Are you looking for zero-premium Medicare Advantage plans to save money? Medicare Advantage plans with no premium* are not uncommon, but availability may depend on where you live. You may also wonder if paying a $0 monthly premium truly mean there are no costs for Medicare coverage. Let’s take a look at how zero-dollar premium Medicare Advantage plans actually work.

How Are Zero-Premium Medicare Advantage Plans Possible?

Medicare Advantage, also known as Medicare Part C, combines the coverage of Original Medicare (Part A and Part B) and often adds additional benefits, such as prescription drug, dental, and vision coverage. Costs for Medicare Advantage programs are kept low because the government pays the insurance companies to handle medical treatment, billing and payments instead of the Medicare program itself.

Private insurers can save on costs by establishing their own networks and setting their own premium rates. These cost savings get passed down to consumers to help make the plans affordable—and some are as low as $0.

Are No-Premium Medicare Advantage Plans* Free?

Although you may enroll in a no-premium Medicare Advantage plan*, the coverage isn’t free. You are still responsible for paying your monthly Part B premium (estimated to be $158.50 in 2022).1 That’s because you will still have Part B medical coverage even if you enroll in a Medicare Advantage plan. There are also other out-of-pocket expenses, which vary among Medicare Advantage plans. These include:

  • Annual deductibles. This is the amount you must pay out of pocket before your plan begins to cover any costs. But not all plans have deductibles, so it may be possible to have a $0 Medicare Advantage premium with a $0 deductible.
  • Coinsurance. This is a percentage of the costs you pay for covered services and items. For example, Part B requires that you pay a 20% of the costs for treatments received.
  • Copayments. This is a set dollar amount you pay when you receive treatment. For instance, your plan might charge a $25 copay for doctor’s visits.
  • Prescription drug costs. The majority of Medicare Part C plans include prescription benefits. Many of these plans have a separate deductible for drug coverage, and there’s usually a copay or coinsurance each time you fill a prescription.

Medicare Advantage plans also have a maximum out-of-pocket limit ($7,550 for in-network services in 2021), which can change every year.2 This is the most you would have to pay out of pocket for covered Part A and Part B expenses during a calendar year. Plans that include prescriptions benefits have a separate out-of-pocket maximum for drug costs.

Zero-Premium Coverage: Always Review the Details

A Medicare Advantage plan with no premium* can be an affordable and cost-effective choice for Medicare beneficiaries. But since plan benefits can vary, it’s not always automatically the best value. For some plans, it may be less expensive overall to pay a higher premium for more coverage.

SAMPLE PLAN A

SAMPLE PLAN B

Monthly Premium

$0

$19 or $228/year (the average premium in 2022)3

Out-of-pocket Maximum

$7,550

$3,400

Annual cost for plan (if out-of-pocket maximums are reached)

$7,550

$3,628

 

As you can see in the examples above, Sample A has a lower premium, but Sample B has a lower annual out-of-pocket cost. This is why reviewing plans details is so important before you purchase coverage.

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References

*Medicare Part B premium still applies.

1. “2021 Medicare Trustees Report.” CMS. August 2021. Retrieved from https://www.cms.gov/files/document/2021-medicare-trustees-report.pdf | 2. “Medicare Advantage in 2021: Premiums, Cost Sharing, Out-of-Pocket Limits and Supplemental Benefits.” KFF. June 2021. Retrieved from https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2021-premiums-cost-sharing-out-of-pocket-limits-and-supplemental-benefits/ 3. “CMS Releases 2022 Premiums and Cost-Sharing Information for Medicare Advantage and Prescription Drug Plans.” CMS. September 2021. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-releases-2022-premiums-and-cost-sharing-information-medicare-advantage-and-prescription-drug

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