How do you explain to clients that "zero-premium" doesn't mean "zero-cost" with Medicare Advantage?
Answered by 27 licensed agents
Answered by Dana Dane on April 2, 2025
Agent Licensed in OR, AZ, CA & 6 other states
Answered by Tony Capraro III on May 6, 2025
Agent Licensed in NH & ME
Answered by Gary Church on June 9, 2025
Broker Licensed in Ca, AZ, NV & TX
Bill Lawler 636-500-1892
Answered by William Lawler on June 22, 2025
Broker Licensed in MO, FL, IA & 12 other states
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.
Answered by Jonathan Potter on April 7, 2025
Broker Licensed in UT, AZ, CA & 14 other states
Answered by Mitch Anderson on June 10, 2025
Agent Licensed in MN, IA & WI
Answered by Holt Rushing on June 18, 2025
Broker Licensed in MS, AK, AL & 29 other states
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.
Answered by Phillip Lovelady on March 25, 2025
Agent Licensed in TX
Answered by Sherry Rose on May 28, 2025
Broker Licensed in Ga, AL, AR & 5 other states
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.
Answered by Steve Wilson on April 14, 2025
Broker Licensed in MN, AZ, FL & WI
Answered by Steven Bleicher on May 23, 2025
Broker Licensed in AZ
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.
Answered by Barbara Barnes, CMIP® on June 12, 2025
Agent Licensed in PA
Answered by DeeDee Whitlock on June 23, 2025
Broker Licensed in LA
Answered by Paul Dzierzanowski on April 4, 2025
Agent Licensed in FL
Answered by Christie Bondos on May 26, 2025
Broker Licensed in CT
Answered by Steve Brauer on April 13, 2025
Broker Licensed in AZ & CA
Answered by Vachik Chakhbazian on June 8, 2025
Agent Licensed in CA, AL, AR & 22 other states
Answered by Marcie Barnes on May 24, 2025
Agent Licensed in TX, AK, AL & 48 other states
Part B stands for outpatient services such as bloodwork, dr. visits, imaging and many more that may require co-payments or co-Insurance.
Answered by Carol Thompson on May 11, 2025
Broker Licensed in FL, LA, MI & NC, SC, VA & WI
Answered by Larry Pereiro on June 2, 2025
Agent Licensed in IN
Answered by Andre Cabral on May 12, 2025
Agent Licensed in NJ
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.
Answered by Rodolfo Rojas on June 23, 2025
Broker Licensed in NV, AL, AR & 22 other states
Answered by Ellen Diehl on April 3, 2025
Broker Licensed in GA
Answered by Babs Atwell on May 1, 2025
Broker Licensed in OH
Answered by Judi Norton on April 14, 2025
Agent Licensed in NM
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.
Answered by Tanja Roulhac on May 12, 2025
Broker Licensed in FL, AZ, CA & 7 other states
Answered by Adriane Williams on March 31, 2025
Agent Licensed in OK, AK, AL & 48 other states
Tags: Medicare Advantage
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