Zero Premium Medicare Advantage Plans: Is It Too Good To Be True?


Recently Kevin Price, Host of the nationally syndicated Price of Business Show, interviewed Dr. David Wilcox.

Health Transparency: The Real Truth with Dr. David Wilcox 

During open enrollment periods, many retirees are courted by the insurance industry offering them plans such as zero premium Medicare Advantage plans. Knowing that the insurance company is accountable to drive a profit for their shareholders, one only has to look under the hood to realize what they are signing up for. Zero dollar premium plans do not generate a profit for the insurance industry, or do they?

Recently the current administration proposed a rule to ban advertisements that market Medicare Advantage plans with confusing words images or logos. The rule would prohibit ads that specifically don’t mention a health insurance plan by name. Why does our political system even need to address this?

In November the Senate Finance Committee released a report that revealed several states had an increase in complaints about deceptive insurance marketing schemes in 2021. In Ohio, seniors were sent mail fliers resembling federal government tax forms promising bigger social security checks if they enrolled in a new Medicare Advantage plan.

Being that there are so many misleading ads and disinformation being pushed out by the insurance companies who are privatizing Medicare, here are some things to consider before signing up with any Medicare Advantage program:

  1. Do your research. These Zero dollar premium plans often have a small network of physicians that they will allow you to see. Once someone signs up for the plan they often find out that their medical team is out of network.
  2. What the average American doesn’t realize and the insurance industry is not transparent about is every plan comes with its own drug formulary. What this means is many times the prescription medications you take are not covered by these zero premium policies so it’s very important to do your research and obtain a list of covered medications.

Statistics show that 13% of the time Medicare Advantage programs deny needed tests and treatments that would have been covered under original Medicare. Take for example a patient story in which the patient’s provider ordered an MRI for an adrenal lesion. The insurance company stated it was too small and to wait for a year to do the MRI. This decision was likely made by someone with little to no medical training. In the medical field, we understand that early detection and intervention lead to better outcomes so this kind of logic makes no sense to the clinicians.

Perhaps the most important point to make for the average American is that these insurance companies have to make a profit to pay their huge CEO salaries. They are simply taking the Medicare dollars that you otherwise would have received for your healthcare and administering them. They are not looking out for the needs of the patients. They are looking out for their shareholders and if you get really sick and need expensive medical care they are most likely going to find ways to deny your care as the example above shows.

Anytime you can remove a third party such as an insurance company from the provider patient relationship you should do this. While it may cost a little more to get Medicare independently you will never have to worry about an insurance company denying you what your healthcare provider prescribes for your care.

According to a statement, “Healthcare is complex and that is not an accident. It is complex by the healthcare entities vying for your healthcare dollars. Covid has exacerbated the American Healthcare System, which was fragile, to begin with. Many clinicians are leaving healthcare due to burnout. How does the average layperson navigate the complexities of the American Healthcare System where a prescription could cost you $5 at one pharmacy and $500 at another? What does the average layperson do when their insurance company rejects their claim? Proactive education of the American Healthcare System prior to accessing it is the key to safely navigating the healthcare system. Until now, little information has been available to provide the layperson with the knowledge they need to be a better partner in their health care. Dr. David Wilcox’s book How to Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival” is a game-changer and will provide you with the skill set you need to navigate the American Healthcare System.


Dr. Wilcox is a Doctorate prepared nurse who also holds a Masters in Health Administration and is Board Certified in Nursing Informatics. Dr. Wilcox has 28 years of healthcare experience in which he worked as a bedside nurse, hospital administrator, and in healthcare information technology which has helped him to develop his unique perspective on the American Healthcare System.

Dr. Wilcox is the author of the book “How to Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival (2021)” available at

Dr. Wilcox currently resides in North Carolina with his wife and their three dogs.

Dr Wilcox’s website: Dr. David Wilcox – Healthcare, American Healthcare System (



Leave a Reply

Your email address will not be published. Required fields are marked *

Follow by Email