Do $0 Premium Medicare Advantage Plans Exist? (Copays, Tiers, Out-of-Network)

Overview

For cost-conscious seniors, the promise of a $0 premium Medicare Advantage plan sounds appealing. These plans do exist—millions of Medicare beneficiaries are enrolled in them—but “zero premium” doesn’t mean zero cost.

Instead, expenses appear in other ways, such as copays, tiered prescription costs, and limits on out-of-network coverage. This article explains how $0 premium plans work, who qualifies, what the hidden costs look like, and how to compare your options.

What Are $0 Premium Medicare Advantage Plans?

Medicare Advantage (Part C) combines Parts A and B and often includes Part D. Some insurers offer a plan premium of $0.

That means:

• You still pay your Medicare Part B premium (about $206.50/month in 2026). Learn more about how Part B costs can affect your budget.

• You’ll pay copays and coinsurance for most services.

• Coverage depends on HMO or PPO networks, which may limit provider choice.

According to the National Council on Aging, many Medicare Advantage plans range from $0 to $200+ in premiums, depending on location and plan design.

Also, KFF reports that in 2025, about two-thirds of Medicare Advantage plans with Part D drug coverage charge no monthly plan premium aside from the Part B premium.

Why Do $0 Premium Plans Exist?

Private insurers get funding from Medicare to cover enrollees. They offset the lack of a premium by:

• Charging higher copays for doctor visits or hospital stays

• Using drug tiers where generics are cheaper but brand-name drugs cost more

• Restricting out-of-network providers

For some people, especially those with few medical needs, this trade-off makes sense. For others, considering the best Medicare Advantage companies may reveal better long-term value.

Who Qualifies for $0 Premium Medicare Advantage Plans?

Eligibility for a zero-premium plan depends on standard Medicare rules:

• Age 65+ (or younger with qualifying disability, ESRD, or ALS)

• Enrollment in Medicare Parts A and B

• Living in the plan’s service area (availability varies by county/state)

• Enrollment during valid periods, such as:

  • Initial Enrollment Period (around your 65th birthday)

  • Annual Enrollment Period (AEP): Oct. 15 – Dec. 7

  • Special Enrollment Periods for life changes like moving or losing other coverage

Those who are “dual-eligible” (Medicare + Medicaid) often find specialized $0 premium Special Needs Plans.

If you’re planning, the 2026 Guide to Medicare Plans offers a clear overview of upcoming changes and options, which can help you decide if a $0 premium Advantage plan aligns with your long-term coverage goals.

Comparing $0 Premium vs. Paid Premium Medicare Advantage

For a broader perspective, some seniors also compare these options to Medigap plans like Plan G, which pair with Original Medicare instead of Advantage.

The Hidden Costs: Copays and Coinsurance

With a $0 premium plan, costs shift to service use. Examples include:

• $20–$50 per doctor visit

• $100–$300/day for inpatient hospital stays

• $30–$47 or more for preferred brand prescriptions

If you’re managing chronic conditions or expensive medications, it’s important to review how these Medicare costs add up. Some beneficiaries even switch back from Medicare Advantage if expenses become too unpredictable — see more on switching from Medicare Advantage to Original Medicare.

Understanding Prescription Drug Tiers

All Medicare Advantage plans, including $0 premium ones, use a tiered drug formulary:

• Tier 1: Preferred generics – lowest copay

• Tier 2: Other generics – slightly higher

• Tier 3: Preferred brand-name – moderate copay

• Tier 4+: Non-preferred brand or specialty drugs – highest cost

Checking your prescription list against a plan’s formulary is essential. And if you’re prescribed newer treatments, such as diabetes or weight-loss medications, it helps to understand what Medicare covers for drugs like Ozempic.

Out-of-Network Coverage in $0 Premium Plans

Most zero-premium options are HMOs, which require you to use in-network providers for all but emergencies.

Some PPOs exist with $0 premiums, but you’ll pay higher coinsurance for out-of-network visits—often around 40%. For people who travel frequently or live in two states, resources like the Medicare guide for snowbirds may be helpful.

FAQs

Do $0 premium Medicare Advantage plans really exist?

Yes—about two-thirds of Medicare Advantage plans now offer a $0 premium.

Who qualifies for zero-premium Medicare Advantage?

Anyone with Medicare Parts A and B who lives in a service area offering such plans may enroll. Additional zero-premium options may exist for those on Medicaid.

What are the hidden costs of $0 premium MA plans?

Higher copays, tiered drug costs, and limits on out-of-network coverage.

How do I compare $0 premium Medicare Advantage plans?

Evaluate provider networks, review drug coverage, and consider out-of-pocket maximums. You may also want to learn about choosing the right Medicare coverage overall.

Action Steps: How to Compare Plans

• Explore your plan options at Healthcare.com, our parent company, or call a licensed insurance agent at 877-388-1028 TTY 711 for personalized help.

• Compare annual costs, not just premiums

• Check star ratings for quality

• Verify provider networks and pharmacies

• Review extra benefits like dental, vision, or fitness programs

• Get expert help through a licensed Medicare insurance agent

Bottom Line

$0 premium Medicare Advantage plans are real and widely available, but they’re not cost-free. Copays, drug tiers, and provider networks ultimately determine your expenses.

If you qualify, a zero-premium plan may lower your monthly bills. But before enrolling, weigh them against your personal health needs and alternatives like Medigap or paid-premium Advantage plans