If you have looked at Medicare plans in South Florida, you have almost certainly seen plans advertised with a $0 monthly premium. A zero premium Medicare Advantage plan is a real thing, and many people enroll in one. But the word “free” leaves out most of the story. This article explains what a $0 plan premium does and does not cover, where other costs show up, and how to compare these plans on equal footing with everything else available to you.
This article is educational only. Medicare.gov and 1-800-MEDICARE (TTY 1-877-486-2048) are the official sources for plan and coverage information.
What a $0 Plan Premium Actually Means
A Medicare Advantage plan, sometimes called Part C, is offered by a private company approved by Medicare. It provides your Part A and Part B benefits, and many plans also include Part D drug coverage. Medicare pays the plan a set amount each month to provide your care.
When a plan lists a $0 premium, it means the plan itself does not charge you an additional monthly premium on top of what you already pay for Medicare. That is the whole of it. It does not mean your Medicare coverage costs nothing.
You Still Pay the Part B Premium
This is the point that surprises people most. To join any Medicare Advantage plan, you must be enrolled in Part B, and you generally continue paying the Part B premium whether your plan premium is $0 or not. For many people it is deducted from their Social Security benefit, which is why it is easy to forget it is there.
So a more accurate way to describe a $0 premium plan is this: you pay your Part B premium, and the plan does not add one of its own.
Where Other Costs Show Up
Every Medicare Advantage plan, whatever its premium, has cost-sharing. That is what you pay when you actually use care. Common forms include:
- Copays: a set amount for a doctor visit, specialist visit, urgent care visit or prescription.
- Coinsurance: a percentage of the cost of certain services, such as some procedures or equipment.
- Deductibles: some plans have a medical deductible, a drug deductible, or both.
- Hospital stays: many plans charge a daily amount for a set number of inpatient days.
- Out-of-pocket maximum: every Medicare Advantage plan has a yearly limit on what you pay for covered Part A and Part B services. Once you reach it, the plan pays for covered services for the rest of the year.
Two plans with the same $0 premium can have very different cost-sharing. One might have lower office copays and a higher out-of-pocket maximum; another might work the other way around. The premium alone tells you none of that.
Networks and Rules Are Part of the Cost Too
Most Medicare Advantage plans use a provider network. HMO plans usually require you to use in-network doctors except in emergencies, and many require referrals to see specialists. PPO plans generally let you go out of network at a higher cost. Some services also need prior authorization from the plan.
None of this makes a plan good or bad. It just means the real question is whether the plan’s network and rules fit the way you get care. If your cardiologist or preferred hospital is not in network, that will matter far more than the premium line.
How Extra Benefits Fit In
Many plans include extras that Original Medicare does not cover, such as some dental, vision or hearing benefits, or a fitness program. These can be useful. They also vary widely in how much they actually cover, and they can change from one year to the next. Read the plan’s Evidence of Coverage or Summary of Benefits to see the limits, and confirm details with the plan before you count on them.
Comparing a $0 Plan Fairly
The fairest way to compare any Medicare option is to estimate a realistic year of costs. A simple approach:
- Write down your doctors and check each one in the plan’s directory for the coming year.
- List your prescriptions with dosages and check how each plan covers them.
- Add up the premiums you would pay, including Part B.
- Estimate copays for the visits and refills you expect.
- Look at the out-of-pocket maximum as your cost in a harder health year.
Some people compare a Medicare Advantage plan with Original Medicare plus a Medicare Supplement (Medigap) policy and a standalone Part D plan. Those paths are structured differently: one tends to have a higher monthly premium with more predictable costs when you use care, while the other often has a lower premium with cost-sharing when you use care. Both are legitimate choices, and the right one depends on your health, your doctors and how you prefer to budget.
When You Can Make a Change
The Medicare Annual Enrollment Period runs from October 15 to December 7, and changes take effect January 1. If you are already in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period from January 1 to March 31 lets you make one change: switch to another Medicare Advantage plan, or drop it and return to Original Medicare and possibly join a Part D plan. Our Medicare page explains how we help people review these options.
Frequently Asked Questions
Is a $0 premium Medicare Advantage plan really free?
No plan is free in the full sense. A $0 premium means the plan does not charge its own monthly premium. You generally still pay your Part B premium, plus copays, coinsurance and any deductibles when you use care.
Do I still pay the Part B premium with a $0 premium plan?
Generally, yes. You must be enrolled in Part B to join a Medicare Advantage plan, and you usually keep paying the Part B premium. Many people have it deducted from their Social Security benefit.
How can a plan charge a $0 premium?
Medicare pays private plans a set amount each month to provide your Part A and Part B benefits. Some plans are able to cover their costs without charging members an additional premium.
What is the out-of-pocket maximum?
It is the yearly limit on what you pay for covered Part A and Part B services in a Medicare Advantage plan. After you reach it, the plan pays for covered services for the rest of the year. The limit varies by plan.
How do I compare a $0 premium plan with other options?
Estimate a full year of costs. Check your doctors and prescriptions against each plan, add premiums including Part B, estimate copays, and look at the out-of-pocket maximum. Confirm details with the plan, Medicare.gov or 1-800-MEDICARE.
Look at the Whole Picture With a Licensed Agent
If you would like help understanding what a zero premium Medicare Advantage plan would mean for your own doctors and prescriptions, call Maher Insurance Group at (866) 220-2834. You can also start with our short online questionnaire, and a licensed agent will follow up when it is convenient for you.
Maher Insurance Group is a licensed independent insurance brokerage and is not affiliated with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer. Contact Medicare.gov or 1-800-MEDICARE for information on all of your options.
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