Medicare Advantage Plans With a $0 Premium: What’s Really Included

What a Zero Premium Actually Means

When a plan advertises a zero premium, it is describing only the premium charged by the plan. Here is what stays on your bill:

• The Part B premium. With nearly all Advantage plans you must keep paying your Part B premium to Medicare, which is $202.90 a month for most people and higher if your income is above certain levels. A zero-premium plan does not remove it.
• The Part A premium, if you owe one. Most people do not, because they have enough work history, but those who do continue to pay it.
• Cost sharing. Copays, coinsurance and sometimes a deductible when you use care or fill prescriptions.

According to KFF, about two-thirds of Medicare Advantage drug plans charge no premium beyond the Part B premium, and roughly three in four enrollees in Advantage plans with drug coverage are in such a plan. KFF also reports that nearly all people with Medicare have access to at least one. So a zero premium is common, not rare, and not a sign that something is wrong. It is also not a signal that a plan is better.

How a Plan Can Afford a Zero Premium

Medicare Advantage plans are paid by the federal government, which sends the plan a set monthly amount for each enrollee. If a plan can provide Medicare-covered benefits for less than the benchmark amount Medicare sets for your area, the plan receives a rebate equal to a share of that difference, and it has to use the rebate to lower your costs or add benefits. That can take the form of a lower premium, a Part B premium reduction, lower copays or extra benefits such as dental and vision.

This is why zero-premium plans exist: the plan uses its payment to cover the premium. It is also why a plan can pay for extras without charging you a monthly fee. KFF notes that plans also use tools like provider networks and prior authorization to manage costs. In other words, the trade is rarely money for nothing. It is usually lower premiums in exchange for rules about where you go and what you need approval for.

What Is Included in Every Plan

Every Medicare Advantage plan, including a zero-premium plan, must cover everything Original Medicare covers. That includes hospital care, doctor visits, outpatient care, preventive services, and emergency and urgent care. Most plans include prescription drug coverage as well. Plans also have to set a yearly limit on what you pay out of pocket for covered Part A and Part B services. Our guide to Medicare Advantage out-of-pocket maximums explains how that limit works and what it leaves out.

Some cost-sharing protections also apply. Federal rules limit what a plan can charge in network for certain services, including chemotherapy, dialysis and skilled nursing care, by tying those amounts to Original Medicare’s cost sharing, so the details depend on how the plan is structured.

What Many $0 Plans Add

Beyond the basics, plans can add benefits that Original Medicare does not include. KFF found that nearly all Advantage enrollees are in plans that offer vision, dental and hearing benefits, with over-the-counter allowances, meal benefits and transportation offered by a smaller share of plans. KFF’s 2026 data show that the share of plans offering over-the-counter, meal and transportation benefits fell from the year before, which shows how quickly the market changes.

The details are where $0 plans differ the most:

• Dental: It may cover cleanings and exams but pay little toward crowns or dentures, or cap benefits at a set amount per year.
• Vision: It may offer an eye exam and an allowance for glasses or contacts at certain vendors.
• Hearing: It may include an exam and a hearing aid allowance, often requiring the plan’s vendor. See our post on Medicare and hearing aids.
• Over-the-counter allowance: It may provide a card for health items, often with a spending limit and a list of eligible products. Our post on OTC allowance cards explains how these work in practice.
• Other extras: Gym memberships, rides to appointments, meal delivery and similar benefits come and go from year to year.

A good rule is to treat an extra benefit as real only if you would use it and if the details hold up on paper. A large dental benefit is not helpful if your dentist is not in the plan’s network. A big allowance is not helpful if the products you buy are not on the eligible list.

What You Still Pay

Cost	Removed by a zero premium?
Part B premium	No, you generally still pay it
Copays and coinsurance	No, set by the plan
Drug deductible and copays	No, vary by plan
Out-of-network charges	No, depends on plan type
Yearly out-of-pocket limit	Applies to covered medical services, not drugs

Because the premium is $0, the costs shift to when you use care. Look carefully for these items in the plan’s documents:

• Primary care and specialist copays. Specialist copays are often higher than primary care copays.
• Hospital stays. Inpatient stays often carry a per-day copay for the first several days. Look at how many days and how much.
• Outpatient surgery, imaging and lab work. These may have separate copays or coinsurance.
• Emergency and urgent care. These usually have set copays, with emergency coverage applying anywhere.
• Prescription drugs. Some zero-premium plans have a drug deductible, and the plan’s tiers and copays determine the rest. Part D also has its own yearly out-of-pocket limit.
• Services you use outside the network. HMOs generally do not cover non-emergency out-of-network care, and PPOs cover it at higher cost.
• Services that are not covered. Some things neither Original Medicare nor the plan covers.

You can see the full list in the plan’s Summary of Benefits and Evidence of Coverage. Cost sharing varies far more than the premiums do, which is why two zero-premium plans in the same county can be very different products.

The Trade-Offs Behind a Low Premium

Zero-premium plans are not tricks, but they come with limits worth weighing.

• Network restrictions. Plans pay for care at in-network providers at the best rates. If your doctors or hospital are outside the network, you may pay far more or lose coverage. See our guide to checking a plan’s network.
• Prior authorization. KFF found that nearly all Advantage enrollees are in plans that require approval for some services, most commonly higher-cost care such as inpatient stays and skilled nursing facility stays. Our post on prior authorization explains what to do if a request is denied.
• Yearly changes. A plan can change its network, copays, drug list and extras every year, and it can leave your area entirely. Reading your Annual Notice of Change each fall is how you catch it. See our guide to reading the Annual Notice of Change.
• Harder to leave later. If you have been on Original Medicare with Medigap and move to Advantage, going back may involve medical underwriting for a Medigap policy in many states. Our post on trial rights when leaving Medigap explains the protections that exist.

The other side is real too. Original Medicare with a Medigap policy typically means a higher monthly premium, but also wide choice of providers and very predictable costs. Neither approach is right for everyone. Our framework for comparing costs shows how to look at both across a quiet year and a hard one.

How to Compare Two $0 Plans

If two plans both say $0, the premium cannot be your tiebreaker. Compare these instead:

• Whether your doctors, specialists and hospital are in the network
• Whether your medications are on the formulary, at what tier, and with what deductible
• The yearly out-of-pocket maximum
• Copays for the services you actually use, especially specialists and hospital days
• Prior authorization requirements for care you expect to need
• Extras you would really use, and any rules about vendors
• Quality ratings, remembering what they measure and what they do not. See our post on star ratings.

Type of plan matters too. HMO plans generally require you to stay in network and may need referrals, while PPO plans offer more flexibility at generally higher cost. See our pages on Medicare HMO plans and Medicare PPO plans.

A Note on Marketing

“$0 premium” is an attention-getting phrase in advertising, and sometimes the pitch goes further than it should. Be cautious of anything that promises “free” benefits without explaining the network, offers gifts for signing up, or claims you are missing out on money. Advertisements may be for plans that are not available where you live. Under CMS marketing rules, plans and their agents generally cannot make unsolicited sales calls to you, so an unexpected call is a red flag. Our post on Medicare scams describes what to watch for.

Frequently Asked Questions

Do I still pay the Part B premium with a $0 premium plan?

Yes, in most cases. The $0 refers to the plan’s premium. You continue to pay your Part B premium to Medicare, unless you get help from a Medicare Savings Program or your plan reduces it.

Why do so many Medicare Advantage plans have no premium?

The federal government pays plans a monthly amount for each enrollee, and plans can use any savings to lower premiums or add benefits. Plans also use networks and prior authorization to manage costs.

Are $0 premium plans lower quality?

Not necessarily. Premium alone does not tell you about quality, the network or your costs. Compare networks, copays, drug coverage and quality ratings.

Can I have a $0 premium plan and a Medigap policy?

No. Medigap policies work only with Original Medicare, and insurers generally are not allowed to sell you one while you are in a Medicare Advantage plan.

What is the biggest risk with a zero-premium plan?

Usually it is cost sharing and access rather than the premium: copays that add up with heavy use, or a network that does not include your doctors. Check both before you enroll.