Understand Medicare in North Carolina
Medicare, the United States federal medical insurance program, provides coverage for more than 1 million people in North Carolina who qualify for Medicare. You can get Medicare if you’re 65 or older or have a qualifying disability.
Your disability typically qualifies if you’ve received at least 24 Social Security or Railroad Retirement Board (RRB) disability insurance payments. You can also enroll in Medicare Advantage Plans if you have End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS).
Most people have premium-free Part A but, if you have to buy it, the cost can reach up to $499 per month in 2022. Part B costs $170.10 per month but can be more if you have higher income. There are 69 Medicare Advantage Plans in the state that are an alternative to Original Medicare. Learn more about your Medicare options in North Carolina.
Medicare Plans in North Carolina
|Compare ratings of North Carolina’s Medicare plan providers:|
|Insurance company||Medicare rating||A.M. Best rating||BBB rating||NCQA rating||J.D. Power ranking|
|Aetna||4 stars||A||A+||2.5 to 4.5 stars||5 out of 10|
|Anthem Blue Cross Blue Shield||4 to 4.5 stars||A+||A+||Not rated||Sixth out of 10|
|Humana||4 stars||A-||A+||1.5 to 4.5 stars||Third out of ten|
|UnitedHealthcare||3.5 stars||A-||A-||4 stars||Fourth out of 10|
Medicare Plan Options in North Carolina
Residents of North Carolina have multiple Medicare plans to choose from. Many are tiered to help North Carolinians find the plan that is best suited to your lifestyle and medical needs. For example, seniors and individuals with disabilities who don’t need much coverage can apply for Original Medicare. North Carolina’s Medicare Advantage program might be a better option if you need more comprehensive insurance. Some Medicare policies offer additional prescription drug add-ons or supplementary coverage.
|Original Medicare (Parts A and B)||Original Medicare is the basic Medicare plan, which is a fee-for-service form of insurance. It has two parts: Part A hospital insurance and Part B medical insurance. Part A covers hospital stays and periods spent at skilled nursing facilities, lab tests an individual has performed, and hospice care. Part B covers doctor’s office visits and home health care services. It may also cover some preventive care, such as screenings for cancers and mental illnesses, including depression. With Original Medicare, you’ll pay a deductible along with your share of the fees incurred during an inpatient or outpatient visit:
|Medicare Advantage Plans (Part C)||Medicare Advantage plans, also known as Part C, are an alternative to Original Medicare offered by private insurance companies. These plans include both Part A and Part B coverage, except for hospice care. Most services are provided by network providers, and you may need primary care physicians, referrals for specialists, and prior authorizations for treatment and medications. Medicare Advantage offers additional coverage for essential needs, such as prescription drugs, dental and vision care. Some Medicare Advantage Plans also cover gym memberships and transportation to and from medical appointments. Part C may also pay for adult day care services:
|Medicare Prescription Drug Coverage Plans (Part D)||Many Medicare Advantage policies add Part D drug coverage automatically to their package, but you can also add Medicare prescription drug coverage to Original Medicare. Medicare prescription drug coverage is offered to all Medicare enrollees, but you may have to pay a penalty if you wait to enroll after being initially eligible. Medicare Part D plans may not all cover the same drugs or have the same costs as Medicare Advantage policies. Standalone Part D coverage is provided by Medicare-approved private insurers. Most plans require a deductible and a copay for each prescription drug:
|Medicare Supplement Insurance Plans (Medigap)||Some North Carolina seniors purchase a Medicare Supplement Insurance policy, also known as Medigap. These plans are intended to fill in the gaps Original Medicare doesn’t cover. Some of these gaps include medical coverage while overseas, Part A and Part B copays, and excess Part B charges. Medigap doesn’t pay for anything related to Medicare Advantage. You cannot have a Medigap plan and a Medicare Advantage Plan at the same time.
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 $499 per month*
Plan B: $170.10 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
Getting support can help when you’re making Medicare decisions. North Carolina has numerous locations where enrollees can receive help through the State Health Insurance Program (SHIP), also known as North CarolinaCares. North CarolinaCares has counselors throughout the state that work with local nonprofits and public health agencies, as well as Area Agencies on Aging (AAAs), to provide seniors with Medicare information.
North Carolina Senior Law Project
The North Carolina Senior Law Project sponsors Legal Aid of North Carolina, which is a nonprofit organization that helps North Carolina seniors age 60 and over apply for Medicare and lower their out-of-pocket health coverage costs. Local offices are staffed with legal professionals who can help seniors resolve billing issues and denied claims.
Contact information: Website | (877) 579-7562
North Carolina Department of Insurance
The North Carolina Department of Insurance is responsible for regulating the state’s health insurance industry and ensuring consumers get fair coverage. The Department supports the Seniors’ Health Insurance Information Program (SHIIP), which provides free health insurance counseling to seniors, and Senior Medicare Patrol (SMP), which helps seniors avoid, detect and report Medicare fraud.
Contact information: Website | (855) 408-1212
Medicare and Seniors’ Health Insurance Information Program (SHIIP)
The North Carolina Medicare and Seniors’ Health Insurance Information Program (SHIIP) connects state seniors with trained volunteers to help answer your Medicare questions. You can get counseling on Medicare coverage, as well as Medicare Supplement Insurance, Medicare Advantage Plans and income-based financial assistance for Medicare. Volunteers provide both one-on-one counseling in-person and over the phone as well as education presentations at community events.
Contact information: Website | (855) 408-1212
North Carolina Area Agencies on Aging
North Carolina provides 16 Area Agencies on Aging throughout the state. Each agency provides free Medicare assistance for local seniors age 60 and over and their families and beneficiaries. A local agency office can connect you with a SHIIP counselor for free and confidential health insurance counseling. Counselors are not affiliated with any insurance companies, nor can they sell insurance plans, so you’re guaranteed to get unbiased advice.
Contact information: Website | (800) 662-7030