At 67, He’ll Keep His Clover Medicare Advantage Plan for 2027. The Premium Will Stay $0. The Most He Can Be Billed Will Jump $1,144
A $0 monthly premium sounds like free coverage until you read the pages most people skip. One number buried in the Annual Notice of Change quietly decides how much a serious diagnosis will actually cost in 2027.
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A 67-year-old opens his Annual Notice of Change from Clover Health (NASDAQ:CLOV). His monthly premium for 2027 stays at $0, so he puts the envelope away and figures his costs are holding steady. A few pages later is a number that matters more: his plan’s maximum out-of-pocket limit. Across Clover’s 2027 plans, analysts reportedly found those limits rose by an average $1,144.
His year will likely look like the last few. An annual physical, a couple of specialist visits, and some generic prescriptions mean he will never get near the cap, and the increase costs him nothing. His year could be far worse. If he manages heart disease, has a knee replacement scheduled, or just finished cancer treatment, the increase in his own plan’s out-of-pocket limit may matter far more than the $0 premium.
A $0 Plan Premium Does Not Mean $0 Medicare Costs
Calling the plan free leaves out the Part B premium. Medicare Advantage members still owe Part B, although some plans give back part of that premium. The standard premium is $202.90 a month in 2026, or $2,434.80 a year, before any giveback. Higher earners pay more. 2027 Part B premiums have yet to be announced.
The $0 figure refers only to the plan’s monthly premium. The maximum out-of-pocket limit sets the ceiling on what he pays for covered in-network Part A and Part B care. Once his qualifying copays and coinsurance reach that limit, the plan pays those covered medical costs for the rest of the year. A higher cap matters most in a year when he needs enough care to reach it, even while the premium line still shows zero.
Where the Higher Cap Starts to Bite
Medicare Advantage plans use their own cost-sharing rules instead of Original Medicare’s Part A hospital deductible, and those copays and coinsurance can add up fast. Here is a sample year for a member with a serious diagnosis:
| Expense (illustrative example) | His cost, annual, per person |
|---|---|
| Hospital stay at $350 per day for days 1 through 6 | $2,100 |
| Outpatient infusions charged at $40,000, 20% coinsurance | $8,000 |
| Specialist visits twice a month at $25 each | $600 |
That total runs past almost any plan’s cap, so the cap decides what he pays, and in a year like this he owes the full 2027 limit, which is now $1,144 higher than his 2026 limit. Repeated treatments such as dialysis, physical therapy after surgery and infusions all follow this pattern. Coinsurance on expensive outpatient services keeps adding up until the cap stops it.
Two gaps push the real maximum even higher. First, the medical cap leaves out Part D drug costs. Drugs have their own separate limit, which rises from $2,100 to $2,400 in 2027. Second, Clover sells PPO plans, and out-of-network care counts toward a separate, higher combined limit.
Switching Back Gets Harder at 67
One alternative is switching to Original Medicare and adding Medigap, but that move can get harder after the one-time federal Medigap open enrollment window closes. In most states, an insurer may review his health history and turn him down or charge more. States including New York, Connecticut, Massachusetts and Maine offer wider protections, so the rules depend on where he lives. Someone already in treatment may have fewer Medigap options than someone who can qualify through underwriting.
Three Moves to Make Before December 7
- Find the 2026 and 2027 in-network maximum out-of-pocket figures in your ANOC. Put them next to the premium, the daily hospital copay, the specialist copay and the coinsurance on outpatient drugs. If a plan raises the cap but continues copays flat, it only costs you more in a sick year. If it raises both, you pay more every year.
- Make sure every doctor, hospital and infusion center you use stays in network for 2027, and check whether prior authorization rules changed. Dropping your oncologist from a $0 plan will cost you far more than $1,144.
- If you expect an expensive year in 2027, compare other Advantage plans in your county on Medicare Plan Finder during the Annual Enrollment Period, October 15 through December 7, 2026. Look at the out-of-pocket cap alongside hospital and specialist copays, drug coverage, premiums and whether your doctors stay in network. A plan with a small monthly premium and stronger medical coverage can sometimes beat a $0 plan. Changes take effect January 1, 2027.
A $0 premium tells him what it costs to stay in the plan. The maximum out-of-pocket tells him what a hard year will cost. Before he decides the plan is still free, he should examine both numbers and evaluate his health.
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Gerelyn Terzo is the author of dividend investing handbook "Dividend Investing Strategies: How to Have Your Cake & Eat It Too." A veteran financial journalist, she covers agri-finance for outlets like Global AgInvesting and the broader stock market and personal finance for 24/7 Wall Street. She began at CNBC and later helped launch Fox Business in New York. Gerelyn currently resides in Woodland Park, Colorado and dabbles in nature photography as a hobby.
