Are there $0 premium Medicare Advantage plans near me?
Zero premium means the plan adds no monthly bill of its own. You still pay Part B, copays and drug costs. How to judge a plan like that.
- Zero premium means the plan adds no monthly bill of its own, but you still pay your Part B premium every month.
- Compare the yearly out of pocket maximum, the most you can pay in one year, instead of comparing premiums.
- Check two things before you pick: that your doctors are in the plan's network, and what your drugs cost on that plan's list.
Yes. Many Medicare Advantage plans in Hidalgo County charge no monthly plan premium, and a premium is the monthly bill for the coverage. Zero premium is not the same as zero cost. Money still goes out.
This part of South Texas is one of the more competitive Medicare markets in the country.
What zero premium means
The plan adds no monthly bill of its own on top of what you already pay. You still pay these.
- Your Part B premium, the monthly bill for the part of Medicare that pays for doctor visits. It is due every month.
- Copays and coinsurance when you use care. A copay is a set dollar amount. Coinsurance is a share of the bill.
- Your drug costs, set by the plan's formulary, the list of drugs it covers and what each one costs you.
- An Income Related Monthly Adjustment Amount (IRMAA), an extra charge on your premium if your income is above a set level.
Medicare pays the plan a set amount each month to take care of you. That payment is why the plan can go without a premium of its own. It is a legitimate way to run a plan.
How a zero premium plan makes money
A plan on that budget holds its costs down somewhere. None of it is hidden from you.
- A tighter network, the list of doctors and hospitals the plan has contracts with.
- A Health Maintenance Organization (HMO) more often than a Preferred Provider Organization (PPO). An HMO pays only inside its own list.
- Prior authorization on more services, so the plan approves the care before you get it.
- A referral, your main doctor's written okay, before you see a specialist.
- Copays on the care people use the most.
- A higher out of pocket maximum, the most you can pay in one year before the plan covers the rest.
You are trading some freedom of choice for a smaller monthly bill.
The number to look at instead: the out of pocket maximum
Compare the yearly out of pocket maximum, not the premium. That number is your worst year, and it is the honest measure of how much protection you are buying.
A plan with no premium and a high yearly maximum can cost you thousands more, in a year with a hospital stay, than a plan with a small premium and a low maximum. In a healthy year the plan with no premium comes out ahead. You are buying protection for the bad year.
The two checks that decide it: your doctors and your drugs
- Are your doctors and your hospital in that plan's network for the coming year? Call the billing office and ask by the plan name, not by the company name.
- What will your prescriptions cost on that plan's drug list, at the pharmacy you use? Two plans with no premium can price the same medicine very differently.
Those two calls rule out most poor matches before you get to anything else.
If you want help sorting it out before you make those calls, see whether a zero premium plan fits your situation. Enter your ZIP code and a licensed agent calls you back.
Giveback plans
Some plans go a step further and pay part of your Part B premium back to you. It shows up as a larger Social Security deposit. That is real money, and it also means the plan had to save somewhere else to fund it. See how a giveback works.
Why we cannot list the specific plans here
What is sold at your address, and what it costs, is set by ZIP code and changes every year. Medicare also sets rules on how an agency may show plan details in public marketing. A list printed here would be out of date by January.
It also would not answer the question that matters, which is how a plan treats your doctors and your medicines. We are an independent agency, so we can put the plans sold at your address side by side. There is no obligation and it takes about half an hour.
Start with your doctors and your drug list, then compare the yearly out of pocket maximums. To do that with someone, call our McAllen office at (956) 687 3334, or enter your ZIP code in the form on this page.
Not sure a zero premium plan is the right fit for you? Enter your ZIP code and a licensed agent from McAllen Insurance Group calls you back to compare the plans sold at your address, in English or Spanish.
Common follow-up questions
If the plan has no premium, how does the company make money?
Medicare pays the plan a set amount each month for every member. The plan then has to cover your care within that budget. Nothing about it is improper, but it does explain the tighter networks and the approvals.
Is a zero premium plan worse than one with a premium?
Not by itself. It usually means a smaller network or a higher out of pocket maximum, the most you can pay in a year. If you are healthy and your doctors are in the network, it can be the better value.
Do I still pay Part B on a zero premium plan?
Yes, always. That monthly bill never goes away, unless a Medicare Savings Program pays it for you.
Want this looked at properly?
We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. There is no obligation to talk it through.
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Gerino Alejos
Licensed insurance agent · License 3128710 · NPN 18243381
Owner of McAllen Insurance Group, an independent agency on North 10th Street in McAllen. Works with clients across Hidalgo, Cameron and Starr counties on Medicare, Marketplace health, life and auto coverage. Se habla español.