Medicare in North Carolina
Key Takeaways
Medicare is a federal health insurance program open to all North Carolinians age 65 and older who are U.S. citizens.
Original Medicare in North Carolina offers coverage for hospital stays and doctors visits. Drug and supplemental coverage also is an option.
Medicare Advantage in North Carolina is another way to get Part A and Part B while also offering things like dental and vision coverage.
Thanks to the Wright Brothers and Michael Jordan, the state of North Carolina is “First in Flight.”
Manning the first motorized airplane or leaping skyward against basketball’s giants can be hazardous to your health. GoHealth is here to serve the health concerns of all North Carolinians.
Find a local Medicare plan that fits your needs
Who is Eligible for Medicare in NC?
Any U.S. citizen age 65 or older that calls North Carolina home is eligible to enroll in the federal Medicare healthcare insurance program. Some people under 65 also may qualify for Medicare in NC:
- Residents who have received 24 months of Social Security Disability Insurance payments or Railroad Board benefits payments are eligible.
- Residents with End Stage Renal Disease or with Lou Gehrig’s disease (also known as ALS) are eligible.
How Much Does Medicare Cost in North Carolina?
While most Medicare offerings have different options with differing costs, Parts A and B are the starting point and have some set costs.
- Part A, commonly called “hospital insurance”, doesn’t have a monthly premium for anyone who has worked at least 10 years.
- Part B, commonly called “medical insurance,” has a monthly premium of $170.10 for 2022.
While Part A and Part B premiums are set, there are scenarios where you may pay less or on rare occasions more for Medicare in NC based on your income.
Other Medicare offerings have varying costs, including:
- Part D, the name given to drug coverage provided by private insurance companies aligned with federal guidelines for Original Medicare beneficiaries.
- Medigap, the name given to supplemental insurance provided by private insurance companies for Original Medicare beneficiaries.
- Medicare Advantage, also known as Part C, offered by private insurance companies that replaces Original Medicare, bundles drug and supplemental coverage and offers additional coverage like dental and vision.
Are you eligible for cost-saving Medicare subsidies?
How do I Apply for Medicare in North Carolina?
Your choices for applying for Medicare in North Carolina include:
- Enrolling online with the Social Security Administration.
- Visiting a local Social Security office.
- Enrolling over the phone at 1-800-772-1213 (TTY: 1-800-325-0778).
If you are receiving Social Security benefits before you turn 65, you may be automatically enrolled in Original Medicare. If not, you have to apply for enrollment. Your first chance to sign up is during your Initial Enrollment Period, which is a seven-month window that begins three months before the month of your 65th birthday.
Does North Carolina have Free Healthcare?
Each state determines how to administer its Medicaid, a federal/state program to help those in financial need with their healthcare costs regardless of age. North Carolina, for example, has a program that allows some people over the state’s income limit for Medicaid to still participate while being responsible for a Medicaid deductible.
The North Carolina Department of Health and Human Services has an online tool to help North Carolinians determine if a financial assistance program may be an option for them.
What extra benefits and savings do you qualify for?
What do the Different Medicare Plans Cover?
Medicare plans in North Carolina help reduce your out-of-pocket costs for hospital stays (Part A) and doctors visits (Part B). You can choose to add a Part D plan to help with prescription costs. Medicare Advantage in North Carolina (Part C) can replace Original Medicare to bundle Parts A, B and D coverages.
All Medicare in NC must offer certain coverages. The 10 Essential Health Benefits are:
1. Outpatient care
2. Emergency service
3. Maternity and newborn care
4. Prescription drugs
5. Pediatric services
6. Laboratory services
7. Rehabilitation and habilitation services
8. Mental health and substance abuse
9. Preventive or wellness services
10. Hospitalization
Are Medicare Advantage Plans Good in All States?
Medicare Advantage plans can offer more benefits than Original Medicare, often with more affordable premiums. The other side of the coin is that while Original Medicare can be used in all states, most Medicare Advantage plans feature a regional network of providers.
But, with an abundance of Medicare Advantage plans available, there’s a good chance that a plan features doctors that you already use. A GoHealth licensed insurance agent can find a Medicare Advantage plan that fits your needs and can check to see if your doctor(s) is in-network.
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Medicare in North Carolina by the Numbers
Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 1,968,785 people are enrolled in Medicare Part A and B in North Carolina. The total number of beneficiaries enrolled in Medicare Advantage Increased from 780,169 to 867,337 year over year. Medicare Advantage participation in North Carolina went from 40.68% to 44.05% year over year. If you’d like to dive deeper into how Medicare in North Carolina breaks down across the state, we provide a glance at who is using Medicare and how.
Medicare
North Carolina
1,968,785 Beneficiaries with Part A & Part B
867,337 Medicare Advantage Beneficiaries
44.05% Meducare Advantage Participation Rate
54.31% Female
45.69% Male
77.81% Non-Hispanic White
16.50% African American
1.76% Hispanic
3.93% Other/Unknown
17.15% Eligible for Medicaid
1 Average HCC Score
$9,791.42 Actual Per Capita Costs
17.58% Hospital Readmission Rate
27.22% of Beneficiaries with an Emergency Department Visit
780,169 Medicare Advantage Beneficiaries, Previous Year
Increased Medicare Advantage, Year over year
40.68% Meducare Advantage Participation Rate, Previous Year
See more +
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.
North Carolina Medicare Resources & Contacts
Beneficiaries spend an average of $9,791.42 each year on Medicare in North Carolina. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which North Carolina-based resources, like these, may be able to help:
1-855-408-1212
http://www.ncshiip.com/What should I know about the North Carolina Department of Insurance?
Residents can get Medicare advice from the department’s Medicare and Seniors’ Health Insurance Program.
1-888-245-0179
Phone lines open M-F, 8 a.m. to 5 p.m.
What should I know about North Carolina Medicaid?
Provides answers to your questions about policies and procedures related to the federal Medicaid program in North Carolina.
1-919-855-4800
COVID-19 questions: call 2-1-1 or 1-888-892-1162
What should I know about the North Carolina Department of Health and Human Services?
Department’s initiatives include empowering residents with tools that lead to healthy lives.
1-844-624-8387
Fax: 1-984-204-8343
What should I know about the North Carolina Department of Military & Veterans Affairs?
Organization has a team devoted to making sure veterans’ needs are met related to benefits.
Nationwide Resources
GoHealth
Speak with an insurance agent that is licensed in North Carolina about your Medicare questions.
1-855-792-0088 TTY: 711
Mon-Fri, 7am-6pm CT
Centers for Medicare and Medicaid Services
If you have general questions about Medicare in NC, or need help with current Medicare benefits.
Social Security Administration
You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.
Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online
Medicare Learning Guides
Healthcare is personal. So is choosing insurance. 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
Medicare guide
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare guide
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Medicare guide
Low Income and Medicare Guide
For individuals with a qualifying income status
Medicare guide
A Caregiver’s Guide
For individuals with a qualifying income status
