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

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

Tony Capraro III · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/how-do-you-explain-to-clients-that-zero-premium-doesnt-mean-zero-cost-with-medicare-advantage#tony-capraro

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

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 636-500-1892

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.

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.

Answered by Holt Rushing on June 18, 2025

Broker Licensed in MS, AK, AL & 29 other states

Answered by Holt Rushing Medicare Insurance Agent

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

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.

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.

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

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.

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

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 at 239-848-8893.

Answered by Paul Dzierzanowski on April 4, 2025

Agent Licensed in FL

Answered by Paul Dzierzanowski Medicare Insurance Agent

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!!

Answered by Christie Bondos on May 26, 2025

Broker Licensed in CT

Answered by Christie Bondos Medicare Insurance Agent

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

Steve 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 Brauer on April 13, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

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.

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.

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

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.

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

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.

Answered by Judi Norton on April 14, 2025

Agent Licensed in NM

Answered by Judi Norton 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.

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.

Answered by Babs Atwell on May 1, 2025

Broker Licensed in OH

Answered by Babs Atwell Medicare Insurance Agent

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.

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.

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

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

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