Medicare Advantage Plans in North Carolina

North Carolina is home to some significant firsts. In 1799, the first gold nugget ever found in the US was uncovered in the mountains. And in 1903, the Wright brothers flew the first plane over the Kitty Hawk dunes.

With all these firsts, it’s no surprise that The Tar Heel State is also a leader in healthcare coverage. Discover first-in-class healthcare plans with GoHealth.

Are you turning 65? If you’re getting ready to enroll in Medicare for the first time, you have many options. There are several kinds of Medicare plans, each with different benefits and premiums.

Medicare Part A

Medicare Part A provides you with hospital coverage. This includes inpatient hospital coverage that pays a portion of your hospital bills. Part A also covers skilled nursing facility care and hospice care.

Medicare Part B

Medicare Part B is medical coverage. This plan covers medical services, preventative services, durable medical equipment, and more. Coverage also includes ambulance services and some mental health services.

Medicare Part D

Medicare Part D plans cover prescription medications. These drug plans help you pay for meds. Private insurance providers offer Part D coverage. You can enroll in a Part D plan in addition to your Original Medicare plan. Just remember that each plan has a unique list of covered medications. You’ll need to check the list to make sure your drugs are covered.

You can choose to enroll in Medicare Parts A and B or even add a Part D plan to your Medicare coverage. But there’s another option to consider.

Medicare Advantage plans in NC, also called Part C plans, must offer the same coverage as Medicare Parts A and B. The difference is that Medicare Part C  are private insurance plans. This means providers are free to set their premiums and offer additional benefits.

Medicare Advantage plans replace Original Medicare (Parts A and B) and bundle benefits in one plan with just one Medicare card. Most Medicare Advantage plans also have prescription drug coverage.

Here’s what can be covered in Medicare Advantage North Carolina plans:

• Hospital coverage for inpatient and emergency care
• Medical coverage
• Preventative care
• Prescription drug coverage
• Durable medical equipment like a walker or wheelchair
• Immunizations and vaccines
• Additional benefits like vision, dental, and hearing coverage
• Telehealth services

Most Medicare Advantage plan premiums are lower than Original Medicare coverage. These plans also put a cap on out-of-pocket spending and often have lower copays. However, each county offers different Part C plans. And to make full use of your coverage, you’ll need to access care with in-network providers.

Adults 65 and older are eligible for Medicare Advantage in North Carolina. If you’re a US citizen or permanent resident, you can enroll in Medicare NC.

Adults younger than 65 are sometimes eligible for Medicare as well. Younger adults who receive Social Security disability benefits or have a qualifying condition can also enroll in Medicare. For example, adults with end-stage renal disease or ALS are eligible for Medicare in North Carolina.

Enrolling in Medicare

To enroll in Medicare, you’ll need to contact the Social Security Administration. You can enroll online, on the phone, or by dropping by your local SSA office. After you enroll in Original Medicare in NC, you have some options.

You can choose to stick with Original Medicare coverage and add a separate Part D coverage (and Medigap, if you wish). Another option is to switch to a Medicare Advantage plan. A GoHeath licensed insurance agent can help you understand your options and get the correct Part C or Part D plan.

When to Enroll in Medicare

The best time to enroll in Medicare is just before you turn 65. You’ll automatically enter a seven-month Initial Enrollment Period (IEP) where you can enroll in the Original Medicare and then find additional coverage. Your IEP starts three months before the month you turn 65, and extends until 3 months after turning 65. For example, if your 65th birthday is in August:

• Your IEP starts in May.
• Your IEP ends in November.

Original Medicare is federally run, and these plans have fixed costs.

Medicare Part A is free for most people. If you worked for more than 10 years (40 quarters) and paid Medicare taxes, you qualify for premium-free Part A. Otherwise, the cost of Medicare Part A is $278 (if you worked 30 to 39 quarters) or $506 (fewer than 30 quarters) per month in 2023.

Medicare Part B also has standard premiums. You can expect to pay $164.90 per month for Part B coverage in 2023. Along with monthly premiums, you will also need to think about deductibles, coinsurance, and copayments.

Medicare Advantage plans work a bit differently. Private insurance companies offer these plans, and they set their rates. This means you can shop around to find a plan with the right price tag. Part C plans often provide more affordable coverage for the same services, and you’ll get the added benefit of a local plan that’s tailored to your needs.

Connect with a GoHealth insurance agent to find out more about the Medicare Advantage plans in your county and ask about plan premiums and costs.

Most Medicare Advantage plans in NC offer prescription drug coverage. But it’s not a federal requirement! Before enrolling in a Medicare Advantage plan, take the time to find out exactly what’s covered and what’s not. All Medicare Advantage plans must offer the same coverage as Original Medicare. But additional benefits are set by each insurance provider.

A GoHealth licensed insurance agent can help you explore plans in your area and find a plan with the right medication coverage.