR & 11 other states

Answered by Michael Denniston Medicare Insurance Agent

Nick Mangini · Answer

That is why Medicare Advantage plans are deceiving since most people get them because it's a low premium but we all know the saying... "nothing in life is free" and that especially pertains to insurance. I would highly suggest getting a Medicare Supplement plan because there are NO copays and everything will be covered with Plan G!

Answered by Nick Mangini on August 24, 2025

Broker Licensed in FL, AL, AZ & 32 other states

Answered by Nick Mangini Medicare Insurance Agent

David Wiley · Answer

No, absolutely not!  Premiums for med supps go up 8-16% a year and you. Also have to have a stand alone Part D as well.  What you save in not paying premiums more than covers your copays!

Ravi Natarajan · Answer

Not exactly. You get what you pay for. It is also very important that your doctors, prescriptions and Hospitals are covered by your Medicare plan.
A Medicare Plan, as a minimum has to have equal or better coverage that FFS Original Medicare.

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.

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

Daniel Maisel · Answer

Hi, I'm Dan the Medicare Man, Daniel Maisel with Insurance Solutions. I'm responding to a message, a question that says, "I picked a Medicare Advantage plan based on the low premium, but now I'm facing high co-pays. Did I make a mistake?" Well, no, not necessarily. It's really important, though, to investigate all these plans. That's what you have an agent for. Yeah, like myself. I'm a certified healthcare professional, licensed with over 100 companies just in Southern California alone. Oh, there are over 67 plans, and I represent different states. But it's important to know how these plans work. None of them, I don't care what they are, no matter what you tell me, none of them are 100% free. There is no plan that does that. Anyone who tells you that doesn't know what they're talking about. That's why you deal with a certified, licensed healthcare professional, a licensed agent or broker.

Now, when you have a Medicare Advantage plan, that's an HMO. People think, "Oh, HMO is bad; PPO is good." Most people confuse them. They don't even know what a PPO is. A PPO is not much different than an HMO. They're both organizations, and if you're going to one of those, its design is to help maintain low insurance costs, not just for you but also for the insurance companies and even for Medicare.

You have PPOs. Does that mean you can do whatever you want? No. You might be able to go outside the network for it, but when you do, guess what? Your co-pays are high. So that's what you're giving up. You got the freedom to some degree, but they're still part of an organization. Other people choose a supplement. You pay a monthly fee, but the purpose of that is you can go to absolutely any doctor in the country, and they pay all the rest of these things that sometimes Medicare Advantage does not cover.

So, a Medicare Advantage plan, some of the procedures you might go through only pay on an 80/20 basis. So you need to know that depends on what it is. That's what your agent's job is. What I deal with on a regular basis is people making decisions when they're 65, and it's more of an emotion. They hear these stories, "Oh, I had this done. I had my heart issue or this or that, and I paid nothing. Everything was free, free, free." There's no plan that exists that is 100% free on everything. The closest you can get to that is a supplement, which costs on a monthly basis.

Check with your agent, have them review with you. Make sure that they explain it to you so you have a full understanding of how the system works. That way, you can get the maximum benefits of whatever plan you have. So I hope that was helpful.

Jennifer McDonnell · Answer

Many seniors pick a Medicare Advantage plan because of the low premium and the extra benefits like dental, vision, hearing, gym, over the counter, and overlook the high 'out of pocket maximum' or the high copays.  They overlook the fact that the plan is an HMO or a PPO and that they should stay with doctors who are in those networks.

Most Medicare Advantage copays are relatively low if you stay out of the hospital.
A trusted independent Medicare advisor can give you a more thorough understanding of your plan and other options you may have.  Usually Medicare Advantage works well for most people.

Joanna Finnegan · Answer

It's always good to know all your options prior to enrolling. Everyone has different needs and concerns. You could look at other Medicare Advantage plans in the areas to see if there is one available with lower copays, or you could look at Medicare Supplement options with higher premiums but much less out-of-pocket as you use your plan.

Answered by Joanna Finnegan on August 6, 2025

Broker Licensed in ID, AR, AZ & 31 other states

Answered by Joanna Finnegan Medicare Insurance Agent

Donna Berube · Answer

I don't believe you made a mistake, a Medigap & prescription drug plan would be significantly more money. Always try to be in network, you pay less copayment in Network. If your income is low, you can also apply for some assistance, through Medicaid or extra help for prescription drugs.

Answered by Donna Berube on August 20, 2025

Agent Licensed in NH

Answered by Donna Berube Medicare Insurance Agent

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.

Joseph Ritter · Answer

What You Can Do Now:
Review Your Plan’s Summary of Benefits

Check which services have high copays.

Look at your prescription drug coverage to spot any gaps.

Use the Annual Enrollment Period (Oct 15 – Dec 7)

You can switch plans once a year to find better coverage or a plan with lower out-of-pocket costs.

Consider a Medigap Plan Instead

If you prefer predictable costs and freedom to choose providers, Original Medicare + Medigap + Part D might be better — but premiums are usually higher.

Talk to a Licensed Agent

They can help compare plans side-by-side based on your doctors, medications, and budget.

Quick Tip:
Don’t cancel your current plan until your new coverage is confirmed — you don’t want a coverage gap.

Joseph Lipski · Answer

It depends on the plan. Some Medicare advantage plans have higher costs than others. It all depends on the network and if your doctors are in the network or not. There are many variables that go into this, which is why you should review your plan annually.

Answered by Joseph Lipski on September 21, 2025

Broker Licensed in NJ, CA, DE & 17 other states

Answered by Joseph Lipski Medicare Insurance Agent

Patrick Hecht · Answer

Not necessarily, a low premium doesn't always mean it's the wrong plan, but it does highlight why it's important to look beyond just the monthly costs. Medicare Advantage plans often trade low premiums for higher copays, coinsurance, or narrower networks. You might not have made a mistake, but rather picked a plan that doesn't match your current usage or health needs. The good news is, you're not stuck; there are review periods like the Annual Enrollment Period (Oct 15-Dec 7) and sometimes Special Enrollment Periods where we can re-evaluate your plan and potentially switch to one with more predictable out-of-pocket costs. I'd be happy to walk you through it and help you plan for next year, or explore options now if you're eligible.

Answered by Patrick Hecht on May 20, 2025

Broker Licensed in VA, CA, MD, PA & WV

Answered by Patrick Hecht Medicare Insurance Agent

Harshil Patel · Answer

It would be best to speak with an agent to review your options. You may have options to make a change if the plan selected is not working for you, based on your individual circumstances. Alternatively, you can review the list of covered medicines (called a formulary) with your doctors to see if there are other medication options.

Answered by Harshil Patel on January 12, 2026

Broker Licensed in NJ

Answered by Harshil Patel Medicare Insurance Agent

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.

Steve Houchens · Answer

It’s hard to know with limited knowledge of the situation is hard to know if you made a mistake. There are many plan with low to zero premiums and there can always be additional out of pocket costs. The most important thing to know is there are inexpensive ways to fill those gaps and reduce costs such as Hospital Indemnity plans. It’s important to understand your coverage and work with an agent that explains these things so you fully understand what you are getting and what to expect and how to handle those possibilities.

Answered by Steve Houchens on September 28, 2025

Agent Licensed in KY & TN

Answered by Steve Houchens Medicare Insurance Agent

Kristen Skinner · Answer

Not necessarily. It is a good time to look at other options. There is what is called OEP which is where you can change to a different Medicare Advantage plan. This is something an agent will be good to look at .

Answered by Kristen Skinner on January 26, 2026

Broker Licensed in OK

Answered by Kristen Skinner Medicare Insurance Agent

Frank Carta · Answer

There are options to handling copays that accompany Medicare Advantage plans. I cannot
say for sure that you made a mistake. I would have to assess what benefits you have now
compared to what was available to you before.

James Stang · Answer

If you did, the Annual Open Enrollment period starts in October. The policies I represent have $0 copay for primary care visits and the copays for specialists vary by $10 to $20. If you see multiple specialists each month the extra cost could certainly add up.

Answered by James Stang on August 14, 2025

Agent Licensed in OH

Answered by James Stang Medicare Insurance Agent

Thomas Magnus, RHU · Answer

Since copays occur infrequently but premiums are monthly, you probably made the right choice. Between January 1 and March 31 you are allowed to switch to another plan - and - it may make more sense to stick it out for a year. Then total up your copays and change course next year if that makes more sense for you.

Answered by Thomas Magnus, RHU on January 19, 2026

Broker Licensed in CA, AZ, NV, OR & WA

Answered by Thomas Magnus, RHU Medicare Insurance Agent

Juliette Chihade · Answer

"You get what you pay for."

It means that lower-priced options often come with lower quality, fewer features, or hidden tradeoffs.   Your Medicare Advantage experience is a perfect real-world example of it in action. The $0 premium looked attractive upfront, but the higher copays on the back end are the "cost" you're now paying.

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, FL, GA, MI & NC

Answered by Cleo Martin Medicare Insurance Agent

Robert Baez · Answer

Not necessarily, but I can help you in finding the right plan now that it's the Annual Enrollment Period (AEP). Please contact me:

Robert Baez
Licensed Trusted Advisor

Más Health & Life
Health | Wealth | Life | Medicare

Contact me.

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.

Shalonda Cave · Answer

You didn't necessarily make a mistake but I always tell my clients to enter in your medications and doctors before picking any plan when it comes to Medicare Plan options. You can do this on Medicare.gov or call me to help you with your options. You can also change plans during the Medicare Open Enrollment Period (Jan 1 - March 31).

Answered by Shalonda Cave on March 23, 2026

Agent Licensed in OH, AZ & FL

Answered by Shalonda Cave Medicare Insurance Agent

Françoise Mueller · Answer

Not necessarily you didn’t “make a mistake,” but you did choose a plan that traded a low monthly premium for higher copays when you actually use your benefits. Many Medicare Advantage plans keep premiums low by shifting more of the cost to doctor visits, tests, hospital stays, and medications, so it’s very common to feel the pinch once you start using the plan.

What I do is help you look at the whole picture your doctors, prescriptions, health needs, and budget and see whether your current plan still makes sense or if there’s a better fit with lower out‑of‑pocket costs. I also help you apply for Medicaid and LIS if we can determine that you may qualify. That would greatly reduce your out of pocket costs.

Gretchen Morris · Answer

Depends on what you want out of your plan and what your financial standing is. Medicare is very individual. The things I look for as a broker is network coverage, drug coverage and then what max out of pocket and copays are affordable for the client.

Answered by Gretchen Morris on November 6, 2025

Broker Licensed in MN, AZ, FL & WI

Answered by Gretchen Morris Medicare Insurance Agent

Janet Cruz · Answer

Many people choose Medicare Advantage (MA) plans based on low or $0 premiums, only to find out later that copays, coinsurance, and out-of-pocket costs can add up, especially if you need frequent care. 

Here’s a breakdown of a Medicare Advantage Plan, in my opinion
1. Low premium = higher cost-sharing: Plans with $0 or low monthly premiums often have higher copays for services like specialist visits, hospital stays, or physical therapy.
2. If you’re generally healthy and rarely need care, these plans can save you money. But if your health needs increase, the out-of-pocket costs can spike.
3. Networks can be limited: Some MA plans also have narrow provider networks or require prior authorizations, which can affect access and costs.

Whenever you have a Medicare Advantage plan, pay attention to the maximum out of pocket costs, which is usually $4,000-$9,000 annually depending on the plan. Compare it to what you’re spending and see if it makes sense. 

This wasn’t a mistake it was a tradeoff based on what you knew and expected. 

I hope this helps.

Victoria Shiu · Answer

It is not a mistake, it is more of a learning curve.  You need to make sure you have a Medicare Advocate that is looking out for your best interests.  Here is what to look for in a Medicare advocate:
1. Licensed professional you can trust
2. Asks your needs in a health plan
3. Reviews your doctors, medications, and pharmacy to make sure you are in the appropriate    network.
4. Reviews your plan's Summary of Benefits
5. Compares your total costs
6. Gives you their email and direct phone number
7. Offers to do an annual review

Nick Morris · Answer

You may or may not have considered everything while picking your plan in the first place. I would suggest consulting with a professional who can help you understand what options you have. Many times, there are opportunities to change your coverage at different times of the year that some people are unaware of. A professional can help assess your situation and let you know your options.

Answered by Nick Morris on September 22, 2025

Agent Licensed in MO, AR, AZ & 6 other states

Answered by Nick Morris Medicare Insurance Agent

Nancy Suozzi-Vidal · Answer

When I research appropriate plans for a client, I start with their preferred providers and prescriptions. Then I compare viable plan premiums, copays, deductibles, coinsurance, need or no need for dental, vision and other value-added benefits. Also, number of specialists, frequency as well as any known upcoming procedures, treatment are very helpful. Typically plans have a “give and take.” The challenge is determining the plan that is cost effective overall based on client’s anticipated utilization. So, I would never recommend a plan just because it has the lowest monthly premium.

Answered by Nancy Suozzi-Vidal on March 1, 2026

Broker Licensed in NY & CT

Answered by Nancy Suozzi-Vidal Medicare Insurance Agent

Toyin Adeleye · Answer

The short answer is yes and no. Medicare Advantage plans are often attractive to people who don't want to pay a hefty sum every month, especially if they aren't working with much. For someone who is relatively healthy, this isn't a bad option- since they won't encounter as many situations where they're paying these high out of pocket costs. But once you need those X-rays or the worst case scenario happens, that's when you really see how costly being on an MA plan can be. 

One option to help mitigate those costs is to get on a Hospital Indemnity plan if there's one available in your area. These plans are made to cover those out of pocket costs you'll see with MA plans. They do come with their own premiums, but they usually end up still being way cheaper than paying for a supplement, and you get to keep all your coverages like dental, vision, prescription drugs from your MA plan. 

If a person can afford a supplement, I usually suggest they go that route. If you are considering going on a supplement, you may have to go through underwriting to do so- some exceptions apply here; but if you are able to get onto one, the more the plan covers, the more you pay in premiums. Take a look at Plan N or Plan G for Supplements if you qualify- you'll pay a lot every month, but you'll often pay nothing for services when you need them.

Brandon Grzywa · Answer

Understanding the difference between Medicare Advantage and Medicare Supplement is a key cornerstone of initial Medicare enrollment. While circumstances change, how out-of-pocket expenses are paid differ substantially between the two policy types. Medicare Advantage plans have low premiums of $0 but include copays and coinsurance, with a maximum annual limit. In contrast, most Medicare Supplements have a small yearly deductible and little to no out-of-pocket costs thereafter.

Answered by Brandon Grzywa on December 29, 2025

Broker Licensed in NE, IA & SD

Answered by Brandon Grzywa Medicare Insurance Agent

Mary Brown · Answer

Choosing a Medicare Advantage plan based on a low premium is common, but high copays can make your overall costs higher, and while switching to a Medigap plan could help cover these costs, it usually requires medical underwriting approval if you’re outside your initial enrollment period.

Answered by Mary Brown on March 30, 2026

Broker Licensed in NJ, DE, FL & NC, OH, PA & TX

Answered by Mary Brown Medicare Insurance Agent

Carol Thompson · Answer

Medicare Advantage plans vary by coverage /service areas.  I advise you to consult with a medicare agent/broker to be sure you are on the best plan available for your needs.

Mark Boone · Answer

It’s hard to answer that question based on the limited info you provided. There are a lot more factors that go into choosing the right plan for you. The zip code you live in and the plans available in your area are the first criteria. Then unless you are willing to switch doctors, you want a plan that your doctor is in network. Also another factor is prescription drug costs. Another factor is the supplemental benefits that come with the plan, such as dental, vision and hearing and also over the counter benefits. The best thing to do is talk to a licensed agent and see what plans are available to you and make that decision.

Answered by Mark Boone on August 17, 2025

Agent Licensed in MN, FL, MI & NC, OH, SC & VA

Answered by Mark Boone Medicare Insurance Agent

Todd Bostic · Answer

You can’t pick a plan based on cost. Most Medicare Advantage plans are $0 or close to it. When deciding which one to pick, you need to determine based on the benefits, not the cost. If it cost a little more every month and you see a specialist pretty often, you need a plan with lower specialist copays.

Answered by Todd Bostic on January 5, 2026

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

Answered by Todd Bostic Medicare Insurance Agent

Dean Chiapetto · Answer

Maybe. You should ALWAYS use a local agent who is a broker for several companies. Both Medicare Supplement and Medicare Advantage. You need to consider the maximum You will pay in a year. The MA has a cap. The Supplement has a premium. The Supplement can also have co-pays and deductibles.

Answered by Dean Chiapetto on November 1, 2025

Broker Licensed in VA, MD, NC, TN & WV

Answered by Dean Chiapetto Medicare Insurance Agent

Andrew Kelly · Answer

There are so many considerations in addition to the premium. Many people don't realize the high copays or the MOP (Maximum Out of Pocket) annual expense which can run from $7000 to $10000, annually for many Medicare Advantage Plans. I recommend sitting down with a knowledgeable agent who deals with both Original Medicare/Supplement and Medicare Advantage Plans and do a side-by-side comparison of the monthly premiums, and also the unpaid possibilities that exist with Medicare Advantage Plans.

Answered by Andrew Kelly on August 7, 2025

Agent Licensed in WA & OR

Answered by Andrew Kelly Medicare Insurance Agent

Carol Conner · Answer

Med Adv is usually for persons that are not sick  or taking alot of meds. 
You could get a hospital indemnity that would help supplement the out of pocket costs. Or consider changing to original Medicare and have a monthly premium but you don’t need referrals and once you beef the annual deductible of 283 with a plan g it will come in and pay with exception of long term Medicare does not cover long term care.

Jaye Maxx Alexander II · Answer

The agent should have made you aware that the low upfront cost is not truly a saving for you and your family. The proper questions asked and answered would have saved you and your family a great deal of money.

Answered by Jaye Maxx Alexander II on July 9, 2025

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

Answered by Jaye Maxx Alexander II Medicare Insurance Agent

Tamela Clayton · Answer

No, you did not necessarily 'mess up', but you DID choose a pay-as-you-go plan, and now it's time to review your doctors, meds and budget to see if there's a better fit for next enrollment.

William Scott · Answer

Having an experienced Insurance Broker would have saved you the aggravation by simply comparing Medicare Advantage plans in your area not just based on Monthly Premiums but the overall cost and benefits in each segment of the plans you’re most interested in.

Answered by William Scott on July 7, 2025

Broker Licensed in GA, CO, NC, OH, SC & TX

Answered by William Scott Medicare Insurance Agent

John Messler · Answer

Unless you have a significant amount of treatment you will be less expensive with a managed care plan. You will have case management involved in your care as well. The biggest benefit of a supplement is having full control of your healthcare without case management.

Answered by John Messler on November 1, 2025

Agent Licensed in NH, ME, NC, OH, PA & TX

Answered by John Messler Medicare Insurance Agent

Mark Murphy · Answer

You may have.  Lower premiums don't always mean higher copays and higher premiums don't always mean lower copays.  It all depends on the county in which you live as to what plans and rates are available to you.
Take heart, if you aren't happy with your Medicare Advantage plan there is an Open Enrollment period from January 1st - March 31st each year where you can make one change to your Medicare Advantage plan.  You can choose another Medicare Advantage plan or go back to original Medicare and choose an Rx plan.  Your new plan would start on the 1st of the following month.
I suggest you call your agent to discuss your options going forward.

Adam Paul · Answer

No, you did not make a mistake. All Medicare Advantage plans have co-pays for services. Medicare Advantage plans are an excellent choice because they include hospital medical, usually prescription drug coverage, and other ancillary benefits, so long as you continue to pay your Part B premium. They have exceedingly rich benefits, too.

Answered by Adam Paul on October 8, 2025

Broker Licensed in CA, NV, OK & OR

Answered by Adam Paul Medicare Insurance Agent

Ashley King · Answer

You chose a plan to fit your budget at the time; you didn't make a mistake doing that. 
Medicare Advantage plans often trade low premiums for higher copays, which can feel frustrating later. You can have options to review your plan and look for one that may be available with lower co-pays.

Nora Alishahi · Answer

This is the right moment to analyze if your choice worked for your particular situation. If not is time to contact a Medicare license agent to look into your situation

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

Mark Walker · Answer

As a long time agent, I am not a big fan of Medicare advantage. It is made not to be used and that’s just wrong. Better to have original Medicare and the supplement of some sort to give you freedom of choice to see any doctor or go to any hospital. 
You have to know that healthcare has a cost and you realistically need to account for that. If you just turned 65 or just went onto Medicare for the first time you can switch within the first year of a Medicare advantage policy, it is called a trial period.

Raid Alemam · Answer

Not necessary but you may have saved money on monthly premiums but over looked deductible or copays such as doctor and specialist visit also copay for medications . So if you donot get sick may be you have saved and if you need medical services you probably would not be saving.

Answered by Raid Alemam on August 27, 2025

Broker Licensed in TX, CA, CO & 7 other states

Answered by Raid Alemam Medicare Insurance Agent

Kathleen Gonzales-Byrd · Answer

Based on when you selected this MA plan, you can change to a different plan during January, February or March (Open Enrollment Period) or you can wait until the Annual Enrollment Period (October 15 to December 7) and select a more appropriate plan.  

Depending on the frequency of co-pays, the lower premium may still be a better option.  Speaking to a Medicare Agent at any time, may help you navigate through this process.

Aisha Saleem · Answer

An agent should be able to assist you in what best fits your lifestyle and health condition by asking pertinent questions that draw a picture of which plan is best for you. Sometimes the low premiums are not as beneficial as they first appear to be - such as in a scenario where a higher amount of healthcare is expected or used.

Answered by Aisha Saleem on June 1, 2025

Agent Licensed in MD & FL

Answered by Aisha Saleem Medicare Insurance Agent

Tonya White · Answer

I can't say whether you made a mistake, but I can see how that can happen, depending on the plan you chose and the services you received that have a high copay. It is important to review plan Summary of Benefits and pay attention to their Annual Notice of Change that is sent just before Open Enrollment. Review your plan options, and determin what's most important to you in a plan. Some low premium plans are very generous in their benefits so it really depends. You should work with an agent to help you review plan options available in your area.

Answered by Tonya White on October 26, 2025

Agent Licensed in CA, MA, MI & 5 other states

Answered by Tonya White Medicare Insurance Agent

Jim Carroll · Answer

It’s not if you made a mistake, but how you use the insurance. Granted, most MA plans have a $0 monthly premium. Most have at least a few thousand dollars in deductible and more in maximum out of pocket costs.

If you only see a doctor when you’re sick or injured, a higher copay might not be a bad trade off if you have less than $5,000 maximum out of pocket and something lands you in the hospital.

On the other hand, if you’re seeing multiple specialists, higher copays will add up quickly, and generally don’t count towards your deductible.

Speak to a licensed health insurance broker to have a Health Risk Assessment done with a thorough overview of your current MA plan. It will be no charge and give you peace of mind.

Frankie Cochran · Answer

not necessarily. often times people focus on the low costs of plans and don't really focus on the other charges associated with the plans. a good broker agent will make sure that the good and bad portions of a plan are explained to you in detail. it's very important to take notes so that you can refer back to them when the questions come up later. Brokers are a vital tool because they are contracted with multiple companies and can really explain the pros and cons of all plans available in your area and drill down on the correct plan for your needs, not limiting themselves to one company that may or may not be the best choice for your needs. brokers also do health risk assessments to look for needs and possible expenses that may come up throughout the year and make sure to discuss those copayments and coinsurances with you.

Answered by Frankie Cochran on April 1, 2026

Agent Licensed in GA

Answered by Frankie Cochran Medicare Insurance Agent

Russell Scott · Answer

Not necessarily.  In the world of Medicare insurance options you should think of the financial side of things like this- It's "pay me now" or "pay me later" insurance.  Medigap policies are generally more expensive premium-wise each month but offer less out-of-pocket exposure for the insured in terms of utilization.  These are more "pay me now".  MAPD plans often have low or no premiums to pay each month but might have larger out-of-pocket costs on utilization.  There's no free lunch.  It's pay me now or pay me later.

Michael Gilman · Answer

It’s really common to choose a Medicare Advantage plan because the premium is low, and then later feel surprised by the copays. You didn’t make a mistake — this is just how these plans are built. They keep the monthly cost low, but you pay more as you use care.

This is also why it helps to meet with an agent who takes the time to learn your story. Everyone’s health, budget, and comfort level are different. When someone understands your situation, they can give you a proper comparison between Medicare Advantage and Original Medicare with a Supplement so you can see what truly fits you.

And honestly, it’s not unusual for people to change their plan from year to year. Your health needs change, your medications change, and the plans themselves change. Adjusting your coverage isn’t a mistake — it’s just proper planning to make sure your Medicare keeps up with your life.

Brenda Skasko · Answer

Not necessarily. Depending on your health and the time of year, you may be eligible to change, if that is your wish. Knowing the time frames, loopholes, and options will help you understand more when you reach out to an agent to help.

Shahnaz Razvi · Answer

With your healthcare needs, an agent will be able to advise you the best choice for your
specific situation.

A Medicare Advantage plan often has low or no premium plans but out of pocket costs for various services you use. 
A Medicare Supplement plan has higher premiums but lower to no out of pocket costs for using various services.

Heather Currier · Answer

It depends on your needs. Typically a needs analysis is done to figure out what your are looking for in a plan, what you can afford financially and whether you have any preferred doctors/pharmacies and any medications you take.

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 contact to me Monday-Friday 9am-6pm

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.

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.

Akia Alexis · Answer

You want to always be sure that you have a trusted advocate that takes time to understand your needs, verify doctor's, medications and educate on any plan that may be beneficial to you. Especially exposing the gaps and what your copays will be so there are no surprises. Medicare Advantage plans can be a benefit you may just need to have a thorough analysis and possibly other options that are available to you.

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.

Kim White · Answer

Not necessarily. High co-pays come with a hospital stay, skilled nursing facility, chemotherapy, or dialysis. Did you get a hospital indemnity plan to help you cover those costs with your advantage plan? If you need a review of your advantage plan, I would be happy to help you and see if we need to make a change.

Dawn Lathe · Answer

If you picked a Medicare Advantage plan and you are now facing high copays, you can take several steps, depending on the time of year. Options are switching to a new plan during an enrollment period, applying for financial assistance, or speaking with your providers about your costs.

David Alelishvili · Answer

You didn't make a mistake, but keep in mind that most medicare advantage plans offer low to no premiums. A good agent will ensure that they review the full summary of benefits with you, and allow you the time to understand the cost for each service covered by your plan to ensure it aligns with your budget. Its never too late to do a mid year plan review, and I would highly advise you to do so, and compare all plan options available to you based on your zip code. Feel free to reach out anytime, I would be more than happy to do a no cost, no commitment, comparison for you.

Joseph &quot;Joey&quot; Gutierrez · Answer

I don't feel a mistake was made. I feel whoever helped you with the new plan did not present it thoroughly with all the additional benefits.  But I don't know the exact situation.

Jose Silva · Answer

Unfortunately some plans have 0 premium but they come with high copays, or deductibles or out of pocket max. When picking a plan is good to look at the plan in its entirety and see if its better to pay higher premium and lower copays or out of pocket max. Some clients dont want the higher premium due to they don't really go to the doctor alot.

Loretta Simmons · Answer

No not necessarily a good agent will go over all of your option for you so you could pick a plan that fits your needs.

Blake Beecher · Answer

When Open Enrollment starts (October 15th), we will know what alternatives are available for next year.  I recommend you give me a call at that time, and let's see what other options will be available.

David Nelson · Answer

If you enrolled in a plan within the first year, you have Trial Rights.  Trial Rates, mean you have the option to switch back to original Medicare + a MediGap policy without Medical Underwriting.  After the first year, you can still switch back but would be subject to Medical Underwriting.

Roberto Alvarez · Answer

If you feel like you are not in the right Medicare Advantage plan, you can still change that plan right now during the Open Enrollment Period, which runs through the end of March. There are MAPD plans both with $0 premiums and low copays with extra benefits like dental, vision, hearing, gym memberships, and monthly over-the-counter benefits. Contact me, and I will be glad to show you your options.

Cory St. Etienne · Answer

It's  an often asked question. I do not believe you made a mistake. Medicare Advantage plans have both in some cases premiums and co-pays depending on your plan. The premiums are the monthly cost depending on the plan and the co-pays are the usage costs as I would call it. Medicare plans have a "Pay as you use" type of model. However, most Medicare plans cost less in the long run than a Medicare Supplement plan. Plus, Medicare Advantage plans bundle your health, prescription, dental, vision, and other benefits into one plan which can save you some money since you will not have to get separate policies for health, dental, vision or other benefits covered by Medicare you might want. Furthermore, if you have both Medicare and Medicaid you are getting your benefits in some cases with no premium payments or co-pays.

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.