HomeTechnologyBeware of Zero Premium Medicare Advantage Plans

Beware of Zero Premium Medicare Advantage Plans

By TOM MURPHY, AP Health Writer

Health insurers will once again flood the Medicare Advantage marketplace this fall with attractive plan offers that have no monthly price.

The number of so-called zero-premium plans has been growing for years, and they may appeal to retirees living on a fixed income. Experts say shoppers should beware, because they can find better coverage for a relatively low monthly cost.

“It’s not a one-size-fits-all program,” said Melissa Brenner, a runner in Charlotte, North Carolina. “You don’t want to look at plan zero and just sign up for it.”

Medicare Advantage Plans are private versions of the government’s Medicare program for people age 65 and older or with certain disabilities. The annual enrollment window for Medicare Advantage 2023 coverage opens next week.

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A closer look at coverage:

Nearly seven in 10 people who signed up for an individual Medicare Advantage plan with prescription drug coverage this year opted for plans with no premiums, according to the Kaiser Family Foundation, a nonprofit organization that studies health care issues. That’s an increase from about five in 10 in 2015.

Kaiser also found that 98% of people eligible for Medicare had access to an Advantage plan with drug coverage that didn’t charge a premium.

“They’re everywhere,” said Bob Rees, vice president of Medicare sales for online insurance broker eHealth.

Medicare Advantage buyers generally had many options. Kaiser found that the average person eligible for Medicare had access to 39 Advantage plans during last fall’s enrollment window, including those that charged premiums.

By 2023, about 57% of Medicare Advantage plans will be premium-free, according to the Centers for Medicare & Medicaid Services.

The adage that nothing in life is free applies here.

The plans charge no premium, but most people who qualify for Medicare will still pay a monthly cost for the program’s Part B, which covers doctor visits and other outpatient care. That usually comes out of Social Security checks and will total $164.90 next year.

Government funds help insurers offer a variety of Medicare Advantage plans with no premiums and extras like dental or vision care not covered by traditional Medicare.

One key difference from traditional Medicare: These plans generally require patients to visit doctors, hospitals or pharmacies in a network. Some plans may not cover care received outside of those networks.

Before looking at a plan’s price, Brenner recommends that shoppers check to see if their doctors are in network and how regular prescriptions would be covered.

Then they should look at the coverage basics. That may include what kind of copays would come with a visit to a specialist or a hospital stay. They should also consider the annual out-of-pocket maximum.

Some of these payments may be higher with a plan that has no premium, so customers could lose savings if they use the coverage frequently.

“There will always be a give and take,” said Brenner, an independent broker who specializes in Medicare Advantage.

The federal Medicare.gov website allows visitors to compare plan coverage, including prescriptions.

A plan that doesn’t charge a premium can end up being a bargain for someone relatively healthy. But it can be hard for shoppers to predict which specialists they’ll need to see or whether they’ll want access to, say, an out-of-state cancer hospital in any given year.

“Older people tend to get sick and use services, so it’s a gamble,” said Tricia Neuman, a Medicare expert at the Kaiser Family Foundation.

Sometimes even routine expenses stick out.

Charles Kolton chose a zero-premium plan several years ago, but was disappointed with the limited dental coverage that came with it. He then switched to a plan that charges $24 a month but also pays up to $2,000 in dental costs, or about double what his previous option covered.

“You can rack up these dental bills pretty quickly,” said the 79-year-old from North Carolina.

People will have from October 15 to December 7 to choose a new plan or decide if they want to keep the same coverage. Rees, the eHealth executive, warns buyers not to wait until December.

There is usually a rush to sign up at the end. Late buyers may be locked out if they haven’t chosen a plan yet.

Nearly half of people eligible for Medicare enroll in Medicare Advantage plans, according to Kaiser. People can also stay with traditional Medicare and sign up for supplemental coverage, which typically comes with a higher premium than an Advantage plan.

For Medicare Advantage shoppers, Neuman expects insurers to continue to offer more zero-premium plans in 2023 as they push to increase enrollment.

“Plans understand that seniors are focused on premiums,” he said.

Follow Tom Murphy on Twitter: @thpmurphy

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

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