Can Medicare Advantage plans have $0 premiums for some people?

May 12, 2022

When you start to look at Medicare enrollment options, the whole process may seem expensive and confusing. You might be shocked to learn that some Medicare Advantage plans have no monthly premium, depending upon eligibility. That’s right — some of the Medicare Advantage medical plans have a $0 monthly plan premium! These plans may even include coverage for services that aren’t part of Original Medicare coverage. Read on to learn how these $0 Medicare Advantage plans work, what they include, and whether or not they’re right for you.

Is there a catch?

Now that you know some Medicare Advantage plans have a $0 monthly premium, you might wonder, “What’s the catch?” Fortunately, there is no catch. Private companies are able to offer $0 monthly premiums because they contract with the federal government. They get reimbursed by the government for some of the plan’s costs, so you don’t have to pay a premium for having the coverage.

How does a $0 monthly premium for Medicare Advantage plans work?

The Medicare Advantage plans with a $0 monthly premium are managed care programs. This means that the plan contracts with a specific network of doctors and facilities to provide you with affordable care. The savings of setting up this provider network means that the plan doesn’t have to charge you a monthly premium for in-network coverage (you will still need to pay deductibles, copays,  coinsurance, etc.) If you choose to go outside of the designated network for your health care services, you’ll pay even more out-of-pocket for your health care.

Why do some Medicare Advantage plans have a $0 premium?

Insurance companies receive money from the government to provide approved Medicare Advantage plans. When a plan spends less than the fee it gets from the federal government, it’s able to offer $0 premiums. The carrier basically passes the savings onto members.

There are two ways plans can pass on the savings: one is to stop charging a monthly premium, and the other is to include more coverage (like dental, prescription, or vision, as examples).

Expenses you will have with Medicare Advantage plans

None of the Medicare plans are 100% free. Even if you choose a Medicare Advantage plan with a $0 premium, you’ll still have some out-of-pocket expenses. For example, you may still have an annual deductible, and you’ll also have copays for covered services (such as a visit to a specialist).

What are the Medicare Advantage benefits?

Medicare Advantage plans are predictable. You’ll know the annual out-of-pocket maximum. This isn’t the case with Original Medicare. If you don’t like surprise bills, a Medicare Advantage plan may be a good choice.

You may gain access to services that aren’t part of Original Medicare. For example, some Medicare Advantage plans offer prescription benefits. Or you might gain access to a free or reduced-cost gym membership or fitness program such as SilverSneakers.

Medicare Advantage plans are easy to manage. The private company that manages your plan will have a website and printed materials with a listing of your coverage. You’ll also get account information to track how much you’ve spent out of pocket. This helps you plan your expenses. After you reach your out-of-pocket maximum, you don’t have to pay any additional copays, coinsurance, or other fees.

Are there rules for Medicare Advantage plans with a $0 premium?

Each Medicare Advantage plan has its own set of rules and requirements, so it’s a good idea to review the plan carefully before you make a decision. For example, people with Type 2 diabetes may need a primary care doctor’s referral to an endocrinologist under some of the Medicare Advantage plans. Other plans might not require a referral for specialist care.

There are also rules on coverage for out-of-network care. These rules may even apply in an emergency. For example, if you become faint while at the grocery store and an ambulance is called, it may take you to a free-standing emergency room rather than a hospital. If this facility isn’t in your network, the plan may not pay any of the costs. Original Medicare pays for hospitalization if you’re taken to a hospital, but free-standing emergency rooms aren’t always considered hospitals.

Keep in mind that Original Medicare and Medicare Advantage rules may change every year. You’ll need to review these changes each time it’s time to re-enroll. If you’re not sure that your current plan is the best one for you, SmartMatch licensed insurance agents can help you sort through the options and their changes. The plan that’s right for you this year might not be the right one for you in a couple of years.

Learn more about Medicare Advantage plans and coverage options

Finding the right Medicare Advantage benefits that meet your needs can be time-consuming. Instead of spending hours and hours trying to choose a plan that suits you, work with our SmartMatch™ licensed insurance agents. Each of our insurance agents takes the time to get to know you and your needs and preferences. You’ll receive helpful information so that you can choose a Medicare Advantage medical plan that fits into your budget and provides the right coverage. To learn more, contact us today.

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