A zero-premium Medicare Advantage plan is a private health insurance plan that covers everything Original Medicare covers, plus extras like dental and vision, without charging you a monthly plan premium. As of 2024, about 18.76 million people (roughly 74% of all Medicare Advantage enrollees) are in one of these plans. The name can be misleading, though: “zero premium” means you pay nothing extra to the private insurer, but you still owe your standard Part B premium to Medicare.
How Plans Can Charge $0
Every Medicare Advantage plan receives a monthly per-person payment from the federal government to cover the same services Original Medicare provides. When a plan estimates it can deliver that care for less than what Medicare budgets (called the benchmark), it gets to keep a portion of the difference as a “rebate.” Federal law requires plans to use those rebate dollars in specific ways: reducing your cost sharing, covering benefits Medicare doesn’t normally include (like dental, vision, and hearing), or eliminating premiums.
Most plans channel their rebates into a combination of all three. That’s how a plan can offer $0 monthly premiums, throw in a dental benefit, and still turn a profit. The model works because insurers are betting they can manage your care efficiently enough that the government’s payment exceeds what they actually spend.
The availability of these plans has grown dramatically. In 2019, about 46% of all Medicare Advantage plans charged zero premiums. By 2024, that figure had climbed to 66% of all plans across more than 2,400 U.S. counties.
What You Still Pay
The “zero premium” label applies only to the plan’s own premium. You must continue paying your Medicare Part B premium to stay enrolled, which in 2025 is $185 per month for most people. That payment goes to Medicare, not to your Advantage plan.
Beyond the Part B premium, zero-premium plans still have out-of-pocket costs: deductibles, copays, and coinsurance for services you use. These cost-sharing amounts often run higher than what you’d see in plans that charge a monthly premium. Think of it as a trade-off: you’re paying less up front each month, but you may pay more when you actually receive care. In 2025, the enrollment-weighted average out-of-pocket limit for Medicare Advantage plans is $5,320 for in-network services, though HMO enrollees average a lower cap of about $4,091. The federal maximum any plan can set is $9,350 for in-network care.
That out-of-pocket limit is one clear advantage over Original Medicare, which has no cap at all. With Original Medicare alone, there’s no ceiling on your annual spending unless you buy a separate Medigap policy.
Supplemental Benefits Included
Most zero-premium plans bundle in benefits that Original Medicare doesn’t cover, funded by those same rebate dollars.
- Dental: About 94% of Medicare Advantage enrollees have access to some dental coverage. Most are offered both preventive and more extensive services. Roughly two-thirds of enrollees with preventive dental benefits (cleanings, exams, X-rays) pay no cost sharing for those visits, though coverage is typically capped at a set dollar amount per year.
- Vision: Nearly 99% of Medicare Advantage enrollees have access to vision coverage, and 93% of them get both eye exams and eyewear (glasses or contacts). Most enrollees pay nothing out of pocket for eyewear, but annual coverage limits average around $160.
- Hearing: Hearing benefits are widely available, often covering hearing exams and sometimes partial coverage for hearing aids.
- Prescription drugs: Most zero-premium plans include Part D drug coverage built in, so you don’t need a separate prescription plan or its associated premium. Plans use rebate dollars to cover the Part D premium cost for most enrollees.
Some plans also offer fitness memberships, meal delivery after hospital stays, or transportation to medical appointments. The specific extras vary by plan and by where you live.
Network Restrictions to Know About
Zero-premium plans come in two main formats: HMOs and PPOs. The type you choose determines how much flexibility you have in picking doctors and hospitals.
HMO plans require you to use providers inside the plan’s network for all non-emergency care. You’ll typically need a referral from your primary care doctor before seeing a specialist. If you go out of network without an emergency, you pay the full cost yourself. In exchange, HMOs generally have lower out-of-pocket costs.
PPO plans let you see any provider, in or out of network, without a referral. You’ll pay less when you stay in network, but you have the option of going outside it for a higher cost. PPO out-of-pocket limits tend to be higher: the average combined in-network and out-of-network limit for PPO enrollees is around $9,519 to $11,001, depending on whether the plan is local or regional.
Before enrolling in any zero-premium plan, check whether your current doctors and preferred hospital are in the plan’s network and whether your prescriptions are on the plan’s formulary (its list of covered drugs). A $0 premium doesn’t help much if you can’t see the providers you need.
How They Compare to Medigap
The main alternative for people on Medicare who want extra financial protection is sticking with Original Medicare and buying a Medigap (Medicare Supplement Insurance) policy. These are fundamentally different approaches to covering gaps in your care.
Medigap policies charge a monthly premium, often $100 to $300 or more depending on your age, location, and plan type. In return, they cover much of the cost sharing that Original Medicare leaves behind, like the 20% coinsurance on doctor visits. You can see any provider who accepts Medicare, anywhere in the country, with no network restrictions and no referrals. But Medigap doesn’t cover dental, vision, hearing, or prescriptions. You’d need a standalone Part D plan for drugs.
A zero-premium Medicare Advantage plan flips this equation. You pay nothing (or very little) in monthly premiums and get dental, vision, hearing, and drug coverage rolled in. But you’re limited to a network, you may need referrals, and your cost sharing when you use services can be higher. You also cannot buy a Medigap policy while enrolled in Medicare Advantage.
For someone who rarely sees doctors and wants to minimize monthly bills, a zero-premium Advantage plan can look very attractive. For someone with complex medical needs who wants unrestricted access to specialists across the country, the Medigap route may cost more monthly but offer greater predictability and freedom.
Checking What’s Available in Your Area
Medicare Advantage plans are tied to geographic service areas, so the zero-premium options you can choose from depend entirely on your zip code. Urban areas tend to have more plans competing for enrollees, which often means more zero-premium choices with richer benefits. Rural counties may have fewer options. The Medicare Plan Finder tool at medicare.gov lets you enter your zip code and filter results by premium, drug coverage, and Star Rating (Medicare’s quality score for each plan) to compare what’s available where you live.
Plans can change their benefits, networks, and cost-sharing amounts every year. A plan that works well for you this year might raise its out-of-pocket costs or drop a provider from its network next year. It’s worth reviewing your options during the annual enrollment period each fall, even if you’re satisfied with your current plan.