You’ve probably seen the advertisements:
$0 Monthly Premium
For someone living on Social Security or trying to control retirement expenses, that can sound extremely attractive.
And $0-premium Medicare Advantage plans are real.
But there’s an important distinction every Medicare beneficiary should understand:
A $0 plan premium does not mean $0 healthcare costs.
You could enroll in a Medicare Advantage plan with a $0 additional monthly plan premium and still pay money when you:
- See a specialist
- Visit the hospital
- Have an outpatient procedure
- Get diagnostic imaging
- Use an ambulance
- Fill prescriptions
- Receive other covered medical services
You also generally must continue paying your Medicare Part B premium to remain enrolled in Medicare Advantage, although certain plans may help pay some or all of that premium, and some beneficiaries qualify for other assistance. Medicare confirms that Medicare Advantage deductibles, copayments and coinsurance vary by plan.
So when you’re comparing Medicare Advantage plans, don’t stop at:
“What’s the monthly premium?”
Ask:
“What could this plan cost me when I actually use healthcare?”
That’s the more important question.
First: What Does “$0 Premium” Actually Mean?
A premium is the amount you pay regularly to maintain insurance coverage.
So when a Medicare Advantage plan advertises:
$0 monthly premium
it generally means the plan itself doesn’t charge you an additional monthly plan premium.
It does not necessarily mean:
$0 doctor visits
$0 hospital stays
$0 prescriptions
$0 outpatient surgery
$0 diagnostic testing
or:
$0 total Medicare expenses.
Medicare explains that Medicare Advantage plan premiums and other costs—including deductibles, copayments and coinsurance—vary by plan.
Think of the premium as one part of the cost equation.
Not the entire equation.
You Generally Still Pay Your Medicare Part B Premium
This is probably the biggest source of confusion surrounding $0-premium Medicare Advantage plans.
To join Medicare Advantage, you must have both Medicare Part A and Part B. Medicare also states that you must continue paying your Part B premium to stay in the plan.
For 2026, the standard Medicare Part B premium is:
$202.90 per month
Some higher-income beneficiaries pay more because of the Income-Related Monthly Adjustment Amount, or IRMAA.
So someone could have:
Medicare Advantage plan premium: $0
while still having:
Medicare Part B premium: $202.90 in 2026
Those aren’t contradictory.
They’re two separate things.
But Some Medicare Advantage Plans Can Help With the Part B Premium
Here’s where the conversation gets more nuanced.
Some Medicare Advantage plans may offer what Medicare describes as a Part B premium reduction.
That means the plan may help pay some or all of your Part B premium.
But Medicare specifically notes that this benefit isn’t available in all areas.
So if you see an advertisement saying a plan may:
“Put money back in your Social Security check”
or:
“Help pay your Part B premium,”
don’t automatically assume every Medicare Advantage plan offers it or that you’ll receive the maximum amount mentioned in an advertisement.
Check the specific plan available in your ZIP code.
And compare what else you’re getting—or giving up—in exchange.
A $0 Premium Plan Can Still Have Specialist Copays
Suppose you have a $0-premium Medicare Advantage plan.
Your primary care physician might have a low or even $0 copay.
Great.
But now suppose you see:
- A cardiologist
- An endocrinologist
- An orthopedist
- A neurologist
- A dermatologist
- An oncologist
Your plan may charge a specialist copayment.
And if you’re seeing several specialists repeatedly throughout the year, those costs can add up.
This is why someone with multiple chronic conditions may evaluate a $0-premium plan differently from someone who rarely uses medical care.
The correct question isn’t:
“Does the plan have specialist copays?”
Most importantly, ask:
“What are MY specialist costs, and how often am I realistically likely to pay them?”
Hospital Costs Can Matter Much More Than the Premium
This is one of the biggest areas to review.
A Medicare Advantage plan may charge hospital cost-sharing in different ways.
For example, depending on the specific plan, you might encounter:
- A copayment per day
- A copayment per stay
- Coinsurance
- Other applicable cost-sharing
The exact structure depends on the plan.
So imagine two plans.
Plan A
$0 monthly premium
but higher hospital cost-sharing.
Plan B
Monthly plan premium
but lower cost-sharing for certain services.
Which one is cheaper?
You can’t answer from the premium alone.
It depends on how much healthcare you use.
That’s why a Medicare Advantage comparison should consider both:
Fixed costs + costs when you use the plan.
Outpatient Surgery Can Have Its Own Cost
Not every procedure requires an overnight hospital stay.
Many procedures happen in:
- Hospital outpatient departments
- Ambulatory surgical centers
- Other outpatient settings
Depending on the Medicare Advantage plan, you may have a copayment or coinsurance for those services.
If you know you’re likely to need a procedure next year, this should become part of your annual plan review.
For example:
“I may need knee surgery next year.”
is much more useful during a plan comparison than simply saying:
“Find me the cheapest plan.”
Your expected healthcare needs matter.
Diagnostic Imaging Can Cost Money Too
Your doctor orders an:
MRI.
Or:
CT scan.
Or another advanced diagnostic test.
Depending on the plan, you could have cost-sharing.
Again, the point isn’t that every Medicare Advantage plan charges the same amount.
They don’t.
Medicare says the plan determines its applicable deductibles, copayments and coinsurance within Medicare’s rules, and costs can vary from plan to plan.
That’s precisely why you compare.
Don’t Forget Ambulance Costs
Ambulance transportation is another service people often don’t think about when comparing Medicare plans.
Medicare Part B covers qualifying ambulance services, and Medicare Advantage plans must cover at least the services Original Medicare covers, although plan rules and cost-sharing can differ.
A Medicare Advantage plan may require a copayment or other cost-sharing for covered ambulance services.
You probably don’t expect to need an ambulance.
Nobody plans on it.
But that’s exactly why insurance comparisons shouldn’t focus exclusively on the benefits you expect to use every month.
You should also understand your potential costs when something unexpected happens.
Prescription Costs Are Another Separate Piece
Many Medicare Advantage plans include Medicare Part D prescription drug coverage.
But:
$0 plan premium doesn’t mean $0 prescriptions.
Depending on your plan and medications, you may encounter:
- A drug deductible
- Copayments
- Coinsurance
- Different drug tiers
- Formulary restrictions
- Pharmacy-network considerations
Medicare states that actual Part D costs can depend on the medicines you take, whether they’re included on the plan’s formulary and which pharmacy you use.
That’s why you should compare Medicare Advantage prescription coverage using your actual medications.
Not somebody else’s.
We’ve covered this in more detail here:
What Happens If Your Medication Is Not on a Part D Formulary?
What Is a Copayment?
You’ll hear this word constantly when comparing Medicare Advantage plans.
A copayment is generally a fixed amount you pay for a covered healthcare service.
For example, a plan might establish a specific dollar copayment for a particular type of visit or service.
The amount varies by plan.
Medicare defines a copayment as a fixed amount you may be required to pay as your share of the cost of a covered benefit.
So when reviewing a plan, look beyond:
Premium: $0
and start examining the rows underneath it.
What Is Coinsurance?
Coinsurance works differently.
Instead of paying a fixed dollar amount, you pay a percentage of the applicable cost.
For example, if a covered service has 20% coinsurance, your responsibility is based on that percentage rather than a predetermined flat copay.
Medicare defines coinsurance as an amount you may have to pay as your share of a benefit, usually expressed as a percentage.
This distinction can become particularly important when you’re comparing more expensive medical services.
What About Deductibles?
A deductible is an amount you may need to pay before certain plan coverage begins paying according to its rules.
Medicare Advantage plans can have different deductible structures.
A plan could potentially have:
- No medical deductible
- A medical deductible
- A prescription drug deductible
- Other applicable deductibles
Again:
Look at the specific plan.
Don’t assume every $0-premium Medicare Advantage plan works the same way.
They don’t.
The Number Every Medicare Advantage Shopper Should Know: MOOP
Now we get to one of the most important numbers in Medicare Advantage:
Maximum Out-of-Pocket Limit
Often shortened to:
MOOP
Medicare Advantage plans have a yearly limit on what you pay out of pocket for covered Medicare Part A and Part B services.
Once you reach the applicable plan limit, Medicare explains that you’ll pay nothing for covered health services for the remainder of the calendar year.
That’s a major feature of Medicare Advantage.
Original Medicare by itself doesn’t have the same annual out-of-pocket limit for Part A and Part B services.
What Doesn’t the Medicare Advantage MOOP Necessarily Include?
This is important.
Don’t assume:
“Once I hit the MOOP, literally everything healthcare-related becomes free.”
The Medicare Advantage medical out-of-pocket maximum generally concerns covered Part A and Part B services.
Prescription drug costs operate under separate Part D rules.
Premiums also shouldn’t simply be treated as medical cost-sharing counting toward your MOOP.
So when comparing your potential financial exposure, separate:
Plan premium
Part B premium
Medical cost-sharing
Prescription costs
That gives you a more accurate picture.
A Simple Example: How a $0 Premium Plan Can Still Cost Money
Let’s imagine a hypothetical Medicare Advantage plan.
We’ll deliberately avoid real copay amounts because benefits vary by plan.
The plan has:
Monthly plan premium
$0
But during the year, John needs:
6 specialist appointments
1 MRI
1 outpatient procedure
1 emergency room visit
Several prescriptions every month
John could owe applicable cost-sharing each time.
So his annual healthcare cost isn’t:
$0.
His plan premium may be $0.
That’s different.
This distinction is one of the most important things to understand when evaluating Medicare Advantage.
Compare Two Hypothetical Medicare Advantage Plans
Consider this example.
| Plan A | Plan B | |
|---|---|---|
| Monthly plan premium | $0 | $45 |
| PCP | Lower cost | Lower cost |
| Specialist | Higher | Lower |
| Hospital | Higher | Lower |
| Imaging | Higher | Lower |
| MOOP | Higher | Lower |
| Extra benefits | More | Fewer |
Which is better?
There isn’t enough information.
We still need to know:
- Your doctors
- Your hospitals
- Your medications
- How frequently you use healthcare
- Your expected procedures
- Your budget
- Your preferred pharmacies
- Which benefits you’ll actually use
Someone who barely visits the doctor might prefer Plan A.
Someone expecting frequent specialist visits and procedures might prefer Plan B.
Or neither could be appropriate because of provider networks or medications.
That’s why:
There is no universally “best” Medicare Advantage plan based solely on premium.
$0 Premium vs. $0 Copay Are Also Different
Here’s another distinction.
$0 premium
means no additional monthly premium for the plan.
$0 copay
means you don’t pay a copayment for a particular covered service under the plan’s terms.
A plan could have:
$0 premium
$0 PCP copay
and still charge cost-sharing for:
specialists
hospital stays
imaging
outpatient surgery
ambulance
and other services.
Don’t let multiple “$0” numbers blur together.
Ask what each one actually refers to.
What About Dental, Vision, OTC and Fitness Benefits?
Medicare Advantage plans may offer supplemental benefits beyond Original Medicare.
These can include benefits such as:
- Dental
- Vision
- Hearing
- OTC
- Transportation
- Fitness
- Other supplemental benefits
These benefits can certainly have value.
But don’t choose a plan solely because the advertisement shows an attractive allowance.
We’ve discussed this in our guide:
How to Compare Transportation, OTC and Fitness Benefits
Ask:
Will I actually use this benefit?
And then ask:
What does the underlying medical coverage look like?
A large supplemental benefit doesn’t compensate for a plan that doesn’t fit your doctors, medications or healthcare needs.
Provider Networks Can Have a Financial Impact Too
Costs aren’t only about copayments.
Networks matter.
Many Medicare Advantage plans use networks of participating doctors and healthcare facilities.
Depending on whether you have an HMO, PPO or another plan structure, receiving non-emergency care outside the network may be restricted or could cost more.
Medicare notes that Medicare Advantage beneficiaries generally need to use doctors in the plan’s network for non-emergency or non-urgent care, subject to the particular plan’s rules.
That’s why a plan with a $0 premium isn’t necessarily a bargain if:
Your doctors aren’t in the network.
Network fit is part of cost.
HMO vs. PPO Can Affect How You Use Your Coverage
You’ll also encounter different Medicare Advantage structures.
Two of the most familiar are:
HMO
and:
PPO.
These can differ in areas such as:
- Provider networks
- Out-of-network coverage
- Referral requirements
- Costs
- Flexibility
When comparing plans, don’t ask only:
“Which one has a $0 premium?”
Ask:
“How would I actually use this plan?”
Someone who receives most healthcare locally may have different priorities from someone who frequently travels or wants greater provider flexibility.
What Should You Compare Instead of Just the Premium?
Here’s a stronger Medicare Advantage checklist.
1. Monthly plan premium
Is it $0 or does the plan charge an additional premium?
2. Part B premium
Remember that you generally continue paying Part B.
3. Medical deductible
Does the plan have one?
4. Primary care cost
What do you pay?
5. Specialist cost
Especially important if you see several specialists.
6. Hospital cost-sharing
What could an inpatient stay cost?
7. Outpatient surgery
What is your responsibility?
8. Diagnostic imaging
Review MRI, CT and other applicable imaging costs.
9. Emergency and urgent care
What would you pay?
10. Ambulance
What’s your cost-sharing?
11. Prescription drugs
Are your medications covered and at what estimated cost?
12. Maximum out-of-pocket limit
What’s your potential annual exposure for covered Part A and Part B services?
13. Doctors
Are your physicians participating?
14. Hospitals
Are your preferred hospitals included?
15. Supplemental benefits
Which ones will you actually use?
That’s a real Medicare Advantage comparison.
Don’t Ask: “What’s the Cheapest Medicare Advantage Plan?”
Ask:
“Which plan gives me the best overall value for my healthcare needs?”
Those aren’t the same question.
Imagine someone with:
- Diabetes
- Heart disease
- Four specialists
- Eight prescriptions
- Frequent imaging
- Regular outpatient procedures
Their priorities may differ significantly from someone who:
- Takes one generic prescription
- Sees a PCP twice a year
- Has no specialists
- Rarely uses medical services
The same plan can look completely different depending on the person using it.
How $0-Premium Plans Fit Into Medicare Open Enrollment
As Medicare Open Enrollment approaches, you’re likely to see more advertising for Medicare Advantage plans.
Open Enrollment runs from:
October 15 through December 7.
That’s when eligible Medicare beneficiaries can make certain changes involving Medicare Advantage and Part D coverage for the following year.
But don’t begin with the advertisements.
Begin with your own healthcare.
We’ve created a preparation guide here:
Medicare Open Enrollment 2027: What You Should Start Doing Before October 15
Gather your:
Doctors
Specialists
Hospitals
Prescriptions
Pharmacy
Current costs
Expected healthcare needs
Then compare plans against that information.
A Better Way to Think About Medicare Advantage Costs
Instead of thinking:
Premium = Cost
think:
Total Medicare Cost = Premiums + Healthcare Use + Prescription Costs
And then consider another factor:
Financial Risk
That’s where your maximum out-of-pocket limit becomes important.
You may not reach your MOOP.
Many beneficiaries won’t.
But you should still know what it is.
Insurance isn’t only about what happens during a healthy year.
It’s also about understanding your financial exposure during a difficult one.
Three Questions to Ask Whenever You See “$0 Premium”
The next time you see an advertisement for a $0-premium Medicare Advantage plan, ask:
1. What will I pay when I use healthcare?
Look at copays, coinsurance and deductibles.
2. What is my maximum out-of-pocket limit?
Understand your potential medical cost exposure.
3. Does the plan actually fit me?
Check doctors, hospitals, medications, pharmacies and plan rules.
If you can answer those three questions, the “$0 premium” headline becomes much more meaningful.
What Does Medicare Say About Medicare Advantage Costs?
Medicare’s own guidance makes the distinction clear.
Medicare Advantage costs vary by plan. Plans determine their applicable premiums, deductibles, copayments and coinsurance, and beneficiaries generally must continue paying their Part B premium. Plans also have an annual limit on out-of-pocket spending for covered health services.
You can review the government’s official information here:
Medicare.gov — Understanding Health Plan Costs
And compare Original Medicare and Medicare Advantage here:
Medicare.gov — Original Medicare vs. Medicare Advantage
Compare the Whole Medicare Advantage Plan
A $0-premium Medicare Advantage plan can be an excellent fit for some beneficiaries.
For others, a different Medicare Advantage plan—or another Medicare coverage approach—may better fit their needs.
The important thing is not to assume:
$0 premium = free healthcare.
Instead, compare:
Premium
Copays
Coinsurance
Hospital costs
Specialist costs
Prescriptions
MOOP
Doctors
Hospitals
Plan rules
Benefits you actually use
That’s how you get closer to understanding the plan’s real value.
Need Help Comparing Medicare Advantage Plans?
Medicare Plan Assistance can help you evaluate more than the number printed next to “monthly premium.”
We can help you review factors such as:
- Doctors
- Hospitals
- Prescriptions
- Pharmacies
- Premiums
- Copays
- Coinsurance
- Maximum out-of-pocket limits
- Supplemental benefits
- Plan structure
📞 Call Medicare Plan Assistance at (561) 808-9410
Compare the full cost and coverage of the Medicare Advantage plans available to you—not just the monthly premium.
Frequently Asked Questions
Does a $0-premium Medicare Advantage plan mean Medicare is free?
No. A $0 premium generally means the Medicare Advantage plan doesn’t charge an additional monthly plan premium. You can still have other costs, including Part B premiums, deductibles, copayments, coinsurance and prescription costs.
Do I still pay Medicare Part B if my Medicare Advantage premium is $0?
Generally, yes. Medicare says you must continue paying your Part B premium to stay enrolled in Medicare Advantage. Some plans may help pay all or part of the Part B premium, and some beneficiaries may qualify for other assistance.
How much is the Medicare Part B premium?
The standard Medicare Part B premium is $202.90 per month in 2026. Higher-income beneficiaries may pay more. The final 2027 standard Part B premium should be checked once officially announced.
Can a $0-premium Medicare Advantage plan charge specialist copays?
Yes. Medicare Advantage deductibles, copayments and coinsurance vary by plan. A $0 monthly plan premium doesn’t eliminate cost-sharing for covered services.
Can Medicare Advantage plans charge for hospital stays?
Medicare Advantage plans can have applicable cost-sharing for covered hospital services. The amount and structure depend on the specific plan, which is why hospital costs should be reviewed before enrolling.
What is the Medicare Advantage maximum out-of-pocket limit?
Medicare Advantage plans have an annual limit on what beneficiaries pay out of pocket for covered Part A and Part B services. Once the applicable limit is reached, the plan pays 100% for covered health services for the remainder of the calendar year.
Do prescription drug costs count toward my Medicare Advantage medical MOOP?
The Medicare Advantage medical out-of-pocket limit applies to covered Part A and Part B services. Part D prescription drug spending follows separate Part D cost rules.
What should I compare besides a Medicare Advantage plan’s premium?
Compare doctors, hospitals, prescriptions, pharmacies, deductibles, copayments, coinsurance, maximum out-of-pocket limits, plan rules and supplemental benefits you’re likely to use.
Where can I get help comparing Medicare Advantage plans?
Medicare Plan Assistance can help beneficiaries compare the Medicare Advantage plans the agency represents based on their healthcare needs and plan costs. Call (561) 808-9410.
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