Most Medicare Advantage plans are free upfront. You still might not be able to afford one.

Core Insights - Medicare Advantage plans have become a dominant force in the U.S. healthcare market for seniors, comprising 54% of the Medicare marketplace, with 76% of these plans offering zero-premium options [1][3][5] - While Medicare Advantage plans may appear cost-effective initially, they can lead to significantly higher out-of-pocket costs in the event of serious health issues, making them less favorable compared to Medigap plans for those who require extensive medical care [2][6][7] Cost Comparisons - Medicare Advantage customers generally pay about $3,500 less out of pocket annually than those with Medigap insurance, but this figure is skewed by the presence of healthier individuals who do not utilize significant healthcare services [6][7] - The out-of-pocket maximum for in-network services under Medicare Advantage plans can reach $9,350 in 2025, with an average of $4,882, while Medigap plans typically cover all extra charges without out-of-pocket maximums [13][25] Plan Structure and Implications - Medicare Advantage plans often have fixed copays and coinsurance, which can accumulate quickly, especially for expensive treatments like chemotherapy or dialysis [3][12][14] - The choice between Medicare Advantage and Medigap plans is critical at age 65, as switching later may be cost-prohibitive due to medical underwriting and potential rejection [17][22] Market Dynamics - Insurance companies are heavily marketing zero-premium Medicare Advantage plans, often omitting crucial information about out-of-pocket maximums, which can mislead consumers [23][24] - The variability in plan offerings and costs across different counties complicates the decision-making process for potential enrollees, as individual needs and circumstances greatly influence the best choice [19][20] Consumer Behavior and Decision-Making - Many new enrollees may not fully understand the implications of their choices, leading to potential financial strain later in life if they require extensive medical care [20][28] - Experts recommend that incoming enrollees carefully compare plan details, including networks, out-of-pocket maximums, and covered medications, to make informed decisions [29]