The television ads are everywhere during Medicare season: “$0 premium! Dental! Groceries! Vision!” And it's true — many Medicare Advantage plans have no monthly premium beyond what you pay for Part B. But a $0 premium tells you almost nothing about a plan's true cost and value. Here's how to look past the marketing.
The Premium Is Just One Number
Your total annual cost for a Medicare plan includes not just the premium, but also:
- Your out-of-pocket maximum (MOOP)
- Copays and coinsurance for services you use
- Your drug deductible and tier-based copays
- The Part B premium (which you pay regardless of your MA plan)
A plan with a $0 premium and a $9,000 MOOP is not necessarily better than a plan with a $50 premium and a $2,500 MOOP. If you have significant health needs, the higher-premium plan could cost you far less overall.
The High-Deductible Problem
Some $0-premium Medicare Advantage plans carry a medical deductible — meaning you pay 100% of covered medical costs until you hit that threshold. Deductibles can range from a few hundred to several thousand dollars. If you visit specialists regularly or have inpatient hospital stays, this deductible significantly affects your real cost of care.
Narrow Networks and Prior Authorization
Lower-premium plans often achieve their economics by contracting with narrower provider networks and applying more aggressive prior authorization requirements. You may find that your preferred hospital, your oncologist, or a specialist you need isn't in-network — or that getting approval for imaging or outpatient procedures takes days or weeks.
Extra Benefits: Valuable or Rarely Used?
Many Medicare Advantage plans advertise dental benefits, grocery allowances, gym memberships, or over-the-counter drug allowances. These can be genuinely valuable — or they can be low-limit benefits that don't match how you'll actually use care. A $500 annual dental allowance sounds great, but if you need a crown and a root canal, it covers a fraction of the cost.
Evaluate extra benefits for what they're actually worth to you — not at face value.
What a Real Comparison Looks Like
A proper plan comparison goes like this:
- Input your specific drug list into Plan Finder and calculate your estimated annual drug costs for each plan
- Verify your doctors' in-network status for each plan you're considering
- Compare the MOOP and estimate your likely out-of-pocket in a typical year and a high-utilization year
- Add up total annual costs (premium × 12 + estimated drug costs + estimated medical costs) for each plan
This analysis takes time, but it's the only way to know which plan is actually best for your situation. We do this analysis for Medicare beneficiaries across 38 states every day. Call us at (530) 395-5309 to get a real comparison — not a commercial.