Medicare Plan Options
Original Medicare’s coverage may be sufficient if you’re generally healthy and don’t need more than routine care. However, if you’re accustomed to private health insurance plans with comprehensive coverage, the base plan may not meet your needs. To help you customize your coverage, private health insurance companies sell policies that complement Original Medicare, including prescription drug and supplemental coverage. For those seeking an all-in-one alternative, North Carolina’s Medicare Advantage program may be a good fit.
Original Medicare is the basic health insurance plan administered by the federal government. Its coverage is in two parts, including Part A, or hospital insurance, and Part B, which pays for routine doctor’s office visits, ambulance services, durable medical equipment, and mental health services. It’s a fee-for-service plan, meaning that it determines what it pays and what you pay for a covered service, and you can go to any health care provider that agrees to its payment terms. You don’t have to choose a primary care provider or get referrals to see specialists.
Medicare Advantage Plans
Medicare Advantage Plans are sold by private insurance companies. There are approximately 100 Medicare Advantage Plans available in North Carolina, but depending on where you live, only a handful may be available to you. These plans cover the same services as Original Medicare, and most plans also have coverage for prescription drugs, vision and dental care, and personal care services. There are four main plan types, including HMOs, PPOs, PFFS plans, and SNPs. Premiums, deductibles, annual out-of-pocket limits, and rules about seeing in-network providers or getting referrals to see specialists vary depending on your plan’s terms.
Medicare Prescription Drug Coverage Plans
While Original Medicare has coverage for a few outpatient prescription drugs, such as some antigens and injectables, most medications aren’t covered under the base plan. Private health insurance companies sell prescription drug coverage, also called Part D drug plans. Each plan has a list of covered drugs, called a formulary, and medications are put into tiers. In most cases, the higher the tier, the less the medication costs you. Even if you don’t rely on prescription medications when you first sign up for Medicare, it’s a good idea to sign up for a drug plan to avoid late enrollment penalties.
Medicare Supplement Insurance Plans
Medicare Supplement Insurance Plans, or Medigap plans, are sold by private health insurance companies to help you pay for some of the costs not covered by Original Medicare. There are 10 plan types, but every type is standardized, meaning that you get the same coverage regardless of the company you buy your policy from. These plans have separate premiums that you pay on top of your Part B premium. To be eligible for Medigap, you must be enrolled in Original Medicare Parts A and B. This coverage can’t be bought alongside Medicare Advantage.
Medicare in North Carolina by the Numbers
|People enrolled in Original Medicare||Average plan cost||Annual state spending per beneficiary||Spending per beneficiary compared to the national average|
|1,205,045||Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.
Medicare Resources In North Carolina
Finding the right health insurance coverage involves evaluating your current and future health care needs, budget, and the policies available in your region. To help you save money on health care expenses and ensure you understand enrollment deadlines, North Carolina has several government and nonprofit agencies that provide professional assistance. Counselors can help you determine whether you qualify for financial assistance programs to make prescription drugs or monthly premiums more affordable. Assistance may be available in person or over the phone.
North Carolina Department of Insurance
The North Carolina Department of Insurance regulates the insurance industry in the state and advocates on behalf of consumers to ensure fair practices. It offers two programs for Medicare beneficiaries, including the Seniors’ Health Insurance Information Program and Senior Medicare Patrol. SHIIP provides free, impartial health insurance options counseling to help seniors make educated decisions regarding their coverage. It’s staffed mainly by trained volunteers who can answer your questions about Medicare’s scope of coverage, available Medigap and Medicare Advantage Plans, and income-based financial assistance. Volunteers provide educational talks at community events, along with one-on-one assistance in person and over the phone. SMP helps you recognize and protect yourself from Medicare waste and fraud via trained volunteers who provide information and help you identify and resolve medical billing issues.
Contact Information: Website | 855-408-1212
Legal Aid of North Carolina
Legal Aid of North Carolina is a nonprofit legal organization that serves state residents aged 60 and over. Its legal professionals can help you apply for Medicare and identify savings programs that can lower your out-of-pocket costs. Your local office can also help you resolve health insurance and billing issues, such as overcharges, denied claims, or canceled policies.
Contact Information: Website | 877-579-7562
Area Agencies on Aging
North Carolina has a network of 16 Area Agencies on Aging that plan and administer programs and services for those aged 60 and over. Through your local AAA, you can meet with a SHIIP counselor who provides free, confidential health insurance options counseling. While counselors aren’t affiliated with an insurance company and aren’t licensed to sell policies, they can help you review your health needs and build a health insurance policy that fits your needs.
Contact Information: Website | 800-662-7030
Social Security Offices
North Carolina is home to 37 Social Security offices. At your local office, you can get information regarding the parts of Medicare, enroll in Medicare, or obtain a Medicare card. Your local office can also help you sign up for the Extra Help program, which helps cover prescription drug plan costs.
Contact Information: Website | 800-772-1213
Learn More From Our Sources
- Medicare | What Part A covers | Last accessed June 2021
- Medicare | What Part B covers | Last accessed June 2021
- Medicare | Prescription drugs (outpatient) | Last accessed June 2021
- Medicare | What Medicare Part D drug plans cover | Last accessed June 2021
- Medicare | Part D late enrollment penalty | Last accessed June 2021
- Medicare | How to compare Medigap policies | Last accessed June 2021
- NC DOI | Medicare and Seniors’ Health Insurance Information Program (SHIIP) | Last accessed June 2021
- Legal Aid NC | Senior Law Project | Last accessed June 2021
- NCDHHS | DAAS Area Agencies on Aging | Last accessed June 2021
- Social Security | Medicare Benefits | Last accessed June 2021