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

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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.

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 & 14 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

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

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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