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 or permanent residents.
- Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). in North Carolina offers coverage for hospital stays and doctor visits. Drug and supplemental coverage are also options.
- Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). in North Carolina is another way to get Part A and Part B while also offering coverage like dental and vision.
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.
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.
Find the ideal Medicare Advantage plan for you.
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 is hospital insurance and doesn’t have a monthly premium for anyone who has worked at least 10 years.
- Part B is medical insurance and has a standard monthly premium of $185 for 2025.
There are scenarios where you may pay less or more for Medicare in NC based on your income.
Other Medicare offerings have varying costs, including:
- Part D, the drug coverage provided by private insurance companies aligned with federal guidelines for Original Medicare beneficiaries.
- Medigap, the 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.
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).
Ready for a new Medicare Advantage plan?
Does North Carolina Have Free Healthcare?
Each state determines how to administer 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 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 Does Medicare 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 substitute for Original Medicare to bundle Parts A, B, and D, as well as supplemental coverage.
All Medicare in NC must offer certain coverages. These 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 whether your doctors are in network.
Get real Medicare answers and guidance – no strings attached.
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.
1,968,785 Beneficiaries with Part A & Part B
867,337 Medicare Advantage Beneficiaries
44.05% Medicare 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% Medicare Advantage Participation Rate, Previous Year
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 Department of Insurance
https://www.ncdoi.gov/consumers/medicare-and-seniors-health-insurance-information-program-shiip
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.
North Carolina Medicaid
Phone lines open M-F, 8 a.m. to 5 p.m.
https://medicaid.ncdhhs.gov/contacts
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.
North Carolina Department of Health and Human Services
COVID-19 questions: call 2-1-1 or 1-888-892-1162
https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities
What should I know about the North Carolina Department of Health and Human Services?
The department’s initiatives include empowering residents with tools to lead healthy lives.
North Carolina Department of Military & Veterans Affairs
Fax: 1-984-204-8343
https://www.milvets.nc.gov/benefits-services/benefits-claims
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.
Nationwide Resources
Speak with a GoHealth insurance agent that is licensed in North Carolina about your Medicare questions.
Mon – Fri, 8 a.m. – 6 p.m. CT
Centers for Medicare and Medicaid Services
You can reach the Social Security Administration 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
1-800-722-1213
TTY 1-800-325-0778
Speak to SSA Representative, Monday – Friday, 8 AM – 7 PM ET
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.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status
Sources
- Medicare costs at a glance. Medicare.gov.
- Apply for Benefits. SSA.gov.
- Social Security Office Locator. SSA.gov.
- What is the Medicaid Deductible? NC.gov.
- Programs & Services. NC.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.