Why Are Some Medicare Advantage Plans Free? $0 Premium Plans Explained
Written by: Corey Whelan
Reviewed by: Eboni Onayo, Licensed Insurance Agent
Many Medicare Advantage (Part C) plans are available for a $0 monthly premium.
In many cases you will still pay a monthly premium for Medicare Part B.
Even with a premium-free plan, you will have costs such as deductibles, copays or coinsurance.
If you don’t like your current Part C plan, there are times during the year when you can switch to a different Part C plan.
Medicare Advantage (Part C) plans provide all the coverage of Original Medicare (Part A and Part B). They also often include extra coverage that may be important to you, such as prescription drugs, dental, vision and hearing. That’s a lot of value — so, why are some Medicare Advantage plans free? Is there a catch?
Many Part C plans come with a $0 monthly premium. That’s great news for people who are concerned about the cost of healthcare, as well as the richness of their coverage. But at this point, you may be asking yourself, “How can Medicare Advantage plans be free?” If so, you’re on to something.
In reality, few things in life are completely free, including premium-free Part C. There are several fees and charges you’ll need to know about, all of which add up to the true cost of your Medicare Advantage plan. Read on to learn all about Medicare Advantage plans, and what their associated costs may be.
Find a local Medicare plan that fits your needs
Are $0 Premium Medicare Advantage Plans Really Free?
With a premium-free Medicare Advantage plan, there is no monthly fee you’re required to pay. However, there are still costs you can expect to incur for your healthcare needs. These include deductibles, copays and coinsurance. You will also have a monthly premium for Medicare Part B and, in some instances, Medicare Part A.
What do I have to pay for if I have a $0 premium?
Part B Premium
If you’re already getting Medicare, you likely know that a monthly premium is required for Medicare Part B. However, some Medicare Advantage plans absorb this cost.
For most people, the Part B premium was $170.10 a month in 2022. You may receive a monthly or quarterly bill for your Part B premium. If you’re already receiving Social Security or Railroad Retirement benefits, your Part B premium may also be automatically deducted from that amount.
Part A Premium (in rare instances)
The vast majority of Medicare recipients are entitled to premium-free Part A. If you or your spouse worked fewer than 10 years and didn’t pay enough taxes to qualify for premium-free Part A, you may be able to buy it if you choose to.
The monthly premium for Part A is determined by your work and tax history. In 2022, premiums were either $274 or $499 monthly.
Copays are the flat fee you pay when you see your primary care physician or a specialist. There are also copays required for other forms of healthcare, including diagnostic tests, emergency room visits, and some prescription drugs.
Copays vary between Medicare Advantage plans. Many premium-free Part C plans feature $0 or low-cost copays for doctor’s appointments. Others require copays of $50 per specialist visit, or more. Each plan outlines its copay structure so you understand the charges when you have to pay them.
A deductible is the out-of-pocket amount you’re required to pay for Medicare-approved healthcare before your insurance plan starts to cover your costs.
Deductibles range from $0 annually to several thousand dollars. Once you’ve met your deductible, you will still have copays and coinsurance costs (if they apply).
Some Medicare Advantage plans have a $0 deductible for healthcare plus a $0 deductible for prescription drugs. Others have a deductible amount for one or both that you’ll have to meet before the plan starts to pay.
Coinsurance refers to a percentage of the total cost of healthcare services, rather than a flat copay fee. Your plan may require you to pay a percentage of the cost of your healthcare (instead of a copay) in some instances after your deductible has been met.
Types of Medicare Advantage Plans
There are several types of Medicare Advantage plans that may be available in your area. The costs for each type vary and are impacted by your choice of in-network or out-of-network providers.
Medicare Advantage plans include:
Health Maintenance Organizations (HMOs) – HMOs only cover healthcare received within their specific network of providers. They are typically an affordable option. Many have $0 monthly premiums, $0 deductibles for both healthcare and drugs, and $0 copays for general practitioner visits. HMOs typically use a primary care physician to manage your care and refer you to in-network specialists.
Preferred Provider Organizations (PPOs) – PPOs have a provider network but, unlike HMOs, they also cover a percentage of the cost for out-of-network services. You will pay higher out-of-pocket costs when you see an out-of-network provider than you would with an in-network provider. PPO plans are typically more expensive than HMOs, but some offer a $0 monthly premium.
Private Fee-for-Service (PFFS) – The difference between PFFS plans and other types of Part C plans is that while HMOs and PPOs often pay your doctors a standard monthly amount for your care, PFFS plans pay per service. PFFS plans vary in how they use provider networks and may allow you to see any doctor that agrees to accept your plan.
Are you eligible for cost-saving Medicare subsidies?
How Does the Medicare Advantage Out-of-Pocket Maximum Work?
An out-of-pocket maximum is the most you are required to pay for healthcare within a plan year. After you meet your plan’s out-of-pocket maximum, it will pay for 100% of your healthcare costs.
Part C plans have an out-of-pocket maximum for healthcare and prescription drugs. This amount is also referred to as the out-of-pocket max, or limit.
The out-of-pocket maximum varies from plan to plan. It includes:
It does not include:
- monthly premiums, including the Part B premium
- the cost for services that are not covered by your plan
- out-of-network healthcare if your plan has a network of providers
- costs you paid that were above the Medicare-approved rate for a particular service
Changing Medicare Advantage Plans
If you currently have a Medicare Advantage plan and wish to change it, you can do so during either of these annual timeframes:
- Medicare’s Open Enrollment Period: Also known as the Annual Enrollment Period, you can join, switch or drop a Part C plan from October 15 to December 7.
- Medicare Advantage Open Enrollment Period: You can drop your current plan and change to a new one from January 1 to March 31. You can also go back to Original Medicare during this time.
Under certain circumstances, you may also change Medicare Advantage plans during a period known as Special Enrollment Period. A Special Enrollment Period is triggered by a change in your life or in your plan. For example, your current Part C plan may no longer be available where you live. Or, you may be moving out of your current plan’s coverage area.
What extra benefits and savings do you qualify for?