A Medicare Advantage plan with a $0 monthly premium can be a useful option. But that price describes the plan premium, not everything you might spend on healthcare.
To understand what a plan could cost you, look at your Medicare premiums, medical care, prescriptions, and the plan’s coverage rules together.
What does the $0 premium mean?
It means the plan charges no monthly premium for the coverage included at that price. You may still pay when you receive care or fill prescriptions.
Two plans with $0 premiums can have different doctor networks, copays, drug coverage, and out-of-pocket limits. The monthly premium is only the starting point.
Do you still pay your Medicare Part B premium?
Yes. You must keep Part B and remain responsible for its premium to stay in Medicare Advantage.
Some people qualify for assistance paying Medicare costs. Some plans also offer a Part B premium reduction, sometimes called a giveback. The amount and availability vary; a $0 plan premium does not automatically include one.
If you do not qualify for premium-free Part A, that premium may also remain part of your budget. Higher-income beneficiaries may owe income-related Medicare premium adjustments.
What other costs should you review?
Doctor visits and medical services
A plan might charge one amount for primary care and another for specialists. Imaging, therapy, outpatient procedures, hospital stays, and medical equipment may have their own copays or coinsurance.
A copay is a set dollar amount. Coinsurance is a percentage of the covered cost.
Deductibles
Check the medical and prescription benefits separately. A plan with no medical deductible may still have a drug deductible. Read which services or medications the deductible applies to.
Prescription drugs
If the plan includes Part D, check each medication individually. Costs can depend on the drug’s tier, deductible, pharmacy, and coverage rules. A $0 plan premium does not mean every prescription costs $0.
Extra benefits
Dental, vision, and hearing benefits can be valuable, but review covered services, participating providers, benefit limits, and your share of the bill. An allowance does not necessarily cover the full cost of treatment.
A simple yearly cost example
Imagine a person whose plan has a $0 monthly premium and the following costs for the care they use:
Plan premium: $0 per month, totaling $0 for the year.
Four primary care visits: $0 each, totaling $0.
Twelve specialist visits: $35 each, totaling $420.
One imaging service: $200.
Covered prescriptions: $30 per month, totaling $360 for the year.
The total for these example expenses is $980.
These are invented amounts for illustration, not a quote or a description of any specific plan. The example assumes no additional deductible applies to the listed care and does not include Part B premiums, other applicable premiums, or services not shown.
The person’s total healthcare spending would be higher after adding those expenses. A year involving hospitalization, surgery, or additional treatment could look very different.
How does the out-of-pocket maximum help?
Medicare Advantage plans limit your yearly out-of-pocket spending for covered Part A and Part B services. After you reach the applicable limit, the plan pays covered medical costs subject to that limit for the rest of the calendar year.
That limit is not an all-inclusive healthcare budget. Premiums and Part D prescription expenses do not count toward the medical maximum. Noncovered services and costs outside the plan’s coverage rules can also remain your responsibility.
Check whether the plan has an in-network limit and, where applicable, a combined in-network and out-of-network limit. Part D has its own separate out-of-pocket rules.
Your doctors matter as much as the price
Before enrolling, verify your specific doctors and hospitals under the exact plan. Seeing the same insurance company’s name on a provider’s website is not enough.
Out-of-network routine care may cost more or may not be covered, depending on the plan. Review referrals and prior authorization requirements, too.
How to compare plans more usefully
Build two budgets: one for the care you expect and another for a year when you need substantially more treatment.
Include premiums, prescriptions, anticipated appointments, and any planned procedures. Then examine the medical out-of-pocket maximum to understand your exposure for covered medical care.
This helps you evaluate whether a plan fits both your everyday needs and your ability to manage a more expensive year.
Get a personalized plan review
Medicare Universe helps people in Arizona, New Mexico, and California compare available options from the insurance companies we represent, with attention to doctors, prescriptions, and overall costs.
Request a no-cost plan review through the form on our website. We will follow up to arrange your consultation. There is no obligation to enroll.
Plan availability, benefits, premiums, and cost sharing vary by location and plan year. Medicare Universe is not connected with or endorsed by the U.S. government or the federal Medicare program.