Core Insights - The article addresses the misconception that "zero-dollar premium" Medicare Advantage plans are free, clarifying that this only refers to the monthly enrollment cost and does not account for out-of-pocket expenses incurred during care [2][11] Cost Structure - Medicare Advantage plans involve cost sharing, including co-pays, deductibles, and coinsurance, which can lead to significant expenses when accessing medical services [4][5] - Co-pays for primary care visits and higher co-pays for specialists are common, with advanced services often incurring separate charges [4] - Some plans may eliminate medical deductibles, but many still have them for prescription drugs or specific procedures, which can surprise enrollees [5] Provider Networks - Most Medicare Advantage plans restrict coverage to specific networks of doctors, hospitals, and specialists, potentially leading to higher costs or lack of coverage if a preferred provider is outside the network [6] - The expectation of broader access based on the notion of a "free" plan can result in disappointment for enrollees [6] Prior Authorization and Drug Coverage - Prior authorization is frequently required for certain treatments or tests, which can delay care during critical health events [7] - Drug coverage varies significantly across plans, with each having its own formulary and pricing, making it essential for enrollees to review these details carefully [8] Financial Considerations - Even with a zero-dollar premium, Medicare Advantage plans include an annual out-of-pocket maximum, which does not eliminate co-pays or coinsurance, potentially leading to high costs for those needing ongoing care [9] - Members must continue to pay their Medicare Part B premiums, which may include income-related adjustments or late enrollment penalties [10]