According to Robert Simm, a licensed broker at GenerationHealth, 36 Medicare Advantage plans are open to Johnston County residents with Part A and Part B for 2027. 26 of them have a $0 monthly plan premium, 27 are rated 4 stars or higher, and the lowest in-network out-of-pocket maximum is $3,400, against Medicare’s $9,850 cap. Check your doctors and hospital in each plan’s network before you choose. Robert Simm, licensed NC health insurance broker, NPN #10447418, at (828) 761-3326.
2027 Medicare Advantage at a glance
Medicare Advantage plans in Smithfield, NC for 2027
GenerationHealth’s 2027 Johnston County data shows 36 Medicare Advantage plans open to anyone with Part A and Part B in Smithfield and the rest of Johnston County. 26 have a $0 monthly plan premium, 27 are rated 4 stars or higher by Medicare, and the lowest out-of-pocket maximum is $3,400.
36Medicare Advantage plans
26with a $0 monthly premium
27rated 4 stars or higher
Not counted above: 25 Special Needs Plans for people with Medicaid or certain chronic conditions. 1 plan is too new to have a star rating.
Out-of-pocket maximums by plan type
The out-of-pocket maximum is the most you pay for covered in-network care in a year. Medicare caps it at $9,850 for 2027. Across Johnston County the average plan sets it at $7,500.
Plan type
Plans
Average maximum
Lowest available
HMO
4
$5,763
$3,400
HMO-POS
12
$7,175
$3,900
PPO
20
$8,043
$3,900
PPO figures are the in-network maximum. In- and out-of-network costs combined are capped at up to $14,800.
Which plans give you the most flexibility?
PPO — most flexible (20 plans). See doctors and hospitals outside the network at a higher cost, usually without a referral. Good if you travel, split time between homes, or want to keep a specialist who is not in every network.
HMO-POS — some flexibility (12 plans). Built around a network, but covers some services out of network, usually at a higher cost. Referrals are often still required.
HMO — least flexible, often lowest costs (4 plans). Covers care inside the network only, except emergencies and urgent care, and usually needs referrals. In Johnston County, HMOs have the lowest average out-of-pocket maximum of any plan type ($5,763).
Does the plan include UNC Health?
UNC Health runs hospitals in Johnston County, including UNC Health Johnston Smithfield and UNC Health Johnston Clayton. Each health system contracts plan by plan, so two plans from the same insurance company can treat the same hospital differently. Check the exact plan before you enroll, and check again every fall because networks change for January 1.
Source: GenerationHealth analysis of CMS 2027 Medicare Advantage plan data for Johnston County (premiums, star ratings and out-of-pocket maximums), updated 2026-10-12. Counts exclude Special Needs Plans unless noted. Plans and networks vary by ZIP code; confirm details with the plan, Plan Match, or Medicare.gov.
Who to Call in Johnston County
The Part Medicare.gov Can’t Answer
I call the billing office. Medicare.gov lists which plans a hospital accepts — it can’t tell you whether your specific cardiologist is taking new patients on that plan in January.
Which UNC Health facilities serve Johnston County?
UNC Health is the health system on record for Johnston County, and 2 facilities in the county carry its name — which does not mean they all sit on the same plan contracts.
01
UNC Health Johnston Smithfield
02
UNC Health Johnston Clayton
Service lines in Johnston County
Cancer Care (UNC Lineberger Cancer Network at Johnston) Heart Care (UNC Health Johnston Cardiology) Orthopedics (Hip and Knee Replacement) Maternity Care Emergency Services
💡 UNC Health network notes
Effective 1 January 2026, UNC Health and UNC Health Blue Ridge are no longer in-network with Humana, WellCare, or Health Care Service Corporation (HCSC, formerly Cigna) Medicare Advantage plans. Anyone holding one of those three and using UNC Health providers is now paying out-of-network rates unless they changed plans. Verified 2026-09-02.
A Humana Medicare Advantage card does not tell you where you stand with UNC Health. Retirees covered under the North Carolina State Health Plan were carved out of the January 2026 exit and can still see UNC Health providers at the same cost, contracted or not. UNC Health Blue Ridge’s president stated publicly that some Humana members received letters telling them to find a new provider that did not apply to State Health Plan retirees at all. Verified 2026-09-02.
Asked directly whether being in a plan means every provider at its hospital is too, UNC Health Rex answers: no, not necessarily. It contracts out anaesthesia, emergency medicine, OB hospitalist, pathology and radiology to independent groups, and works one surgery through to five separate bills — the facility, the surgeon, the anaesthesia group, the radiology group and the pathology group. Read that as five bills to reconcile rather than five ways to be overcharged: at an in-network facility federal law caps those ancillary specialties at your in-network cost-sharing. Rex publishes each group’s billing number so you can check anyway. The more expensive version of this question is the reverse one Rex also answers — your surgeon being in-network does not mean the hospital is, and the hospital is where the money is. Verified 2026-09-02.
UNC Health announced the exit on 27 October 2025, twelve days into an Annual Enrollment Period that had opened on 15 October and closed on 7 December. Anyone who had already chosen a plan in those first twelve days picked it without knowing. Members who missed the AEP window can still move during Medicare Advantage Open Enrollment, 1 January to 31 March. Verified 2026-09-02.
The numbers
What does the data actually show for this Medicare question?
Original Medicare
Medicare Advantage
Network
Any provider taking Medicare nationwide
Johnston County contracted providers
Out-of-pocket cap
Set by Medigap (very low)
$9,850 in-network max (2027)
Monthly premium
Higher — Medigap + Part D + Part B
Lower — often $0 above Part B
Referrals required
No
HMO yes; PPO usually no
Drug coverage
Separate Part D plan
Usually built in (MAPD)
Extras (dental/vision/hearing)
Not included
Often included
Best fit
Predictable bills, frequent specialist use
Healthy retiree, wants low premium
2027 Medicare numbers
What are the 2027 Medicare numbers for Johnston County residents?
$202.90
Part B premium per month
2026 standard rate (CMS has not published 2027 yet). Higher with IRMAA based on income.
$283
Part B annual deductible
2026 figure. You pay this before Medicare covers 80% of outpatient care.
$9,850
MA in-network out-of-pocket max
2027 cap on in-network Medicare Advantage spending.
$2,400
Part D out-of-pocket cap
2027 cap on prescription costs — but tier placement still matters.
10 minutes. You'll know where you stand.
Rob Simm · Licensed NC Medicare Broker · NPN #10447418
Licensed in NC · No pressure · Your data never sold
What is Plan Match?
✓ Snap a photo of your meds and providers — no typing
✓ Every plan at your ZIP, ranked by your costs
✓ Just date of birth and ZIP code to start
✓ Free, private, results in 3 minutes
5 mistakes Johnston County residents make
Avoid these before you enroll.
Three are specific to Johnston County. Two apply to every NC resident. All five are fixable — if you catch them before enrollment.
Last reviewed: 2026-10-12 · Robert Simm, Licensed NC Medicare Broker, NPN #10447418
⚠ Johnston County mistakes I see every AEP
Mistake 01 Johnston-specific
Picking a Medicare Advantage plan that drops UNC Health mid-year.
Why it hurtsMA carrier contracts with UNC Health can change inside a plan year. Johnston County residents have lost in-network access to specialists they relied on, with no prorated premium refund.
What to doBefore enrolling, confirm contract dates with the carrier directly. PPOs and Medigap plans both reduce this risk.
Mistake 02 Johnston-specific
Assuming Medigap won’t cover UNC Health.
Why it hurtsMedigap plans are not networks. As long as the doctor accepts Original Medicare, they accept Medigap. Some Johnston residents pay $150+ per month extra on an HMO they didn’t need.
What to doIf keeping UNC Health access matters, Medigap Plan G or Plan N gives you the broadest stable access. No referrals, no network worries.
Mistake 03 Johnston-specific
Attending hotel-ballroom Medicare seminars instead of meeting a Johnston-based broker.
Why it hurtsMulti-county seminars are licensed agent recruiting funnels — the follow-up agent is paid more for certain carriers, so you leave with the plan that pays them best, not the plan that fits Johnston County.
What to doMeet a Johnston County–based broker in person, or have them come to your home. One-on-one always beats ballroom.
Mistake 04 NC-wide
Missing the Part B late enrollment penalty if you’re working past 65.
Why it hurtsIf you don’t sign up for Part B during your Initial Enrollment Period and don’t have qualifying employer coverage, you owe a 10% penalty for every 12 months you delayed — for the rest of your life. A 3-year delay = 30% higher Part B premium forever.
What to doIf you’re working past 65, get a Certification of Creditable Coverage from HR before you stop work. That document protects you from the penalty.
Mistake 05 NC-wide
Missing your 6-month Medigap open enrollment window.
Why it hurtsYou have one 6-month window after you turn 65 and enroll in Part B to buy any Medigap plan with no medical underwriting. Miss it and NC insurers can deny you coverage — or charge dramatically more — if you develop a health condition. This is the single most expensive mistake I prevent.
What to doUnderstand your window the day you turn 65. Even if you pick MA now, know the Medigap door closes 6 months later. Call me before that window closes.
The difference
What’s the difference between doing it alone and working with an independent NC broker?
What you need
Doing it alone
Robert Simm — NC #10447418
Plans you can compare
Whatever Medicare.gov lists, no NC context
Every major NC carrier, filtered to your situation
Johnston County network knowledge
Generic federal directories, often 6 months stale
Direct contract verification with each carrier
2027 numbers applied to your budget
Generic rules — no IRMAA math, no spousal coordination
Run with your real income and household
Part D formulary check
Manual entry per drug, per plan
I pre-check every prescription on every eligible plan
Same person next year
Different agent every call
Same broker, same answer, every AEP
Cost
$0 (just your time and risk)
$0 — paid by carrier
⚠ Penalty & Deadline Warning
If you delay Medicare Part B without creditable employer coverage, you’ll pay a 10% lifetime penalty for every 12 months you delayed — added to your Part B premium for the rest of your life. The 2026 standard Part B premium is $202.90/month, so a 24-month delay raises it to roughly $243/month, permanently. Your Initial Enrollment Period is a 7-month window: 3 months before your 65th birthday month, the birthday month itself, and 3 months after.
💡 Broker Tip · Provider Verification
Before you enroll in any Medicare Advantage plan, give me the names of every doctor you see — primary care, cardiologist, oncologist, endocrinologist — and I’ll call each one’s billing office directly to verify they accept the plan. Provider directories on Medicare.gov run 4–6 months stale, and “in-network” on the directory doesn’t always mean the provider is accepting new patients on that plan.
Common questions
Frequently asked questions
How many Medicare Advantage plans are available in Smithfield, NC for 2027?
Johnston County has 36 Medicare Advantage plans for 2027 that anyone with Medicare Part A and Part B can join. 26 of them have a $0 monthly plan premium and 27 are rated 4 stars or higher. There are also 25 Special Needs Plans for people who have Medicaid or certain chronic conditions.
What Medicare Advantage plans in Smithfield, NC have the lowest out-of-pocket expenses?
The lowest in-network out-of-pocket maximum on a 2027 plan in Johnston County is $3,400, and the average across all 36 plans is $7,500. By plan type: HMO plans start at $3,400 (average $5,763); HMO-POS plans start at $3,900 (average $7,175); PPO plans start at $3,900 (average $8,043). Medicare caps the in-network maximum at $9,850 for 2027. A low maximum protects you in a bad year; your copays decide what a normal year costs.
Which Medicare Advantage plans in Smithfield, NC are priced well?
26 of the 36 plans in Johnston County have a $0 monthly plan premium for 2027. You still pay your Part B premium. A $0 premium is not automatically the cheapest choice: compare the out-of-pocket maximum (as low as $3,400 here) and the copays for the doctors and drugs you actually use.
Which Medicare Advantage options in Smithfield, NC have good flexibility?
20 PPO plans let you see doctors outside the network at a higher cost, usually without referrals. In-network costs are capped at your plan’s maximum; in- and out-of-network costs combined are capped at up to $14,800. 12 HMO-POS plans use a network but cover some services out of network. 4 HMO plans cover care inside the network only, except emergencies and urgent care, and usually need referrals for specialists.
What Medicare Advantage plans in Smithfield, NC are rated the best?
27 of the 36 plans in Johnston County carry a 2027 Medicare star rating of 4 stars or higher, and 1 plan is too new to be rated. Star ratings measure quality and member experience across the whole plan, not whether your doctors are in network, so check the network first.
Which Medicare Advantage plans in Smithfield, NC include UNC Health?
UNC Health runs hospitals in Johnston County, and each health system contracts plan by plan, so two plans from the same insurance company can treat the same hospital differently. Check the specific plan before you enroll. With an HMO, non-emergency hospital care is covered in network only; an HMO-POS or PPO can also cover an out-of-network hospital, at a higher cost.
When can I change my Medicare Advantage plan in Smithfield, NC?
During Medicare’s Annual Enrollment Period, October 15 to December 7, 2026, for coverage starting January 1, 2027. If you are already in a Medicare Advantage plan, you get one more change from January 1 to March 31, 2027. Turning 65, moving, or losing other coverage can open a Special Enrollment Period.
Does this answer change if I live in Johnston County specifically?
Yes — carrier networks, Medigap rates, and Medicare Advantage plan availability all vary by zip code. The figures and plan recommendations on this page are calibrated to Johnston County, NC.
How do I verify any Medicare agent is licensed in NC?
No. Brokers are paid by the insurance carrier when you enroll, and the commission is identical whether you enroll directly, through Medicare.gov, or through a broker.
It pays to talk to the right broker
Does it matter which Medicare carrier you choose?
It doesn’t — because I get paid by the insurance carrier to manage your plan. Most call centers get paid more to steer your business toward certain carriers based on volume and contracts. The only thing I’m optimizing for is making sure you’re covered correctly when you actually need it. That’s what keeps people coming back. And referring their neighbors.
Nearby counties
Medicare Advantage in the counties next to Johnston
Moving, or splitting time between two counties? Plans are approved county by county, so compare the county you will actually live in.
Compliance disclaimer: We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE (1-800-633-4227) for information on all of your options. GenerationHealth.me and Robert Simm are independent agents not affiliated with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent may contact you. Information on this page is for educational purposes only and should not be considered legal or financial advice. Plan availability, premiums, and benefits vary by location and carrier.
Licensed in North Carolina, Texas & Georgia·NPN 10447418·AHIP Certified for Plan Year 2027
12+ Years · 500+ Families Served · Your Data Never Shared
Robert Simm is the licensed insurance broker behind GenerationHealth (generationhealth.me), an independent brokerage serving Medicare, ACA Marketplace, and supplemental health coverage across North Carolina, Texas, and Georgia under NPN 10447418.
Rob works directly with every client — no call center, no lead handoff. Plan comparisons on this site are built from CMS Plan Benefit Package data compiled by GenerationHealth, not from carrier marketing material.
GenerationHealth is not connected with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE, 24 hours a day / 7 days a week, or consult www.medicare.gov to get information on all of your options.
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