Are $0 premium plans for medical insurance for real?

Dear Kyle, Alan and Tom: I'm glad all the political ads have gone away, but TV seems to be constantly running commercials on how I may be missing some of my "Medicare benefits" like dental, vision, even paying some of my bills! What is the deal? Zero premium?

Mark

Kyle: OK, Mark, here goes: most people are automatically enrolled in Medicare Part A (hospital) at age 65 and it's free; most people then enroll in Medicare Part B (doctor) and pay $174.70 each month; many people enroll in Medicare Part D (drugs) and pay whatever the premium is plus whatever the drugs cost. The majority of those TV commercials are about Medicare Part C which are Medicare Advantage plans.

Alan: The most obvious example of a Part C plan in California is Kaiser Senior Advantage. The plan contains Parts A, B and D in one package.

The commercial I see most often is for Humana, and they do offer a $0 premium plan. Unfortunately, the Humana plan available to us in Napa only has St. Helena Hospital and Marin General.

Kyle: Some Advantage plans include dental and vision, some have them for an extra charge.

One of the popular plans from last year was the United Healthcare PPO plan. Many Advantage plans, like Kaiser, are Health Maintenance Organizations (HMO) which typically means a limited network and no coverage outside the network. A Preferred Provider Organization (PPO) usually means a wider network and some coverage outside the network.

Alan: Much to our chagrin, United Healthcare is not offering their PPO Advantage plan for 2025 and is instead offering an HMO whose service area is only Napa and Sonoma counties. Anthem still has a PPO Advantage plan for 2025 but we're a little nervous about 2026.

Kyle: We've been showing the two Aetna Advantage PPO plans: one is $0 premium, the other is $46. The $46 plan has a lower annual Maximum Out of Pocket (MOOP). No lie, it's really called MOOP. Anyway, the network covers 17 to 18 counties including Napa.

Alan: A fairly recent (to me) Advantage plan in our area is Imperial Health Plan. Imperial has four HMO plans in Napa, all with $0 monthly premium.

According to the Better Medicare Alliance's 2024 State of Medicare Advantage Report:

1. Medicare Advantage total enrollment is 33.8 million in 2024, representing about 55% of the Medicare population.

2. The average monthly premium is $18.50.

3. 56% of members are enrolled in an HMO plan and 43% in a PPO.

4. Over 98% of enrollees are in a plan that includes prescription drug coverage.

5. Among all plans, 99% offer vision, dental and hearing coverage.

Kyle: By the way, the Medicare Part B premium increases to $185 next year. If you are an individual tax filer and your income is above $106,000, that premium jumps to $259. If it is above $133,000, you will pay $370, and so it goes.