Medicare Blog

if my medicare advantage plan premium is $0 how do the insurance company make money

by Shayna Roberts Published 2 years ago Updated 1 year ago

If you combine these amounts, your “$0 monthly plan premium”  Medicare Advantage plan is being funded by almost $600 monthly. When you choose to sign up for a Medicare Advantage plan, the government takes the funds you have paid in, plus the Part B premiums you are paying and reassigns some of that amount to your Medicare Advantage carriers.

$0 Medicare Advantage plans aren't totally free
Medicare Advantage plans are provided by private insurance companies. These companies are in business to make a profit. To offer $0 premium plans, they must make up their costs in other ways. They do this through the deductibles, copays and coinsurance.
Oct 6, 2021

Full Answer

Do Medicare Advantage plans have a $0 premium?

Many Medicare Advantage Plans have a $0 premium. If you enroll in a plan that does charge a premium, you pay this in addition to the Part B premium. Whether the plan pays any of your monthly Medicare Part B (Medical Insurance) premium. Some plans pay all or part of your Part B premium.

How much do Medicare Advantage plans cost?

Costs and coverage—for most of us, when it comes time to choose a Medicare plan, those 2 factors are the bottom line. You may be surprised to learn that some Medicare Advantage plans have a monthly plan premium of $0. That's right—zero dollars per month.

How do Medicare Advantage insurance companies work?

Medicare Advantage companies have a contract with the federal government. Medicare pays these private companies to take on the risk of its policyholders. So, instead of Medicare paying for your claims, they pay the insurance company to manage them.

What is the difference between Original Medicare and Medicare Advantage plans?

Medicare Advantage plans also offer one level of predictability not available with Original Medicare: There’s a yearly limit on how much you’ll ever have to pay out of pocket.

Where does the money come from for Medicare Advantage plans?

Three sources of revenue for Advantage plans include general revenues, Medicare premiums, and payroll taxes. The government sets a pre-determined amount every year to private insurers for each Advantage member. These funds come from both the HI and the SMI trust funds.

Is Medicare Advantage profitable for insurance companies?

While some of that money would provide patients with extra health benefits, Kronick estimates that as much as two-thirds of it could be going toward profits for insurance companies.

What are $0 premium plans?

A zero-premium plan is a Medicare Advantage plan that has no monthly premium. In other words, you don't pay anything to the insurance company each month for your coverage. That's in comparison with the average Medicare Advantage premium of $23/month in 2020.

What are the negatives of a Medicare Advantage plan?

Medicare Advantage can become expensive if you're sick, due to uncovered copays. Additionally, a plan may offer only a limited network of doctors, which can interfere with a patient's choice. It's not easy to change to another plan. If you decide to switch to a Medigap policy, there often are lifetime penalties.

What are the advantages and disadvantages of Medicare Advantage plans?

Medicare Advantage offers many benefits to original Medicare, including convenient coverage, multiple plan options, and long-term savings. There are some disadvantages as well, including provider limitations, additional costs, and lack of coverage while traveling.

How much profit do health care insurance companies make?

The health insurance industry continued its tremendous growth trend as it experienced a significant increase in net earnings to $31 billion and an increase in the profit margin to 3.8% in 2020 compared to net earnings of $22 billion and a profit margin of 3% in 2019.

Are Medicare Advantage premiums deducted from Social Security?

Yes. In fact, if you are signed up for both Social Security and Medicare Part B — the portion of Medicare that provides standard health insurance — the Social Security Administration will automatically deduct the premium from your monthly benefit.

What is the least expensive Medicare Advantage plan?

Aetna Medicare Advantage plans have the cheapest overall prices, costing an average of $7 per month for 2022. Aetna's Medicare Advantage plans stand out for those who are looking for affordable coverage.

Does Medicare Advantage cost less than traditional Medicare?

(See Methodology for more details on the data and analytic approach.) Our analysis finds: Medicare spending for Medicare Advantage enrollees was $321 higher per person in 2019 than if enrollees had instead been covered by traditional Medicare.

Can you switch back to Medicare from Medicare Advantage?

Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 each year. Your coverage under traditional Medicare will begin January 1 of the following year.

Who is the largest Medicare Advantage provider?

UnitedHealthcareUnitedHealthcare is the largest provider of Medicare Advantage plans and offers plans in nearly three-quarters of U.S. counties.

What are the top 3 Medicare Advantage plans?

The Best Medicare Advantage Provider by State Local plans can be high-quality and reasonably priced. Blue Cross Blue Shield, Humana and United Healthcare earn the highest rankings among the national carriers in many states.

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