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“$0 premium” is real, not a trick. It’s also close to universal: 98% of Medicare beneficiaries can reach one in 2026. Which means the question people usually ask — which carrier has the best $0 plan? — is the wrong question, and answering it is how most articles on this subject go wrong. Here’s what the $0 label does and doesn’t tell you, and how to pick between the ones available where you live.
The Quick Answer
- $0 plans are everywhere. 98% of beneficiaries have access to one, 67% of Medicare Advantage drug plans charge no additional premium, and 76% of enrollees already pay nothing beyond Part B
- You still pay Part B — $202.90 a month in 2026. “$0 premium” only means the plan adds nothing on top
- The $0 tells you nothing about the plan. Two $0 plans in the same county can differ by thousands of dollars in what they cap your spending at
- So don’t shortlist by carrier. The useful comparison is between the specific $0 plans offered in your ZIP code, on three numbers set out below
Where the $0 Comes From
The usual explanation — the insurer delivers the benefits for less than Medicare pays and keeps the difference — is wrong in a way that matters.
Plans bid against a benchmark set for your county. A plan bidding below the benchmark receives part of the difference back as a rebate, and KFF’s analysis of 2026 plans states that plans are required by law to use rebate dollars to help cover the cost of extra benefits, reduce cost sharing, or reduce the Part B and/or Part D premium. Plans with high star ratings can qualify for larger rebates through the quality bonus program.
So a $0 premium is one of several things a plan can do with rebate money. Another plan, with the same rebate, might spend it on lower copays or a richer dental allowance instead. Neither is being generous and neither is cheating — they’re spending the same pot differently. That’s also why benefits vary so sharply between neighboring counties: different benchmark, different rebate.
The practical consequence is the important part. A $0 premium is a decision about where the money went, not evidence that the plan is cheaper overall. The plan charging $20 a month may have put its rebate into copays you’d actually benefit from.
What Paying a Premium Buys You in 2027: We Checked
If a $0 premium were a sign of a worse plan, the plans that do charge a premium should look clearly better on the numbers that matter in a bad year. We tested that on every ordinary Medicare Advantage plan with drug coverage on sale for 2027 — 3,196 of them, open to anyone, without special needs plans — splitting them by whether the total monthly premium (health and drug together) is $0.
| Ordinary plans with drug coverage, 2027 | $0 total premium | Charge a premium |
|---|---|---|
| Number of plans | 2,112 | 1,084 |
| Average monthly premium | $0 | $74.12 |
| Median in-network out-of-pocket limit | $6,500 | $6,600 |
| Plans at the $9,850 legal maximum | 11.0% | 10.9% |
| Median drug deductible | $650 | $650 |
| Drug deductible at the $700 maximum | 35.2% | 37.7% |
| Rated plans at four stars or more | 65.3% | 68.5% |
Our own count from the CMS CY2027 Landscape file and the 2027 Star Ratings Data Tables. For 2026 the same split gave an identical $5,900 median limit and $440 median drug deductible on both sides.
On average, the premium buys almost nothing you can see in these rows. The out-of-pocket limit is $100 apart, the drug deductible is the same, and the share of plans at the ceiling is the same. Paid plans are slightly more likely to be rated four stars or better, by about three points. That does not mean every paid plan is a bad deal — a particular plan may charge a premium for a broader network, a lower copay on the specialist you see every month, or a richer dental benefit, none of which shows up in an average. It means the premium is not a shortcut. Two plans in your county, one free and one at $74 a month, can protect you equally well; you only find out by reading both.
Why “Which Carrier Is Best” Is the Wrong Question
Plenty of articles rank carriers for $0 plans. We’re not going to, and it’s worth explaining why rather than just declining.
The reason is geographic. Plans are approved and priced county by county, so a carrier’s $0 lineup in one county tells you very little about the next one, and a national list is an average of plans most readers cannot buy.
Those rankings also rest on an assumption that doesn’t hold: that a carrier strong on star ratings must also be strong on $0 availability. The two move independently. A carrier can have outstanding quality ratings while offering $0 premiums on a relatively small share of its plans, and a carrier with mediocre ratings can offer $0 on nearly all of them. A single “best $0 carrier” label welds the two together and then tells you nothing about the plan actually sold at your address. We take that apart at length in why there is no best Medicare Advantage plan.
What’s genuinely worth knowing about the large carriers is how they’re structured, not how they rank. Our reviews cover that: Kaiser Permanente, which operates its own hospitals and doctors and only exists in part of the country; UnitedHealthcare, the largest by enrollment; and Humana. Read those for how each one works. Then check what they actually offer at your address, because that’s the only version of them you can buy.
The Three Numbers That Separate Two $0 Plans
Once you’ve filtered to the $0 plans in your county — and there will usually be several — these are what distinguish them.
| What to compare | Why it decides more than the premium |
|---|---|
| The out-of-pocket maximum | The legal ceiling for 2026 is $9,250 in network, but the enrollment-weighted average is $5,421. Two $0 plans can sit thousands of dollars apart inside that range. This is the number that decides what a bad year costs you |
| Copays for the care you actually use | A $0 premium funded by higher specialist copays is a good deal if you rarely see a specialist and a bad one if you see three. Price your own year, not a generic one |
| Your own drugs on the formulary | Advertised “$0 Tier 1” says nothing about your medications. Check them by name and dose. Drug costs have a separate $2,100 annual cap |
And one check that isn’t a number at all. A $0 plan is only cheap if it still covers the people you see, and the network listing is not proof of that — CMS has conceded that the directory inside Plan Finder can be wrong. The receptionist who books your appointments cannot be.
When a $0 Plan Is the Right Answer — and When It Isn’t
A $0 premium suits someone who uses relatively little care, takes few or no regular medications, and whose doctors happen to sit inside the plan’s network. For that person the trade is straightforward: nothing paid monthly, modest cost-sharing when care is occasionally needed.
It suits someone else much less well. If you manage a chronic condition, see specialists regularly, or have surgery ahead of you, the money you don’t pay monthly comes back through copays, and it can come back with interest. A plan charging $15 or $20 a month that buys a lower out-of-pocket maximum and lower specialist copays may cost less across the year — and the arithmetic isn’t close in a heavy year.
The way to settle it isn’t a rule of thumb. Take last year — your actual visits, procedures and prescriptions — and price it against each shortlisted plan’s copay schedule. A year you’ve already lived is a better forecast than any general guidance, including this.
How to Shortlist, in Order
- Search by your actual address on the Medicare Plan Finder, not by carrier. National reputation doesn’t tell you what’s sold on your street.
- Filter to $0 premium if you want, but treat it as a filter rather than a finding — you’ll likely still have several plans left.
- Sort what’s left by out-of-pocket maximum, and note the spread. This is usually where the real differences appear.
- Price the drugs, not the tiers. Type each medication in with its dose and read the annual total the tool gives you for the year; a “$0 Tier 1” badge is not a price.
- Call the doctors’ offices yourself once you are down to two or three plans, naming the exact plan rather than the carrier, and ask whether they are taking it for 2026.
- Leave the stars until the end. They belong to the contract rather than the brochure, and they are useful for separating two plans that already pass on cost and network — not for choosing between plans that don’t.
Frequently Asked Questions
Are $0 premium plans really free? No. You pay the $202.90 Part B premium either way, plus copays, coinsurance and any deductible when you use care, up to the plan’s out-of-pocket maximum. The $0 refers only to what the plan adds on top.
Why would an insurer offer a plan for nothing? Because plans bidding below their county benchmark receive rebate dollars, and the law requires those dollars to go toward extra benefits, lower cost sharing or a lower premium. Waiving the premium is one way to spend a rebate. Lowering your copays is another.
Are $0 plans lower quality? Not inherently. Premium and quality rating are set by different things. Check the specific contract’s star rating rather than inferring anything from the price.
Which carrier has the best $0 plans? The question has no national answer, because approval and pricing happen at the county level. Sort the $0 plans offered at your own address by out-of-pocket maximum, strike out any that drop a doctor you use or a drug you take, and the shortlist you are left with is the only ranking that applies to you.
Do all $0 plans include drug coverage? Most do — those are MA-PD plans — but some are MA-only. If you join one of those, you’d need a standalone Part D plan, so confirm before enrolling.
Do plans with a premium protect you better than $0 plans? On the 2027 figures, barely. Among ordinary plans with drug coverage, the typical out-of-pocket limit is $6,500 on $0 plans and $6,600 on plans that charge a premium, and the typical drug deductible is $650 on both. Paid plans average about $74 a month. Compare the specific plans; the premium alone tells you very little.
Bottom Line
With 98% of beneficiaries able to reach a $0 premium plan and 76% of enrollees already in one, “$0 premium” has stopped being a distinguishing feature. It’s the baseline.
What still distinguishes plans is what the rebate bought instead, and that shows up in the out-of-pocket maximum, the copay schedule and the formulary. Compare those three across the $0 plans sold at your address and you’ll be making the comparison the advertising is designed to skip — and you’ll get a better answer than any national ranking could give you.
Put your own ZIP code and your own medication list into the official Medicare Plan Finder, then read the out-of-pocket maximum on every $0 plan it returns before you read anything else about them. If you would rather have someone sit through that with you, your State Health Insurance Assistance Program will, free, and it has nothing to sell you.
Sources
- Medicare Advantage 2026 Spotlight: A First Look at Plan Premiums and Benefits — KFF. Source for 98% of beneficiaries having access to an MA-PD with no additional premium, the 67% of MA-PDs charging no additional premium, the 76% of MA-PD enrollees paying no premium beyond Part B, and the legal requirement that rebate dollars fund extra benefits, reduced cost sharing or a lower premium.
- Medicare Advantage in 2026: Premiums, Out-of-Pocket Limits, Supplemental Benefits and Prior Authorization — KFF. Source for the $9,250 in-network out-of-pocket ceiling and the $5,421 enrollment-weighted average.
- 2026 Medicare Parts A & B Premiums and Deductibles — Centers for Medicare & Medicaid Services. Source for the $202.90 standard Part B premium.
- Final CY 2026 Part D Redesign Program Instructions — Centers for Medicare & Medicaid Services. Source for the $2,100 annual out-of-pocket cap on prescription drugs.
- CY2027 Landscape file, CY2026 Landscape file and 2027 Star Ratings Data Tables — Centers for Medicare & Medicaid Services. Source for the comparison of $0 and paid-premium plans (our own count of 3,196 ordinary plans with drug coverage).
All figures on this page were checked against the sources above on September 16, 2026. The 2027 comparison of $0 and paid-premium plans is our own count, added on October 18, 2026.
Disclaimer: Figures mentioned in this article reflect 2026 data from the Centers for Medicare & Medicaid Services (CMS) and KFF analysis, and vary by state, county and plan. Always confirm current details directly with Medicare.gov, 1-800-MEDICARE, or a licensed agent before making a decision.
Unai Sampedro founded and edits Medicare Plan Compass. He is not a licensed insurance agent or broker and takes no commission from any insurer; the site is funded by advertising. Articles are written from CMS and Medicare.gov documents and reviewed each year when new figures are published. Nothing here is personalized advice: the goal is to explain the rules in plain language so readers can ask better questions before they speak to someone who can advise them.