At first, zero-premium Medicare Advantage plans can sound enticing.
These are currently the most popular Medicare Advantage plans on the market. Last year, close to 70% of all Medicare enrollees who chose Medicare Advantage over Medigap plans enrolled in a zero-premium plan.
Medicare Advantage plans are designed to be an affordable, all-in-one managed care solution for Medicare beneficiaries to help protect them from high Medicare Part A and B deductibles.
In most cases (but not all), these plans also include prescription drug coverage built right into the plan.
All Medicare Advantage plans are offered by private insurance companies who are approved by Medicare.
And, of course, when the premium is zero, it’s tough to beat the price.
But before you enroll, you should understand the disadvantages of Medicare Advantage plans in general, and zero-premium Medicare Advantage plans in particular.
But first, here are some things to like about them:
- Affordability. Anyone can afford a zero-premium Medicare Advantage plan. Even the indigent and people on Medicaid.
- Comprehensiveness. Medicare Advantage plans bring most aspects of care under one roof. This makes billing and care coordination much easier. This is especially important for complicated medical situations, and for some who may be experiencing cognitive decline.
Drawbacks of Zero-Premium Medicare Advantage Plans
But it’s also true that you get what you pay for.
If you want a zero-premium, you’ll get some basic protections under your Medicare Advantage plan. But there are also some very significant tradeoffs.
Before you elect a zero-premium Medicare Advantage plan over other alternatives, like a Medigap Plan G or a Medi-Share 65+ health sharing plan, you should understand these tradeoffs, and weigh them against the extra monthly cost of Medigap premiums or health sharing plan contributions.
Higher Out-of-Pocket Costs
A zero-premium plan is very nice… as long as you don’t need medical care!
Once you need care, however, your low-cost, affordable zero-premium Medicare Advantage plan can prove very expensive, indeed.
While Medigap Plan G limits your out-of-pocket costs for all services under Medicare Part A and B to your Part B deductible of $240 per year (as of 2024), and Medi-Share 65+ limits your expenses for these services to $500 per household, Medicare Advantage plans may expose you to thousands of dollars each year in out-of-pocket costs.
These out-of-pocket expenses can include copayments, coinsurance, deductibles, and a variety other expenses.
It’s essential to carefully review the plan’s cost-sharing structure to understand your potential expenses.
| Plan Type | Maximum Out-of-Pocket Costs for Medicare Part A and B services (2024) |
|---|---|
| Medicare Advantage | $8,850 |
| Medi-Share 65+ | $240 per individual |
| Medigap Plan G | $500 per household |
This can include copayments, coinsurance, deductibles, and other expenses. It’s essential to carefully review the plan’s cost-sharing structure to understand your potential expenses.
These zero premium plans can be a great option for some. But they’re often marketed to people who can least afford the potential out-of-pocket cost.
But if you can’t afford to pay $8,850 in out-of-pocket deductibles, copays, and co-insurance, or you would have to skip or delay needed medical care because of the high out-of-pocket costs of a zero-premium Medicare Advantage plan, you could wind up just kicking the can down the road, and incurring potentially devastating health setbacks later.
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Limited Provider Networks
Many zero premium plans have very narrow networks of healthcare providers compared to traditional Medicare.
This means you may be restricted to a specific network of doctors, clinics, and hospitals. If your preferred healthcare providers are not in the plan’s network, you may need to switch providers or pay out-of-network costs.
It also means you may not have access to some of the top specialists or upper-tier medical centers such as the Mayo Clinic or Cleveland Clinic.
Medigap plans and the Medi-Share 65+ plan, on the other hand, allow you to use their benefits with any doctor or hospital.
Service Area Limitations
Some zero premium plans may have limited service areas, primarily focusing on urban or specific regions.
If you don’t live in a big city, you travel frequently, or reside in different locations throughout the year, you may find you can’t see a doctor in your plan when you need to.
Potential for Plan Changes
Zero premium plans can change from year to year.
Health plans periodically increase premiums, modify their provider networks, lists of covered medications, cost-sharing arrangements, and other plan details.
This means your plan’s coverage and costs may not remain consistent from one year to the next.
With Medigap and Medi-Share 65+, at least you know you can still keep your doctor, since these aren’t HMOs, and don’t confine you to limited care networks.
Additionally, if you enroll in Medi-Share 65+ prior to age 75, you receive a guaranteed price lock-in until you turn 75.
Less Generous Extra Benefits
While some Medicare Advantage plans offer additional benefits like dental, vision, or prescription drug coverage, zero premium plans may provide fewer extra benefits or less comprehensive coverage in these areas.
Some of the better Medicare Advantage plans have valuable supplemental benefits as well, such as transportation assistance for non-medical purposes, personal assistant services, meal delivery services, and housekeeping assistance.
Zero premium plans are less likely to offer these and other supplemental benefits.
You will either have to pay more out-of-pocket for these services or go without.
The Medi-Share 65+ Cost-Sharing Option
For those seeking a more predictable cost structure without compromising on care, Medi-Share 65+ presents itself as a viable alternative.
With Medi-Share 65+, your out-of-pocket exposure is limited to $500 per year per household for all Part A and Part B expenses.
That’s a stark contrast compared with the unreasonably high out-of-pocket costs associated with some Medicare Advantage plans.
Also, With Medi-Share 65+. you have the freedom to choose your own doctor without worrying about excessive out-of-network charges. Both Medi-Share 65+ and Medigap plans allow you tremendous latitude to choose your own doctors, clinics, hospitals, and other providers.
You may need to get pre-authorization for some non-emergency procedures and surgeries, however.
Prescription Drug Options
Customize your Medi-Share coverage by adding a Part D prescription drug plan.
Unlike most Medicare Advantage plans, neither Medigap nor Medi-Share 65+ include prescription drug coverage.
Medi-Share 65+ comes with an excellent drug discount program for generic drugs.
And all MediGap Advisors clients receive free access to the MediGap Prescription Plus card, which provides discounts of up to 80% off of the retail price of hundreds of commonly-prescribed generic drugs.
Most people, however, choose to supplement their Medi-Share 65+ or Medigap plan with a Medicare Part D policy that helps pay for prescription drug coverage.
A Christian Health Sharing Community
Medi-Share 65+ is a faith centered community of people who profess adherence to the Christian value of helping bear one another’s burdens.
Medi-Share’s Statement of Faith asks that all members affirm these values and live according to Biblical standards.
How to Enroll in Medi-Share 65+
First, gather your Medicare enrollment letter or your Medicare card. You’ll need your Medicare card number from these documents.
Then, once you’ve got them in hand, come back to the computer, and follow these steps:
- Click the enrollment link here, and provide some basic contact information.
- Click “I’m not a robot,” and then submit.
- Choose your desired effective date.
- Enter identification information, address, and marital status of the oldest applicant.
- Enter the number of persons applying in your household.
- Click “See Pricing.” If the birthday you entered puts you or the oldest applicant at age 65 or older, the next page will give you pricing for the Medi-Share 65+ plan.
- Click “Select.”
- Enter identifying information for the primary applicant.
- Click “Onward.”
- Enter your address information.
- Click “Save and Continue.”
- The next page will ask you if you are enrolled in a Medicare Advantage or Medigap plan, or if you plan to be when your Medi-Share plan becomes effective.
- To join Medi-Share 65+, you must click “No.” You only need one of these plans. You cannot join Medi-Share 65+ at the same time you’re enrolled in either Medicare Advantage or Medigap. If you’re transitioning from either plan to Medi-Share 65+, you must cancel your old plan when your Medi-Share 65+ plan becomes effective.
- Enter your 11-digit Medicare number from your Medicare card or benefits verification letter.
- Enter your Medicare Part B start date, using the drop-down menu.
- Click “Continue.”
- Answer the remaining questions as prompted.
- Select a payment method.
- Make sure you cancel other Medicare Advantage or Medigap insurance as of your Medi-Share 65 Plus effective date.
Any questions? Need help choosing between Medi-Share 65+, Medigap, and Medicare Insurance? Or would you rather sign up over the phone? Just click here to make an appointment with one of our expert Personal Benefits Managers, and all your questions will be answered!
If you have any questions or hit a glitch on your application, call us at MediGap Advisors, or make an appointment with a Personal Benefits Manager.
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The Bottom Line
Ultimately, while zero-premium Medicare Advantage plans have their place, you must carefully evaluate the long-term costs, coverage, and flexibility to make sure it really is the best decision for you.
Medi-Share offers more financial predictability and personalized care without compromising on quality. Couple Medi-Share 65+ with a Part D plan for complete coverage and excellent care.
Medigap plans, such as Plan G, are also another alternative that can limit your exposure, and allow you to see any doctor that accepts Medicare.
Click here to make an appointment with a Personal Benefits Manager today to discuss your needs, and get free help to ensure that you’re enrolling in the best possible plan for your situation.
For Further Reading: Medigap Plan G | Medicare Advantage Plans | The Less Expensive Alternative to Medigap | Medigap Shopping Tips – Don’t Overpay!
Whitney Kline is one of your Personal Benefits Managers at Medigap Advisors. She loves working for Medigap Advisors especially helping clients choose the right Medicare plan.