$0 Premiums vs MOOP: Why the Monthly Price Tag Isn't the Whole Story

MEDICARE MONDAY Episode 20 | September 21st, 2026

Presenter:

Mitch Hudson | Agency Manager at American Republic Insurance Services

Watch Episode 20 of Medicare Monday for a clear look at MOOP versus $0 premiums, why drugs sit outside the medical cap, and the AEP prep step that actually protects your wallet.

In Episode 20 of Medicare Monday, Mitchell Hudson from American Republic Insurance Services sits down to explain why a $0 premium Medicare Advantage plan is not automatically the cheapest option — and how shopping only by the monthly price tag can cost thousands later.

As Annual Enrollment approaches, Mitch says residents across Central Illinois will have their mailboxes, TVs, and phones fill up with ads promising $0 premiums.

The Trap: Ignoring the fine print, especially your plan's maximum out-of-pocket (MOOP) for medical expenses.

He defines MOOP as the medical out-of-pocket maximum — doctors, specialists, surgeries, hospital observation or confinement, cancer care, and durable medical equipment.

Plans vary widely & in his example:

• A $0-premium plan might carry a MOOP of $8,000, $9,000, or $10,000
• Where a $50-a-month plan might cap medical costs at $3,600.
• Add that $3,600 to a guaranteed $600 in annual premiums ($50 × 12) and you are looking at about $4,100 — still far below the higher MOOP ceiling.

Another common misconception: Prescription drug costs do not roll into the medical MOOP.

• Drugs have their own maximum out-of-pocket, stages, and separate coverage. High pharmacy spend does not automatically protect you under the medical MOOP.

With Annual Enrollment starting October 15, his homework is not flashy brochures or commercials.

Gather your medical history — doctors, specialists, and prescriptions down to milligrams, daily dose, and refill frequency — then bring it to a professional for a full look past the $0 premium headline so you are ready if a health curveball shows up in 2027.

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