What $0 Premium Really Means in Medicare Advantage
What $0 Premium Really Means in Medicare Advantage
The truth behind $0 plans.
“There’s no such thing as a free lunch.” — Milton Friedman
Every year, millions of Americans turning 65 are enticed by bold advertisements for $0 Medicare Advantage plans. “All-in-one coverage with no monthly premium? Count me in!” they think. But while $0 premium MAPD plans can be a great fit for some, it's crucial to understand what that “$0” really means—and what you're still expected to pay.
Let’s break down what’s included, what’s not, and how to make sure a $0 premium plan won’t cost you more in the long run.
First Things First: What is a $0 Premium?
A $0 premium Medicare Advantage plan means you don’t pay an additional monthly premium for the coverage provided by that private insurance plan. However, you are still responsible for paying your Part B premium to Medicare, which is $174.70/month in 2025 for most people.
So the “free” plan? It only refers to the extra cost from the private insurer—not the entire Medicare program.
What You Still Pay With a $0 Premium Plan
Even with a $0 premium, you may face out-of-pocket costs such as:
Copays for doctor visits and specialists (e.g., $20–$50 per visit)
Hospital stay costs (daily copays for each night admitted)
Diagnostic tests and imaging (like MRIs and CT scans)
Outpatient surgeries
Durable Medical Equipment (DME)
Part D drug copays and deductibles
Each plan has its own cost-sharing structure, so it’s essential to read the fine print.
Out-of-Pocket Maximums Still Apply
While Original Medicare has no cap on your spending, Medicare Advantage plans are required to include an annual out-of-pocket maximum—which is good news!
However, these limits can vary:
Some are as low as $3,000
Others exceed $8,000
These caps don’t include prescription drug costs, so you could still face significant expenses in a bad health year.
The $0 Premium Tradeoff: Networks and Authorizations
The lower premium of MAPD plans often comes at the cost of limited flexibility:
❌ You may be restricted to in-network doctors and hospitals
❌ Referrals may be required for specialists
❌ Certain procedures may need pre-authorization
If you go out-of-network without prior approval, you could be responsible for 100% of the cost.
What About the Extra Benefits?
Many $0 premium plans also advertise added perks:
✅ Dental, vision, and hearing benefits
✅ Gym memberships (like SilverSneakers®)
✅ Transportation to appointments
✅ Over-the-counter allowances
✅ Part B premium givebacks (in some plans)
These are real benefits—but they vary widely between plans and zip codes. Some are generous, some are barebones. Make sure to verify exactly what’s included and how to access it.
Case Example: $0 Premium, But…
Let’s say Sally, 68, has a $0 premium MAPD plan. She needs:
6 specialist visits per year ($40 each = $240)
2 MRIs ($250 each = $500)
A 4-day hospital stay ($350/day = $1,400)
That’s $2,140 in out-of-pocket costs—not including prescriptions or her Part B premium.
Sally’s plan didn’t cost extra each month, but it wasn’t free when she needed care.
How to Choose the Right MAPD Plan
Before signing up for a $0 premium plan, ask:
Are my doctors in-network?
How much are my copays for key services?
What is the maximum out-of-pocket limit?
Are my medications covered affordably?
What are the referral and authorization rules?
What extras do I actually need?
How KEyO Insurance Services Can Help
At KEyO, we help you look beyond the headline and into the real-world costs of your Medicare plan. We compare $0 premium MAPD options in your area, review doctor networks, estimate your potential spending, and help you maximize your benefits while minimizing surprises.
With Trusted Care. Tailored for You., you’ll choose coverage that fits your life—not just your inbox.
Final Thought:
$0 premium doesn’t mean $0 cost. It means you need to look deeper—and we’re here to help you do just that.
