Medicare Advantage Plans in North Carolina
Key Takeaways
Medicare Advantage plans in North Carolina offer extensive healthcare benefits. This includes hospital and medical coverage, as well as dental and vision benefits.
U.S. citizens over 65 can enroll in Medicare. Adults under 65 can also qualify for Medicare if they’re receiving Social Security disability benefits.
The cost of Medicare plans in NC depends on federally mandated costs and what plan you choose.
Over 2 million North Carolinians are enrolled in Medicare, and many choose to sign up for one of the more than 163 different Medicare Advantage plans that are available in the state. Plans vary by ZIP code, so it’s important to explore your options. Let’s delve into some of the choices you can consider as you seek health coverage that helps you achieve greater wellness and peace of mind.
Medicare Plans in North Carolina
If you’re getting ready to enroll in Medicare for the first time or considering switching plans, you have many options. Your journey starts with signing up for Original Medicare, also known as Parts A and B, and exploring your options for accessing Part D prescription drug benefits.
Medicare Part A
Medicare Part A provides you with coverage for inpatient hospital stays as well as skilled nursing facility care and hospice care.
Medicare Part B
Medicare Part B covers medical services, preventative care, durable medical equipment, ambulance services, and some mental health services.
Medicare Part D
Medicare Part D plans are offered through private insurance carriers to cover prescription medications. 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 called a formulary, so you should make sure your drugs are included.
You can choose to enroll in Medicare Parts A and B and add a Part D plan. But there’s another option to consider.
North Carolina Medicare Advantage Plan Coverage
Medicare Advantage plans, also called Medicare Part C, must offer the same coverage as Medicare Parts A and B. The difference is that Medicare Part C are private insurance plans that may offer additional benefits like vision, dental, and hearing coverage. Every Medicare beneficiary in North Carolina has access to at least one Part C plan, but there are different ones available in each county.
Medicare Advantage substitutes for Original Medicare (Parts A and B) and bundles benefits in one plan. Most plans also feature Part D prescription drug coverage, and all put a cap on out-of-pocket spending, often with lower copays. However, keep in mind that you’ll need to access care with in-network providers to make full use of your coverage.
Medicare Advantage Plan Eligibility and Enrollment in North Carolina
U.S. citizens or permanent residents who are 65 and older are eligible for Medicare Advantage in North Carolina.
Adults younger than 65 are sometimes eligible for Medicare as well if they receive Social Security disability benefits or have a qualifying condition. For example, adults with end-stage renal disease or ALS are eligible for Medicare.
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 three months after turning 65. For example, if your 65th birthday is in August:
- Your IEP starts in May.
- Your IEP ends in November.
NC Medicare Advantage Plan Costs
Original Medicare is federally run, and these plans have fixed costs.
Most people do not need to pay monthly premiums for Medicare Part A. If you or your spouse worked for more than 10 years (40 quarters) and paid Medicare taxes, you qualify for premium-free Part A.
Medicare Part B has standard premiums. You can expect to pay $174.70 per month for Part B coverage in 2024. Along with monthly premiums, you will also need to think about deductibles, coinsurance, and copayments.
If you choose a Medicare Advantage plan, you’ll still be responsible for your Part B premiums, though some plans can help with these costs. As of 2024, the average monthly premium for a Part C plan in North Carolina is $17.10. Everyone in the state on Medicare has a plan option with a $0 monthly premium.
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.
Are There North Carolina Medicare Advantage Plans with Prescription Drug Coverage?
Most Medicare Advantage plans 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.
Medicare Learning Guides
If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you!
Medicare guide
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
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Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
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Medicare Beneficiary Guide
For those currently enrolled in Medicare
Medicare guide
Low Income and Medicare Guide
For individuals with a qualifying income status
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A Caregiver’s Guide
For individuals with a qualifying income status
