PREMIUM IS NOT TOTAL COST
Why a $0-Premium Medicare Advantage Plan Can Still Cost More Next Year
A $0 Medicare Advantage premium can be valuable, but it does not mean healthcare is free. Part B, medical cost sharing, prescription costs and the plan’s maximum out-of-pocket exposure still matter.
A $0-premium Medicare Advantage plan does not charge a separate monthly plan premium, but you generally must continue paying the Medicare Part B premium.
You may also pay deductibles, copayments or coinsurance when you use medical services or fill prescriptions. Those amounts—and the plan’s provider network, pharmacy pricing and maximum out-of-pocket limit—can change from one year to the next.
$0 premium does not mean a bad plan or a free plan. It means the complete cost structure needs to be compared.
THE COMPLETE COST STACK
What Can You Still Pay?
Medicare Part B premium
You generally keep paying Part B to remain enrolled in Medicare Advantage, even when the private plan premium is $0.
Medical cost sharing
Primary care, specialists, hospitals, outpatient surgery, imaging, therapy, ambulance and equipment can each have plan-specific costs.
Prescription costs
Drug deductibles, tiers, coinsurance, pharmacy status and coverage restrictions can affect total annual spending.
Some plans may help pay part of the Part B premium, but that feature is plan- and area-specific. Always verify the official plan materials rather than assuming a rebate or reduction applies.
MEDICAL COSTS
Copays Can Matter More Than the Premium
| Cost area | What to examine | Why it matters |
|---|---|---|
| Inpatient hospital | Per-day or per-stay cost and number of charged days | One admission can outweigh many months of premium differences |
| Outpatient surgery | Facility and professional cost sharing | Separate services may produce separate charges |
| Specialists and therapy | Copay or coinsurance per visit | Frequent care makes small per-visit changes accumulate |
| Diagnostic imaging | Copay versus percentage coinsurance | Percentage costs can be difficult to estimate without allowed amounts |
| Ambulance and durable equipment | Copay, coinsurance and authorization rules | These less-frequent services can still create substantial expenses |
| Maximum out-of-pocket limit | In-network and any combined network limits | This is the plan’s annual ceiling for covered Part A and Part B services—not a promise that typical costs will be low |
For a deeper explanation, read Medicare MOOP vs. deductible.
PRESCRIPTION COSTS
The Drug Benefit Has Its Own Moving Parts
- Drug deductible: determine which tiers are subject to it and when coverage begins paying.
- Tier placement: a medication can remain covered but move to a different copay or coinsurance tier.
- Preferred pharmacy pricing: another network pharmacy may cost more for the same covered drug.
- Utilization rules: prior authorization, step therapy and quantity limits can affect access.
- Formulary changes: the drug, strength or formulation may be treated differently next year.
- Mail order and supply size: 30-day and 90-day fills can price differently.
If a medication is changing, use what to do when a Medicare plan no longer covers your prescription.
NETWORKS AND RULES
Cost Is Also Affected by Where and How You Receive Care
A plan may have attractive copayments but not include the doctors or facilities you intend to use. An HMO may handle routine out-of-network care differently from a PPO, and a PPO may charge higher out-of-network costs.
Prior authorization can affect when certain services, procedures or equipment are covered. A benefit that looks generous on a summary page can also have frequency, vendor, network or medical-necessity rules.
Do not compare benefits in isolation. A dental allowance, over-the-counter amount or Part B reduction does not replace the need to verify your core medical providers, prescriptions and likely financial exposure.
If provider access is changing, read the guide for a plan that loses a doctor or hospital.
USE THE ANOC
How Can the Cost Change Next Year?
The Annual Notice of Change summarizes important differences taking effect January 1. Compare the upcoming year against your current plan materials, including:
- Plan premium and any Part B premium reduction.
- Medical deductible and medical maximum out-of-pocket limit.
- Hospital, specialist, outpatient and diagnostic cost sharing.
- Prescription deductible, tiers and pharmacy arrangements.
- Provider network and service-area information.
- Additional benefits, vendors and usage limits.
- Prior authorization and referral rules.
Then compare those plan changes with your own expected healthcare use. A plan can become more expensive for one person and remain cost-effective for another.
THE RIGHT CONCLUSION
A $0-Premium Plan Can Still Be the Best Fit
The purpose of this comparison is not to argue against $0-premium coverage. Many people receive suitable Medicare coverage through plans with no additional monthly premium.
The point is to avoid treating one number as the entire decision. The best Medicare Advantage plan is the one whose providers, prescriptions, costs and rules fit the person using it.
Compare likely cost and worst-case exposure
Review both what you are likely to spend in a typical year and what the plan could require if you experience a hospitalization, extended treatment or other significant care.
COMMON QUESTIONS
$0-Premium Medicare Advantage FAQ
Do I still pay Part B with a $0 Medicare Advantage plan?
Generally, yes. You must remain enrolled in Part B and keep paying the Part B premium unless another program or plan feature pays part of it for you.
Does $0 premium mean there is no deductible?
No. Premium and deductible are separate. Review both the medical and prescription deductible provisions of the specific plan.
What is the Medicare Advantage maximum out-of-pocket limit?
It is the plan’s annual limit on what you pay for covered Part A and Part B services. The amount and network structure vary by plan, and prescription spending is tracked separately.
Can a $0-premium plan cost more next year?
Yes. Even if the plan premium remains $0, medical copays, hospital costs, drug coverage, pharmacy pricing, benefits or the out-of-pocket limit may change.
Is a higher-premium plan automatically better?
No. Compare the total coverage structure. A higher premium does not guarantee that the plan fits your doctors, prescriptions or likely healthcare use.
ANNUAL PLAN REVIEW SERIES
Continue the Medicare Annual Review Series
These six guides separate the annual review into plan changes, plan endings, prescriptions, Medigap eligibility, total costs and review preparation. For local dates and planning, see Medicare AEP 2026 in Springfield, Missouri.
OFFICIAL INFORMATION
Official Medicare Advantage cost resources
LOOK BEYOND THE PREMIUM
Compare Your Likely Medicare Costs
Thompson Medicare Brokerage helps Missouri and Illinois beneficiaries compare plan premiums, medical cost sharing, prescriptions, providers and annual financial exposure together.
Thompson Medicare Brokerage is not connected with or endorsed by the U.S. government or the federal Medicare program. This article provides general educational information. Enrollment rights, coverage, costs, provider participation, formularies and plan availability depend on individual facts, location and the applicable plan year. Thompson Medicare Brokerage does not offer every plan available in every area. Contact Medicare.gov, 1-800-MEDICARE or your State Health Insurance Assistance Program for information about all available options.