$0 Medicare Advantage plans: Are they really free?

If you’re shopping for a Medicare plan, you may have noticed Medicare Advantage plans with monthly premiums as low as $0. Wary shoppers may wonder: Is there a catch?

“It’s important to understand that when you get Medicare, it comes with monthly costs,” says Don Truong, the director of sales at Sharp Health Plan. “That’s true whether you have a Medicare Advantage plan or you don’t. With that said, Medicare Advantage plans with $0 premiums may help lower your overall health care costs.”

Truong helps answer some of the most common questions about Medicare Advantage plans:

Is a “free” Medicare Advantage plan really free?
Certain Medicare Advantage plans have a $0 monthly premium, but that won’t eliminate every cost associated with your plan or through Medicare. Standard Medicare costs apply to everyone who qualifies for Medicare:

• Part A costs $0 a month if you or your spouse paid Medicare taxes for at least 10 years while working or if you get Medicare before turning 65.

• Part B has a monthly premium that changes every year and can be higher depending on your income. For 2023, the Part B premium is $164.90.

• Part D costs vary depending on your plan and your income.

• If you sign up late for Part A, B or D, you may have to pay late enrollment penalties in addition to your monthly premium costs.

Unless you qualify for financial help, those with Medicare pay these costs every month. “There’s a misconception that Original Medicare is free, but it’s not,” explains Truong. “When you do the math, not having good coverage on top of Medicare could actually end up costing you more.”

Here’s an example of what someone with Medicare could save on their monthly premium with a Medicare Advantage plan:

Without Medicare Advantage: $354.90 a month

• Original Medicare ($164.90 for 2023 Part B premium)

• Medicare Supplement ($157 for average Medigap coverage)

• Part D ($33 for average drug plan)

With Medicare Advantage: $164.90 a month

• Original Medicare ($164.90 for 2023 Part B premium)

• Medicare Advantage Plan ($0 for Part A, B and D coverage)

“In this scenario, the person could save $190 a month,” says Truong. “That’s over $2,000 a year.”

What types of Medicare Advantage plans are there?
There are several types of Medicare Advantage plans, but HMO plans are most common.

• Health maintenance organization (HMO) plans require most of your care and services to come from providers within your plan’s network.
   

• Preferred provider organization (PPO) plans allow you to see most health care providers. You can pay less if you visit a provider or hospital within your plan’s network.

How do you qualify for a Medicare Advantage plan?
To qualify for enrollment in a Medicare Advantage plan, you must be eligible for Medicare and be enrolled in Original Medicare.

When can I enroll in a Medicare Advantage plan?
You can only join a Medicare Advantage plan during certain times of the year. Consider these points when you’re shopping for a plan:

• If you do not have a Medicare Advantage plan: You can enroll in a Medicare Advantage plan during the initial period when you can first sign up for Medicare.
   

• If you want to change your Medicare health and drug coverage: Make your changes during Medicare’s open enrollment period, from Oct. 15 to Dec. 7.
   

• If you already have a Medicare Advantage plan: You can change your Medicare Advantage plan to a different one or to Original Medicare with or without drug coverage during the Medicare Advantage open enrollment period. This takes place every year from Jan. 1 to March 31.
   

• If you want to switch to a Medicare Advantage plan with a five-star rating: Medicare allows you to switch once during the five-star special enrollment period.

Is a Medicare Advantage plan right for me?
As with shopping for any health insurance plan, it’s important to consider your options. Be sure to evaluate the quality of a Medicare Advantage plan before choosing one. Every year, Medicare evaluates plans based on a five-star rating system. You can compare the quality of different plans using Medicare’s plan finder tool.

“Five stars is Medicare’s highest rating, so it’s a huge accomplishment,” says Truong. “Our team is beyond thrilled that Sharp Health Plan received another five-star rating from Medicare for 2023.”

The quality of your plan’s network also matters. If certain doctors, hospitals or facilities are must-haves for you, make sure they are in your network. You can keep a list of your favorite providers using Medicare’s website.

Still have questions about Medicare?
Sharp hosts free online seminars, where you can learn more about enrollment periods and how Medicare works. Sign up for the "Understanding How Medicare Works" seminar or the “Understanding Your Medicare Open Enrollment Options” seminar.

These classes are also available in Spanish. Please visit Entienda Cómo Funciona Medicare for more information.

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