How do you explain to clients that "zero-premium" doesn't mean "zero-cost" with Medicare Advantage?

Question

Dana Dane · Accepted Answer

Benefits vary from plan to plan. Often times you may have a $0 copay with an in-network primary care physician, for example. There is usually cost sharing for out-patient surgeries, hospitalization, major diagnostic tests as well as other services. Cost sharing can be a set dollar amount or a percentage of the cost.

Answered by Dana Dane on April 2, 2025

Agent Licensed in OR, AZ, CA & 6 other states

Answered by Dana Dane Medicare Insurance Agent

Gary Church · Answer

Explaining the zero premium means stating that you pay for the health plan through co-payments and deductibles. If hospitalized, consider the hospital stay's co-pays and meeting the MOOP. Office visits, outpatient services, and emergency room visits.

Answered by Gary Church on June 9, 2025

Broker Licensed in Ca, AZ, NV & TX

Answered by Gary Church Medicare Insurance Agent

Steve and Sue Brauer · Answer

Most Medicare Advantage plans do not have a monthly premium, but DO have copays for Medicare services. I tell people that Original Medicare is more of a "pre-pay" system, where Advantage plans are a "pay as you go" model.

Answered by Steve and Sue Brauer on April 13, 2025

Broker Licensed in AZ & CA

Answered by Steve and Sue Brauer Medicare Insurance Agent

Mike Alexander · Answer

I never say 0 premium, I always say no additional premium, othrt than you part b premium,
You will always have to pay your part b cost, unless you are very low income

Mark Bilgere · Answer

I explain clearly that there is no FREE healthcare available. Any plans referred to as "premium free" or "no premium" have a cost. That cost could be in the form of copays or coinsurance. It may not have a monthly cost, but it will have payments due.

As you use your Advantage plan, you will have either a fixed dollar amount ( copay) or a percentage (coinsurance) of the bill to pay. The one exception is typically a visit to your primary care provider.

Lt Col Tim Brown · Answer

Sometimes people hear what they want to hear. I cant tell you how many times I've told people something about a plan and then they repeat back what they thought they heard or what they really wanted it to be and I have to say "no that is not what I said". Words have meanings. Zero Premium means just that, no premium. I tell people that MAPD plans are co-pay driven, meaning you have co-pays as you use the plan. There is a max out of pocket, etc. People hear what they want to hear. I have to do my best to make sure that does not happen.

Answered by Lt Col Tim Brown on July 4, 2025

Broker Licensed in TN, AL, CO & 10 other states

Answered by Lt Col Tim Brown Medicare Insurance Agent

William Lawler · Answer

A "zero premium" means that you will pay $0 per month for your Advantage plan. But there will be co-pays and co-insurance if you use medical services. Advantage plans have a MOOP (maximum-out-of-pocket) ceiling on their plans. Each Advantage plan has different a MOOP. 
Bill Lawler

Terri Reagin · Answer

As a licensed insurance agent, It is my responsibility to read the copays, deductibles, and out of pocket costs associated with each advantage plan choice by carefully reviewing the summary of benefits and the outline of coverage including drug costs.

Answered by Terri Reagin on September 12, 2025

Broker Licensed in OK, AR, CO & 6 other states

Answered by Terri Reagin Medicare Insurance Agent

Christopher Boyd · Answer

This is one of the most dishonest and most-misleading sayings in the business: "zero premium/zero co-pays". Unless an individual has some form of federal, state, local, or hospital financial assistance, he/she will have a co-pay and many circumstances such as chemotherapy, durable medical equipment, inpatient hospital care, ambulance, emergency room, urgent care, etc, co-pays can be quite high. For example, many Advantage Plans in my marketing area cover only 80% of Chemotherapy and Durable Medical Equipment, meaning the patient can be responsible for 20% of the cost until they reach the plan's annual maximum out of pocket (MOOP). The MOOP can range from $3000 to $13000 per year depending on network restrictions and plan allowances. I met a man once who had cancer and maxed out his MOOP of $6,700 two years in a row, and then nearly maxed out again in the third year, when he passed away. He and his family were very angry with the agent who signed him up and never explained the plan rules and restrictions.

Answered by Christopher Boyd on July 30, 2025

Agent Licensed in IN, KY, MI, OH, PA & TN

Answered by Christopher Boyd Medicare Insurance Agent

Mark Maliwauki · Answer

Nothing to do with healthcare regardless of what plan it is, is truly zero anything.

Zero premium plans come with deductibles for several things including Rx, hospital stays, procedures etc... you are going to still have to pay something to use the plan. 

MA plans, however, have generally been a good alternative to a Medicare Supplement for healthier individuals because if you don't take Rx, don't see a Dr., have no health issues, you don't have to cover the Medicare Supplement and Rx plan premiums which are both going up again on average 30% every year.

Ann Sanfelippo · Answer

A “zero-premium” Medicare Advantage plan simply means you don’t pay an additional monthly premium beyond your Part B premium. You still have copays, coinsurance, and deductibles when you use medical services, such as doctor visits, hospital stays, or outpatient procedures. Costs can add up quickly if you need frequent care, even though the monthly premium is low. That’s why it’s important to look at the plan’s out-of-pocket maximum and expected usage, not just the premium.

Answered by Ann Sanfelippo on January 10, 2026

Broker Licensed in FL, AL, AZ & 14 other states

Answered by Ann Sanfelippo Medicare Insurance Agent

Pamela Masters · Answer

I explain to my clients the definitions of each thing like premiums, copays and coinsurance. We go through the plan thoroughly as well so by the time our appointment is over they will have all the information. I also leave a book with them to help remind them of what we discussed.

Answered by Pamela Masters on November 30, 2025

Broker Licensed in NC

Answered by Pamela Masters Medicare Insurance Agent

Tony Capraro III · Answer

How do you explain to clients that zero premium doesn't mean zero cost with Medicare Advantage? Great question! What we do here at my State Farm agency on Kelly Street in Manchester is tell folks exactly what the out-of-pocket costs can and will be with a Medicare Advantage plan. Just because there's zero premium, there are always out-of-pocket costs. In the state of New Hampshire, they're anywhere from $4,500 to $10,000 every year. It resets every year.

So, the 800 numbers, your mailbox being stuffed, the commercials, all are leading you toward Medicare Advantage because that's all they can offer and sell. Here at my State Farm agency, we do offer Medicare Advantage, but we also offer Medicare Supplement. We give people the pros and cons of both, the good and bad, and then let them make the decision.

But work with someone like myself who can offer both, not just the zero premium Medicare Advantage plans that they don't tell you about the out-of-pocket costs. We'll be glad to help you. We help people every single day.

Edward Smith, ChFC, CRPS, AIF · Answer

I always use the example of pay now or pay later. With a Medicare Advantage plan you do not have a monthly premium as with a Medicare Supplement, but you do have co-pays and co-insurance cost if and when you use the plan. The max out of pocket with a Medicare Supplement Plan G for instance is the total of all monthly premiums plus the Part B deductible (currently $258 in 2025), where the out-of-pocket maximum with a Medicare advantage is going to be the co-pays and co-insurance amounts added together up to the maximum out of pocket or (MOOP) for the particular plan you have chosen.

Answered by Edward Smith, ChFC, CRPS, AIF on July 28, 2025

Broker Licensed in OH, GA, IN, KY & TN

Answered by Edward Smith, ChFC, CRPS, AIF Medicare Insurance Agent

Jonathan Potter · Answer

So the word premium refers to how much the plan will cost you every month. Generally they are zero or no premium plans but there are some that will cost anywhere from $33-100. This is the cost to subscribe in the plan.

Zero cost can refer to the plan premium but some people get that confused with the plan copays when you use the plan for doctor visits. If someone uses the term zero cost I would clarify if they are talking about the cost to be on the plan or the copays when you use the plan.

Ronnie Robinson Jr · Answer

Zero premium only applies to the cost of the Medicare advantage plan. The co-pays coinsurance, max out-of-pocket, etc., are additional cost the client may have when using the plan.

Steven Graves · Answer

That’s a great question, and it’s important to clarify. When we say a Medicare Advantage plan has a “zero premium,” we’re referring specifically to the fact that there’s no additional monthly premium for the plan itself beyond what you already pay for Medicare Part B.

However, “zero premium” doesn’t mean zero cost overall. These plans often come with out-of-pocket expenses such as:

Copayments for doctor visits, specialist appointments, or hospital stays

Coinsurance for certain services or procedures

Deductibles in some cases

Out-of-network charges if you go outside the plan’s provider network

Drug costs if the plan includes prescription coverage

Each plan also has an annual out-of-pocket maximum, which helps protect you financially, but you can still incur costs along the way—especially if you have complex or frequent healthcare needs.

So, while the monthly cost may be low or even $0, it’s important to look at the total cost of care based on how often you use healthcare services and which providers or medications you need.

This is why we always review not just premiums, but the full picture—so you can choose the plan that fits your health needs and budget.

Regards,

Serving all of Texas Florida and California
Contact me.

Jacqueline Proffit · Answer

The phrase "zero-premium" is accurate, but it only refers to the monthly cost charged by the private insurance company for the Medicare Advantage plan itself. It does not mean the member pays nothing for healthcare.
"The plan itself costs you $0 per month, but when you see a doctor or go to the hospital, you will have a copay or coinsurance. This plan transfers the cost from a fixed monthly premium to a fee-per-service structure. That's why we need to review the Summary of Benefits to see what your doctor visits and hospital stays will cost."

Nick Mangini · Answer

There is a simple saying... "NOTHING IN LIFE IS FREE!" There's another simple saying... "THERE'S NO SUCH THING AS FREE LUNCH". Medicare Advantage plans have very good marketing and put the carrot in everyone's face telling them that it's "zero premium" which basically means that you are paying on the back-end in copays, coinsurance, deductibles, etc. There is something called a "max out of pocket" cost which means that is your max financial risk for that plan. Just because it's "zero premium" does not mean that is "zero cost"!

Answered by Nick Mangini on November 20, 2025

Broker Licensed in FL, AL, AZ & 32 other states

Answered by Nick Mangini Medicare Insurance Agent

Ellen Diehl · Answer

Advantage plans are "managing" your care for their profit.  I only sell Supplement plans that allow you to go to any Dr. in the USA USA USA that accepts Original Medicare Part A & B.

Cheri Rogers · Answer

Zero Premium means that there is no monthly insurance Premium. You will have copays related to many medical services but the copays are small compared to the actual cost of medical services.

Sherry Rose · Answer

Zero Premium is the cost you pay for the plan unless you have a penalty related for not carrying a prescription drug plan.  I do not define a plan as zero cost since that could not be the case.

Lilyana Uzdenova-Gomez · Answer

In the world of insurance the coverage is usually obtained through payment of premiums, copays, deductibles, coinsurance or a combination of all. Often, when a plan doesn’t have a monthly premium it may have higher copays, deductibles and coinsurance than the plans with monthly premiums. 
 Always consider long term use of the plan with the potential healthcare expenses factored in.

James Hale · Answer

Zero-premium sounds like ‘free Medicare’ — but it’s not zero-cost. It’s more like a cell phone plan with $0 monthly fee… until you start using data, minutes, or roaming.

The honest breakdown:

✅ Zero premium = You pay $0 extra to the insurance company each month for the Medicare Advantage plan.

❌ You still pay your regular Medicare Part B premium — about $202.90 per month in 2026 for most people.

❌ When you actually use healthcare, you pay copays, coinsurance, and deductibles:

Doctor visits: often $20–$50 each
Hospital stays: hundreds or thousands before the plan kicks in fully
Prescriptions: copays that add up fast
Other services: tests, therapies, surgeries

Even with a generous plan, you could still face thousands of dollars in a bad health year — though most plans cap your maximum out-of-pocket (often $5,000–$9,000+).

Real-world example:
Last year I had a client with a $0 premium plan. He thought his heart procedure would cost almost nothing. Between the hospital copay, specialist visits, and rehab, he still paid over $4,000 out of pocket that year.

Bottom line:
Zero-premium plans can be great if you’re healthy and stay in-network. But they shift costs from monthly premiums to when you get care. That’s why we always look at your total estimated costs — not just the flashy promise of a $0 premium.

Mitch Anderson · Answer

The "cost" associated with a Medicare Advantage plan can come from the premium, copays, and coinsurance. It is important to understand the risk of cost and how they are similar and different from one Medicare Advantage plan to the next as they can very significantly.

Answered by Mitch Anderson on June 10, 2025

Agent Licensed in MN, IA & WI

Answered by Mitch Anderson Medicare Insurance Agent

Rodney Powell · Answer

Some Advantage plans have a $-ZERO premium, but that doesn’t mean you pay nothing.

You’ll still have out-of-pocket costs like deductibles, copays, and coinsurance when you use services.

Jay Larshus · Answer

There are "zero-premium" Medicare Advantage plans but you still must pay your Medicare Part B premium. In addition, even though the Advantage plan may have $0 Premium, these plans will have Co-Pays for certain services and in some cases, you may pay coinsurance. Any copays or coinsurance you pay will count towards the Plan's Maximum out of pocket cap.

Answered by Jay Larshus on October 1, 2025

Agent Licensed in TN & VA

Answered by Jay Larshus Medicare Insurance Agent

Mary Green · Answer

"Zero premium" gets your attention, doesn't it? It makes people think, "How can insurance be free?". I explain to my new clients that it just means"zero additional premium out of your pocket ". You are already paying the premium, it's the Medicare Part B that is charged to your social security benefit. Medicare pays that Part B premium to the Advantage plan company, and it covers the insurance plan benefits they are offering.

Answered by Mary Green on November 30, 2025

Broker Licensed in AL, CO, FL, GA, TN & VA

Answered by Mary Green Medicare Insurance Agent

Edward Givens · Answer

Bottom line:
“$0 premium only means you don’t pay to enter the door. But once you’re inside—seeing doctors, filling prescriptions, getting labs—that’s when the real costs show up.”

Sarah Rollins · Answer

Medicare Advantage plans are copay-driven plans, meaning most services are a fixed cost. That is the cost of your healthcare. 

The premium is the cost of your insurance policy. Two very different things. So a $0 premium simply means that the policy is $0. But there will still be healthcare costs.

Andrew Sandlin · Answer

I go about explaining this to individuals with two key points. 

1) I point out that just because the Medicare Advantage plan is 0 premium doesn't mean you get out of paying the part B cost each month. Again, the part B cost is going to be there no matter what coverage route we choose to walk down. It is just 0 premium to add the Medicare Advantage plan through whatever carrier we choose.

2) I always explain Medicare Advantage as more of a "pay as you go" system. In other words, the plan itself may be 0 premium each month but we have to understand that when we use the coverage, doctors and hospitals are going to ask us for payments in the form of copays. Overall, we save money upfront by not paying premium dollars each month but we do pay for things when we use the plan.

Phillip Lovelady · Answer

My Daddy use to say, "Son, there ain't no such thing as a free lunch." This is the case with the zero dollar premium Medicare Advantage(MAPD.) In order to enroll in a MAPD, you have to be enrolled in Medicare A AND B, so you still have to pay your Part B premium. 

The Zero Premium does not mean "zero cost."  MAPD plans are a "Pay as you go" plan. Depending on what plan you enroll in you may  have co pays for Doctor visits, Specialist, and Hospital stays.

Barry Baker · Answer

The Center for Medicare Services (CMS) pays the insurance company for your plan. There is a premium, but it's not paid by the Medicare beneficiary. It's not a "zero-cost", the beneficiary paid into the system (taxes) during his or her working life (at least 40 quarters).
"Zero-premium" to the beneficiary. but not CMS

Steve Wilson · Answer

This is a great question and one that I carefully walk through to explain to my current and prospective clients.  Medicare Advantage plans MAY or MAY not have a premium and I always start with that foundation after I explain how the Medicare Part B premium works.  

If the plan has a premium of any amount ranging from $0 premium to anything beyond $0, it is almost certain that many costs will have copayments or sometimes other coinsurance.  The most common examples might be a specialist copay or a hospital admission copay.

There are some common "zero cost" items and those most commonly include (1) seeing your primary care physician for services, and (2) preventive care services.

I always take a very consultative approach so that the consumer has a really good understanding of how the plan works and this avoids any surprises.

Steven Bleicher · Answer

This question has more to do with your educational background than a full comprehension of Medicare. There can be a variety of premiums that are an integral part of a healthcare system. In effect, a premium is usually a monthly payment for a service provided. It can be a payment for a Medicare Supplement, or one for the Part D(rug) plan or one for a Hospital Indemnity plan. But “costs” are another entity. A cost could be a true “copay” at the pharmacy for an Rx prescribed by your doctor or a fee for a laboratory who will draw your blood based on an upcoming appointment with the doctor. So, costs are “indeterminate”, depending on any health checks/issues while premiums are definite costs that are common in the Medicare system.

Answered by Steven Bleicher on May 23, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Steve Houchens · Answer

Basically to explain it doesn’t mean zero cost would be to go over all benefits of the plan and go through explanations of benefits. Zero premium means no cost to the client for the plan but doesn’t state or imply anywhere that there are zero cost associated with the benefits you receive.

Answered by Steve Houchens on September 4, 2025

Agent Licensed in KY & TN

Answered by Steve Houchens Medicare Insurance Agent

Jim Tretola · Answer

This can be explained by discussing the Summary of Benefits and out-of-pocket expenses that a Client may be exposed to in an Advantage Plan. Most people understand that everything is NOT for free. Clients enrolling in Zero Premium Plans, should consider other
Plans to protect them from out-of-pocket costs, specifically Cancer and Hospital Indemnity Plans. Many people don not realize that if they are hospitalized for a handful of days, or need Cancer treatment, that they will be spending thousands of dollars. People also do not take enough notice of the Maximum Out-of-Pocket limits on Advantage Plans.

Kristen Skinner · Answer

Well first I tell them that they still have to pay their Part B premium; which is a part of Original Medicare. And then if they have a "zero premium" plan, then they have co pays. I always give them the MOOP on those plans also. 
If you carefully explain and go over everything, the client usually understands better.

Barbara Barnes, CMIP® · Answer

This can be complicated and difficult to understand for some people. I look at it two ways to try to make it make sense…

1. Just because YOU are not paying a premium, doesn’t mean a premium is not being paid by someone else. For $0 Premium Medicare Advantage plans, the ‘premium’ is being paid by the US Government. They don’t call it a premium, though. When you choose a Medicare Advantage plan, Medicare is no longer responsible for paying your claims. Instead, the insurance company that you chose for your Medicare Advantage insurance plan is responsible for paying your claims, according to your policy provisions and in accordance with Medicare guidelines. This frees up money in the Medicare system that the US Government uses to pay the insurance company offering the Medicare advantage plan. There is definitely a cost.

2. You may not be paying a premium, but you will pay for the services that you receive according to your plan’s contract. Depending on the plan, you will be responsible for copayments, deductibles and coinsurance, up to the plan’s maximum out-of-pocket provision. The maximum out-of-pocket requirement on your plan is an important number for you to know. That is the point within the plan year when you’ve paid the maximum amount that you are required to pay, and your insurance company will pay the rest for the remainder of the year. In Pennsylvania, this maximum can range from $4000-$9000 per person per year, depending on the plan. So even if you are not paying a premium, there will be a cost to receive medical care.

Before you buy a plan, it is important that you understand what you are buying and how it works. Please reach out to a professional Medicare insurance agent for assistance so that there are no surprises at the time of a claim.

Rick Boyd · Answer

For many Medicare Advantage plans they come with a zero monthly premium, yet you still have to pay your Medicare part B premium. Advantage plans are a “pay as you go “ type plan wheee you pay co-pays or coinsurance for many if not most of the services. In essence, the more services you use in your Advantage plan, the more you pay.

Answered by Rick Boyd on July 28, 2025

Broker Licensed in KY, AZ, CA & OH, TN, TX & UT

Answered by Rick Boyd Medicare Insurance Agent

DeeDee Whitlock · Answer

I go over every aspect of the coverage & explain EXACTLY how Medicare Advantage works & the fact that MD Anderson & Mayo usually does not accept these type plans. I would rather them know every detail before hand because I want clients in my office to hug my neck NOT ring it!!!

Answered by DeeDee Whitlock on June 23, 2025

Broker Licensed in LA

Answered by DeeDee Whitlock Medicare Insurance Agent

Vernon Jones · Answer

i would explain zero premium as no cost for the actual plan, but there will be cost for service rendered on a Medicare Advantage plan. I call it pay as you go or pay as you use the plan from copays, deductible, co-insurance or out of pocket charges.

Answered by Vernon Jones on August 20, 2025

Broker Licensed in NC & SC

Answered by Vernon Jones Medicare Insurance Agent

Melanie Blackston · Answer

When thinking of a "ZERO premium" means no monthly plan fee, but costs are still associated to copays/coinsurance, deductibles, prescription tiers, and you still pay your Part B premium monthly.

Brianna Douros · Answer

Hey y'all, it's Brianna, your favorite life and health insurance agent and owner of Be Real Insured. Today, we're gonna touch on hospital indemnity plans. They are paired beautifully with Medicare Advantage plans. As we know, Medicare Advantage plans do have some advantages, but they also have some gaps. One of those gaps is the hospitalization copay, which can be up to four hundred dollars for the first day, one through six, or even one through eight, depending on your Medicare Advantage plan, before your plan starts to pick up any of those costs. So it can become quite a hefty bill in the event that you're hospitalized. One way to protect yourself is with a hospital indemnity plan for a little over a dollar a day. You can offset those costs. Okay, it's really great. I've also had individuals on group coverage or even just original Medicare have this in place just to offer some additional protection. I hope that helps! If you guys have any questions, don’t hesitate to reach out to me. Until next time, y'all keep it real!

Shalonda Cave · Answer

Define zero-premium clearly and let them know that zero premium means you do not have to pay a monthly premium for the Medicare Advantage plan itself. Also, highlight potential out-of-pocket costs while using real-life scenarios to help them better understand.

Answered by Shalonda Cave on December 29, 2025

Agent Licensed in OH, AZ & FL

Answered by Shalonda Cave Medicare Insurance Agent

Kim Gibas · Answer

A zero-premium plan is just that—you won’t be billed monthly for the plan itself. However, you should still expect out-of-pocket costs for things like copayments, coinsurance, and deductibles when you receive care. 

So while the monthly premium is zero, it's important to consider these other costs when evaluating whether the plan fits your budget. 

I’m here to help you understand all the potential costs, so you can make an informed choice that works for you!"

Heidi Delaney · Answer

Medicare Advantage plans may have a $0 premium, but this does not mean that you will not pay anything for services.  In place of an additional premium, you will have copays and coinsurance for the services you use.  

Some individuals with Medicaid may not have copays and coinsurance due to the state Medicaid program picking up the cost-share amounts for them.

Jeffrey Barone · Answer

I explain to them that Zero Premimum means that they don't pay a monthly fee to be in the plan but there are costs when utilizing the plan ie: doctor visit copays, some procedure copays.

Paul Dzierzanowski · Answer

Quite simply, premiums and costs are two different things. A premium is something you pay, usually on a monthly basis, in order to have a Medicare Advantage plan. A cost is something you pay once you have established yourself as a member in a Medicare Advantage plan and obtain some type of service. If you need any more help on your specific situation, don't hesitate to call me directly.

Answered by Paul Dzierzanowski on April 4, 2025

Agent Licensed in FL & GA

Answered by Paul Dzierzanowski Medicare Insurance Agent

Elijah Pannell · Answer

A Medicare Advantage plan with a $0 monthly premium can be appealing, but it is important to clarify that this does not mean there are no costs associated with the plan. While the premium may be $0, members are still responsible for other out-of-pocket expenses. These may include copayments, coinsurance, deductibles, and costs for services not covered or those received out-of-network. Additionally, prescription drug coverage, dental, vision, or hearing services may involve separate charges depending on the plan’s benefits.

To ensure informed decision-making, members should review the plan’s summary of benefits and coverage documents carefully. For more detailed information on cost considerations and quality, contact me

Toyin Adeleye · Answer

The zero or low premium Medicare Advantage plans are what initially reel most people into Medicare Advantage plans; people understandably want to save money where they can.  However, let's explore an example where this plan is not as cheap as it seems:

Ms. Flynn sees a cardiologist once a month, and she's on a Medicare Advantage plan with Bloom Health that has a $0 premium- she won't pay anything for the plan itself every month, but she will pay a copay for the service itself. For seeing a specialist, Bloom Health requires Ms. Flynn to pay $50 every time (in this case every month) she goes to see her cardiologist. This might not be too bad for Ms. Flynn.

Now let's say Ms. Flynn finds out she'll need a heart surgery, and the copay for that is $400 per day for the first 6 days of hospitalization, she'll be responsible for that as well- and now she's immediately looking at $2,400 she has to cough up. If Ms. Flynn can make this happen, then no problem; but if this is well beyond her budget, this can put her in a bad financial situation and cause her a lot of stress. 

Her Bloom Health plan has an $8,000 out of pocket maximum- meaning if the worst case scenario happens in a year, she can be responsible for paying up to this amount in copays. After this amount, the plan is responsible for all costs, but we absolutely do not want to get to that point.

It's up to Ms. Flynn to think about what a bad year for her could look like, and if that $0 premium plan, along with the other things the plan offers, is actually worth it.

Vachik Chakhbazian · Answer

A zero-premium Medicare Advantage plan means there's no monthly fee for the plan itself, but it's not necessarily "free" overall. You'll still have to pay your Medicare Part B premium, and you may also have out-of-pocket costs for services, medications, or other plan-specific expenses.

Answered by Vachik Chakhbazian on June 8, 2025

Agent Licensed in CA, AL, AR & 22 other states

Answered by Vachik Chakhbazian Medicare Insurance Agent

Mary Brown · Answer

“Zero-premium” means you don’t pay an extra monthly fee for the Medicare Advantage plan itself. But that doesn’t mean your health care is free. 
A zero-premium plan can be a great option for many people, but it doesn’t mean zero-cost. The key is making sure the copays, drug coverage, and out-of-pocket limits fit your budget and health needs.

Meghan Blankenship · Answer

A "zero-premium" Medicare Advantage plan means you don't pay a monthly fee for the plan itself-but it doesn't mean you won't have other costs. It's like getting into a concert for free, but still paying for parking, snacks or a seat upgrade.

What "Zero-Premium" means: You pay $0 per month for the plan, but you still pay your Medicare Part B premium (about $174.70/month in 2025). The plan may include extra benefits like dental, vision, or fitness. 

What "Zero-Premium" does NOT mean: It doesn't mean zero out-of-pocket costs. You may still pay for Copays for doctor visits, specialists, and hospital stays. Coinsurance for lab tests, imaging, or durable medical equipment; Deductibles for certain services; Drug costs under Part D (if included).

Carol Thompson · Answer

There may be no premium cost with most plans however there is Part B cost. 

Part B stands for outpatient services such as bloodwork, dr. visits, imaging and many more that may require co-payments or co-Insurance.

Marcie Barnes · Answer

When I explain a Medicare Advantage plan that has a $0 premium.  I explain that although your premium is $0, you will have a cost share on services.

Mike Henry · Answer

You have to tell them about all the deductions and copayments. All usually the insured sees is zero premium

Jennifer Kalbach · Answer

I personally lay it all out and explain and read the summary of benefits to them and highlight the costs that they will be responsible for and most importantly the MOOP.

Pat Papson · Answer

Each plan does have certain co-pays for different procedures. 

Best to check your options with your agent to find a plan that fits your needs.

Thank you

Rodolfo Rojas · Answer

Zero premium for a specific plan is just for the cost of the plan that you have chosen. 
The plan has charges for specific services. For example, your primary visits, most likely are zero and the specialist may be $25.00
It just depends on the plan that you have chosen. 
Some plans may cost you a certain amount, but it may have fewer charges for a specific service.

Rich Baker · Answer

I tell my clients that while we can, most of the time, find plans with a zero dollar premium, all medicare advantage plans have copayments and coinsurances for most services on the back-end. Someone who is healthy and only sees their primary care doctor once a year can save money vs paying for a Medigap plan, but it’s a risk-reward decision. A few days in the hospital or an unexpected need for cancer infusions can change that equation very quickly. 

I thoroughly cover the copays listed in the summary of benefits with each client so they know what the potential costs are for those most common services, and what the Maximum Out Of Pocket (MOOP) is so they know what their total potential financial exposure is.

There are other ways to mitigate some of the potential costs, like hospital indemnity plans to help cover the hospital co-pay, but I will never pitch a plan with no premium as ‘no cost.’

Andre Cabral · Answer

Federal government funds private companies to assist their members and, depending on the plan, it may have a $0 monthly premium. However it doesn't mean $0 cost, for there are co-pays and deductibles, though limited by an annual Maximum out-of-pocket.

Answered by Andre Cabral on May 12, 2025

Agent Licensed in NJ

Answered by Andre Cabral Medicare Insurance Agent

John Messler · Answer

Zero premiums just mean no cost for the plan, but there are several costs along the way when you use the healthcare. There is caution throughout that starts with deductibles, co-pays, and coinsurance. 

The supplements have premiums that average about $200 but there are minimal out-of-pocket after that just a part B deductible and very little coinsurance and co-pays, depending on the specific plan.

Earl Beck · Answer

You explain to the client that even thoughbtheirbisca $0 monthly premium, there are still costs involved.  There are copays, coinsurance costs, deductibles, etc.

Larry Pereiro · Answer

Medicare Advantage plans different by carrier. "zero-premium" simply means that the carrier does not charge a premium for the coverage. There may be some benefits that also have zero cost share while other benefits can have co-pays and co-insurance until the maximum out of pocket limit has been reached.

Answered by Larry Pereiro on June 2, 2025

Agent Licensed in IN

Answered by Larry Pereiro Medicare Insurance Agent

Jim Carroll · Answer

Blunt but honest; sometimes you really do get what you pay for. Insurance companies are businesses, and receive a monthly payment from the Centers for Medicare & Medicaid Services. They would go out of business if they paid 100% of everything. That's why there's a give and take.

I tell my clients to think about a double-sided scale, like Statue of Justice holds. Imagine your monthly premiums are in one scale and the other side is empty. Your premiums make the scale go down. Then, put everything else you have to pay (deductible, 20% coinsurance, and maximum out-of-pocket) on the other side. What happens? The more you add to one side, it goes down and the other side goes up.

Unfortunately, people look at the immediate benefit of not having a monthly premium and don't weigh the extra costs of the plan that are shown in the Summary of Benefits. This is why a needs assessment is so important. Deciding whether to enroll in a Medicare Advantage plan or a Medicare Supplement depends on you health and how much you will spend on medical care for the entire year.

Medicare Advantage Plan (average costs for easy math)
Monthly Premium:   $0
Part B Premium (what comes out of your monthly Social Security check): $185x12= $2,200
Annual Deductible:  $5,000
Coinsurance:  20% until you reach your Maximum Out-of-Pocket
Maximum Out-of-Pocket:  $9,400
Dr. copays, 2 visits per year:   $50
2 Specialist, 2 visits each per year:  $200

TOTAL..................................................$7,470 (this is only factoring the Deductible and not Coinsurance to reach your Maximum OOP)

VS.

Medicare Supplement Plan G
Monthly Premium:   $200x12= $2,400
Part B Premium (what comes out of your monthly Social Security check): $185x12= $2,200
Annual Deductible:  $257
Maximum Out-of-Pocket:  $0
Dr. copays, 2 visits per year:   $0
2 Specialist, 2 visits each per year:  $0

TOTAL..................................................$4,857

Angelina Watkins · Answer

"Zero-premium" means you don't pay a monthly fee for the plan itself, but you will still have other out-of-pocket costs like copayments, coinsurance, deductibles, and the mandatory Part B premium. These costs are what the plan uses instead of a monthly premium to cover your medical services when you use them. It's crucial to compare these variable costs across plans, not just the monthly premium, to find the best fit for your budget and health needs.

Jason Marshall · Answer

Zero premiums means you pay nothing for the plan however there may be other cost list co-pays, deductibles and prescription drug cost that may need to be paid.

Judi Norton · Answer

Zero Premium needs to say Zero MONTHLY Premium.  Zero cost with a Medicare Advantage Plan is misleading and many clients are concerned about their finances and any word Zero needs to be explained further.

Mark Davisson · Answer

This is a tough question as many people are resistant to paying a monthly premium for coverage when many times, depending on cricumstances, Medicare supplemental policies will save you money in the long run despite having a monthly premium.  That is one of the reasons that they are hard to get as they cover everything regardless of cost as long as you pay the monthly premium.

Conversely, Medicare Advantage plans have very high costs for co-pays for hospitalization and  have high maximum out of pocket costs before the plan picks everything up.  This number is ofen up to $9,000 per year while Medicare suppemental policies operate as the monthly premium is your maximum out of pocket and gives you the freedom to see any doctor or use any hospital you want that accepts Medicare.  Even if you pay 250 per month for one of these plans which is a bit high, your maximum out of pocket for the year will be $250 per month or 3,000, not the 9,000 potential cost of the nonpremium plan.

Babs Atwell · Answer

I explain to all our clients that a Medicare advantage plan typically has no extra monthly premium beyond their part b premium.  However there are some exceptions to that as well.  Rather than an extra monthly premium, they will typically have copays with a Medicare Advantage plan.  Those copays vary depending on the specific plan they would choose.  Whereas with a Medicare supplement plan, they would typically have an extra monthly premium beyond their part b premium.  However, with a Medicare supplement plan, they MAY have less out of pocket expenses for copays and doctor visits depending on their use.  This is why we always recommend a personalized consultation with a trusted local/agent broker to discuss your specific needs.

Holt Rushing · Answer

Tell them that the cost of the plan is zero, but you still have copays. Tell them it takes care of the part A deductible, and 20% of part B, but it comes in forms of copays. Tell them it's privatized insurance.

Tanja Roulhac · Answer

What "Zero-Premium" Means
A zero-premium Medicare Advantage plan means you do not have to pay a monthly premium for the plan itself.

However, this does not mean you won’t have to pay any other costs.

What You Still May Have to Pay
Copayments or coinsurance for doctor visits, specialist visits, hospital stays, and other services.

Deductibles before coverage starts for some services or drugs.

Costs for services not covered by the plan.

Premium for Medicare Part B, which you must keep paying even if your Medicare Advantage plan has no premium.

Important to Remember
Think of zero-premium as just one piece of the total cost puzzle. While it can help reduce your monthly out-of-pocket spending, you’ll likely still pay when using healthcare services.

Andrew Bartley · Answer

So the zero is just to you the federal government fully funds the plan as long as you pay your part B premiums and qualify for part A

Jason Meadows · Answer

A “zero-premium” Medicare Advantage plan means you don’t pay a monthly premium for the plan itself, but it doesn’t mean your healthcare is free. You still typically have out-of-pocket costs like copays, coinsurance, and possibly deductibles when you use services.

A simple way to explain it is: you’re not paying upfront each month, but you may pay as you go when you receive care. That’s why it’s important to look beyond the premium and understand the full cost of using the plan, including the maximum out-of-pocket limit.

Irma Lopez · Answer

Zero premium doesn’t mean zero cost because there are costs associated with the plans.  Every beneficiary should be very well informed of the co-pays, deductibles and maximum out of pocket amounts for the desired plan.

Tabitha Self · Answer

"Zero-premium" simply means the cost to enroll and stay enrolled with the Medicare Advantage plan selected.  However, many Medicare Advantage plans require copays for doctor and hospital visits as well as prescription drugs if a Medicare Advantage with Prescription Drug Plan is elected.  In addition, many Medicare Advantage plans only cover what original Medicare covers, so it is important to meet with a licensed Medicare Broker to determine what type of plan is most appropriate for you.

Amanda Holder · Answer

When someone asks about a zero premium. I share with them that the premium is the cost just to have the plan before any other services are used. I advise them with a Medicare Advantage plan that they may have other co-pays or co-insurances associated with other benefits such as doctor office visits, specialists, or medication.

Michelle Brown · Answer

That a "zero-premium" Medicare Advantage plan isn't free, emphasize that "premium" is just the monthly fee to have the plan. Clients will still be responsible for the mandatory Medicare Part B premium will pay out-of-pocket costs like copayments, coinsurance, and deductibles when they receive medical care.

Adriane Williams · Answer

Zero premium means the plan doesn’t have a monthly cost. That doesn’t eliminate costs plan share or the cost to do business with other providers.

Christie Bondos · Answer

It's simple most people will pay the Part B Premium right out of their Social Security or receive a quarterly bill for $185.00. When reviewing a plan there are many copayments, deductibles, and coinsurances within the plan. IT must be reviewed in it's entirety!!

Anita Hawkins · Answer

When discussing a zero premium Medicare Advantage plan, I explain that although they will not pay a premium for that plan, the plan will require them to pay a copay (a set dollar amount) or a co-insurance (a percentage of the cost) for most medical services they receive. What those copays and co-insurances are will vary from plan to plan.

Adam Richter · Answer

A zero premium plan is one that does not chage you monthly for the cost of the plan but is made up of copays that the plan has set for various services such as doctor visits, surgery, hospitalization, er and prescription, etc.

Fewee Bondad · Answer

I would explain what premiums means first which is the monthly cost to keep the plan.  But with the plan comes some expenses as you see your doctors or take exams.  These would be copays coinsurances and deductibles.  So I would explain what each of the terms mean so that they fully understand.

Lynn Hapke · Answer

When signing up for a zero premium Medicare Advantage plan, be aware that you will have copays and coinsurances.  If you only use it only  for preventative services, you may not have out of pocket costs.  However, where you will find gaps in MAPD's will be with 20% coinsurance for items such as chemotherapy, durable medical equipment, copays for Physical Therapy, daily hospital rates that can be around $400 per night up to a maximum out-of-pocket.  Medicare Advantage Plans are required to cover all the pieces that original Medicare A & B cover with some additional benefits not usually covered by Medicare, such as Dental, Vision, hearing, Over-the-counter items and some transportation costs.  

  Make sure you use a broker and ask lots of questions!!

Dawn Gonsoulin · Answer

Most Medicare Advantage plans may have a zero dollar premium. This doesn't mean all benefits with the plan will have a zero cost to it.  Most benefits in a Medicare Advantage plan have copays or coinsurances associated with the services rendered. There are some benefits like a primary care visit or labs that may have a zero dollar cost. The only members who have zero dollar cost to them are the individuals who are enrolled in Medicare and is a Full Medicaid recipient.

Ida Washington · Answer

“Zero premium” does not mean “zero cost” when you enroll in a Medicare Advantage plan. It simply means there is no monthly premium for the plan. However, you may still have out-of-pocket expenses, such as copayments for doctor visits (including specialists), outpatient procedures, lab work, and durable medical equipment.

Pam Johnson · Answer

A couple of different ways I use to explain this, is you may not pay any additional premiums for this plan, but you are responsible  for your Medicare Part B.  Unfortunately, it does not mean the healthcare is free.  
Another way to explain that is there may not be any cost for your plan, but you are responsible for copays and deductibles.  This is typically why we avoid free, because there are other costs associated with these plans. 
Hope this helps.