Medicare Advantage plans are sold by private insurance providers; these plans replace Original Medicare with benefits and service as good, and in some cases better, than Original Medicare. Because these plans are offered by private insurance companies, they may look and feel similar to plans offered by employers, which can provide some familiarity for Medicare beneficiaries.

Medicare Advantage Plans typically use HMO, PPO or PFFS networks. Below is the list of the Medicare Advantage Networks, and how they work.

Health Maintenance Organizations (HMO)
These networks have a specific network of select physicians and may require referral from a primary care physician before a patient can see a specialist. HMOs may also provide additional benefits, like coverage for deductibles and more.

Preferred Provider Organization (PPO)
A preferred provider organization allows customers to save money when they use a physician inside the plan's network. Customers are still able to see doctors outside the network, but might have to pay a higher cost.

HMO and PPO plans are the most popular types of Medicare Advantage plans.

Private Fee-For-Service (PFFS)
Private Fee-For-Service plans work similarly to that of Original Medicare, but the plan determines how much it will pay the physician or facility and how much the patient will pay out-of-pocket.

HMO “Point of Service” (HMOPOS)
A HMO “Point-of-Service" plan operates like a HMO but allows for some services to be covered by an out-of-network physician often for a higher copayment or coinsurance.

Medical Savings Account (MSA)
A Medical Savings Account plan combines a high-deductible plan with a bank account where money is deposited by the plan to be used for health care services.

There is also a type of Medicare Advantage plan called a Special Needs Plan. These are for individuals with certain chronic conditions and to people who qualify for both Medicare and Medicaid. All special needs plans must provide Medicare prescription drug coverage.

Medicare Advantage plans must cover all of the medically necessary services that Original Medicare covers. This includes hospital stays, doctor visits, preventive care, and more.

In addition, Medicare Advantage plans are popular because they also may provide additional benefits not offered by Original Medicare. One or more additional benefits may be included such as routine dental, vision and hearing, prescription drug coverage, fitness benefits and OTC cards.

When considering benefits, it's important to note that not all Medicare Advantage plans offer every benefit, and you may not have a Medicare Advantage plan with certain benefits in your area. In addition, SmartMatch does not sell every Medicare Advantage plan.

Medicare Advantage costs vary by plan. You will still have to pay your Part B premium, and some plans may have additional premiums. You'll also have copays, coinsurance, and deductibles, but many plans have a cap on your out-of-pocket expenses.

In addition, some Medicare Advantage plans offer low or no premiums; however, there may not be such a plan available in your area, and SmartMatch does not sell every Medicare Advantage plan.

Medicare Supplement plans are sold by private insurance companies, like Medicare Advantage; however, their coverage and benefits are standardized at the federally level, with the exception of Massachusetts, Wisconsin and Minnesota which standardize the plans differently.

This simplifies the shopping process, as all plans with the same letter designation offer the same basic benefits, with the only difference being prices between different insurance companies. You don't need to worry about hidden differences in coverage or benefits between plans of the same letter designation.

There are ten (10) different standardized Medigap plans available in most states. These plans are identified by letters (A, B, C, D, F, G, K, L, M, and N). 

However it's important to note that Plans F and C are not available to new Medicare beneficiaries who became eligible for Medicare on or after Jan. 1, 2020, and again, Massachusetts, Minnesota, and Wisconsin have their own standardized Medigap plans.

Medicare Supplement (Medigap) plans are designed to help fill the "gaps" in Original Medicare (Part A and Part B) coverage. While Original Medicare covers many healthcare costs, you're still responsible for out-of-pocket expenses like deductibles, copayments, and coinsurance. Medigap plans help pay for some or all of these costs, depending on the specific plan you choose.

Important Tip: Medicare Supplement plans do not include prescription drug coverage. You will likely need a standalone Medicare D drug plan if you choose Medicare Supplement.

Here's a general overview of what Medigap plans can cover:

Medicare Part A Coinsurance and Hospital Costs: This includes hospital stays beyond what Medicare covers (up to an additional 365 days), hospice care coinsurance or copayments, and skilled nursing facility care coinsurance.

Medicare Part B Coinsurance or Copayments: Medigap can help cover the 20% coinsurance you usually owe for Part B services like doctor visits, outpatient care, and medical supplies.

Part B Excess Charges: Some doctors and providers may charge more than the Medicare-approved amount for a service. Medigap can help cover these excess charges.

Blood (First 3 Pints): If you need a blood transfusion, Medigap can help cover the cost of the first 3 pints of blood each year.

Foreign Travel Emergency (Some Plans): Certain Medigap plans offer limited coverage for emergency medical care while traveling outside the U.S.

For specific information on what each Medigap plan covers, visit the table in the section below.

Medicare Supplement (Medigap) plan costs can vary significantly depending on several factors. Also keep in mind, you will also need to pay your Standard Part B premium, in addition to the monthly premiums for your specific plan:

1. Plan Type:

Each Medigap plan (A, B, D, G, K, L, M, N) offers different levels of coverage. Plans with more comprehensive coverage typically have higher premiums. For instance, Plan G is generally more expensive than Plan N because it covers the Part B deductible.

2. Insurance Company:

Premiums can differ substantially between insurance companies even for the same plan type. This is because each company sets its own rates based on various factors.

3. Pricing Methods:

Insurance companies use different pricing methods for Medigap plans:

Community-rated: Everyone pays the same premium regardless of age.
Issue-age-rated: Premiums are based on your age when you first buy the policy and typically stay the same regardless of age increases.
Attained-age-rated: Premiums increase as you get older.

4. Location:

Premiums can also vary based on where you live due to differences in healthcare costs and state regulations.

5. Additional Factors:

Some insurance companies offer discounts for factors like:

Gender
Being married
Not smoking
Paying premiums annually instead of monthly
General Price Range:

While it's impossible to give exact figures due to the varying factors, here's a general idea of monthly premium ranges for a 65-year-old non-smoker in Kansas City, Mo., for 2024:

Plan G: $158-$410
Plan N: $122-$349
High-Deductible Plan G: $42-$99

Medicare prescription drug plans are sold by private insurance carriers; they can either be standalone plans or rolled into Medicare Advantage plans called MA-PDs.

Numerous factors account for the variety of drug coverage costs, including:

- Type of prescription
- Whether or not it’s on your plan’s formulary
- Which tier the drug falls under
- Whether your deductible has been met, or if you’re in catastrophic coverage
- Whether your pharmacy is in or out of network

You can expect to make the following payments for a Medicare drug plan (per Medicare.gov):

- An annual deductible
- Premiums
- Coinsurance or copayments
- Coverage gap costs
- Costs for late enrollment, if applicable

The four prescription drug coverage stages are transitional phases during which your drug plan costs may change depending on which stage you are in. They include:

Annual deductible: Starts with your first prescription of the plan year. In this phase, you pay the full cost of your prescriptions until spending reaches the amount of your deductible.

Initial coverage: During this phase, your plan covers a portion of your prescription drug purchases for medications covered under your plan’s formulary. You pay the rest in the form of a copayment or coinsurance (the amount depends on the drug’s tier level).

Coverage gap: In the coverage gap, your plan is limited to how much it can pay for your medications. If you enter the gap, you pay 25% of the plan’s cost for covered brand-name drugs and 25% of the cost for generic drugs. Beginning in 2025, you'll move out of the coverage gap once your out-of-pocket cost for covered medications reaches $2,000 (not including premiums).

Catastrophic coverage: Before 2024, once you reached catastrophic coverage, you continued to pay 5% of your drug costs for the rest of the year; however, that coinsurance requirement was removed in 2024. Beginning in 2025, you'll pay no more than $2,000 in out-of-pocket costs.

Below is a sample of the kind of tier levels that prescription drug plans use to establish cost levels:

Tier 1: Most generic prescription drugs, lowest co-payment
Tier 2: Preferred brand-name prescription drugs, medium co-payment
Tier 3: Non-preferred brand-name prescription drugs, high co-payment
Specialty drugs and biosimilars: High-cost prescription drugs, highest co-payment

It's important each year to check your Annual Notice of Change and evaluate whether the medications you take have changed in the plan formulary, or the list of prescription drugs covered by your plan.