Call Us
Menu

Medicare in North Carolina

North Carolina residents 65 and older are eligible for affordable healthcare insurance

Reviewed by: Shikita Nunnery, Licensed Insurance Agent. Written by: Bryan Strickland.

Key Takeaways

  • Medicare is a federal health insurance program open to all North Carolinians age 65 and older who are U.S. citizens.

  • 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 doctors visits. Drug and supplemental coverage also is an option.

  • 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 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.

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:

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 $148.50 for 2021.

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.

You may benefit from this useful cost guide that includes more information. [1]

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. [2]
  • Visiting a local Social Security office. [3]
  • 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. [4]

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. [5]

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.

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 1,870,475 people are enrolled in Medicare in North Carolina. The total number of beneficiaries enrolled in Medicare Advantage in North Carolina is 709,140. The previous year, 633,257 enrolled in Medicare Advantage. Medicare Advantage participation in North Carolina went from 34.73% to 37.91% 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.

Outline of North Carolina
1,870,475
Beneficiaries with Part A & Part B
709,140
Medicare Advantage Beneficiaries
37.91%
Medicare Advantage Participation Rate
54.65%
% Female
45.35%
% Male
1
Average HCC Score
$9,641.33
Actual Per Capita Costs
20.09%
% Eligible for Medicaid
32.78%
% of Beneficiaries with an Emergency Department Visit
17.69%
Hospital Readmission Rate
76.85%
% Non-Hispanic White
17.90%
% African American
1.65%
% Hispanic
3.60%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

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 $9,641.33 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:

North Carolina Department of Insurance

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.

North Carolina Medicaid

1-888-245-0179
Phone lines open M-F, 8 a.m. to 5 p.m.

https://medicaid.ncdhhs.gov/contact

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

1-919-855-4800
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?

Department’s initiatives include empowering residents with tools that lead to healthy lives.

North Carolina Department of Military & Veterans Affairs

1-844-624-8387
Fax: 1-984-204-8343

https://www.milvets.nc.gov/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 related to benefits.

Nationwide Resources

Speak with an insurance agent that is licensed in North Carolina about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in NC, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

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

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.

Previous Next

New to Medicare Guide

Helpful information to get you started with enrolling in Medicare.

Medicare Beneficiary Guide

For those currently enrolled in Medicare.

Medicare Plans Guide

Costs, coverage and enrollment details for each Medicare plan.

Low Income & Medicare Guide

For individuals with a qualifying income status.

A Caregiver’s Guide

For those helping a loved one with Medicare.