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

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

Charise Karjala · 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#charise-karjala

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

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.

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 & SC

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

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
251-424-5865

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.

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!

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.

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.

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

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

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 trade off based on what you knew and expected. 

I hope this helps.

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

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

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

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

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.

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

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

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

Broker Licensed in OH & PA

Answered by Sophia Davis 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.

Answered by Russell Scott on June 13, 2025

Agent Licensed in OK, MO & TX

Answered by Russell Scott 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.

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.

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.

Answered by David Alelishvili on July 21, 2025

Broker Licensed in NY

Answered by David Alelishvili Medicare Insurance Agent

Joey 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.

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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