Medicare plays a key role in providing health and financial security to beneficiaries residing in North Carolina. With more than two million North Carolina beneficiaries enrolled in Medicare, we’ll cover some very important information below about Medicare in North Carolina. We want to help you better understand your options and make the decision-process as seamless as possible once you’re ready to enroll in Medicare or discover different coverage options.

Who Qualifies for Medicare in North Carolina?

Medicare covers most North Carolina residents who are 65 or older, and it also covers disabled North Carolina residents. In general, Medicare enrollment in North Carolina works the same way as it does in the rest of the country. If you qualify for Original Medicare, also known as Part A and Part B, it will help cover 80% of your health care costs.

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll be responsible for paying this penalty for as long as you have Part B, and you could have a gap in your health coverage.

Once you reach Medicare eligibility, you can begin choosing additional coverage options to help pay for the remaining 20% of your medical expenses through Medicare Advantage (Part C), Medigap, and/or a Medicare Prescription Drug (Part D) plan.

Who Qualifies for Medicare

North Carolina Medicare Enrollments

1,199,444

Original Medicare Plans
(Part A and B)

816,609

Medicare Advantage & Other Health Plans

782,001

Stand-alone Medicare
Part D (Drug plans)

2,016,053

Total Medicare Beneficiaries
in North Carolina

North Carolina Medicare Advantage Plans (Part C)

More than 37% of North Carolina Medicare beneficiaries select Medicare Advantage plans.

Medicare Advantage plans are private, Medicare-approved insurance companies. They provide all of your Original Medicare benefits and often include extra benefits such as drug, dental, and vision coverage.

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this period, Medicare beneficiaries in North Carolina who already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare.

As of 2020, 117 Medicare Advantage plans are available in North Carolina. The average monthly Medicare Advantage premium changed from $23.22 in 2019 to $19.30 in 2020. $0 is the lowest monthly premium for a Medicare Advantage plan in North Carolina.

According to the Centers for Medicare and Medicaid Services (CMS), as of May 2020, there are 816,609 beneficiaries enrolled in Medicare Advantage and other plans in North Carolina. More than 37% of North Carolina Medicare beneficiaries were enrolled in a private Medicare Advantage plan in 2019. 100% of people with Medicare have access to a Medicare Advantage plan.

Depending on your county, North Carolina Medicare beneficiaries can select from between four and 29 Medicare Advantage plans. North Carolina’s Medicare Advantage enrollment is actually very much in line with the national average.

North Carolina Medicare Supplement (Medigap) Insurance Plans

North Carolina requires insurers to sell Medigap Plan A to Medicare beneficiaries who are under age 65.

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that beneficiaries would otherwise incur if they only had Original Medicare on its own. Typically, Medigap plans are popular for those who want little to no copay when they access healthcare services.

North Carolina allows Medigap insurers to pick their own rating approach, so most plans in the state use attained-age rating. Additionally, federal rules require North Carolina Medigap insurers to offer plans on a guaranteed-issue basis during an enrollee’s open enrollment period. This open enrollment period begins when the person is at least 65 and enrolled in Medicare Part B.

However, federal rules don’t guarantee access to North Carolina Medigap plans for people under 65. Yet, North Carolina does have rules to ensure access to Medigap plans for disabled enrollees under age 65. North Carolina statute § 58-54-45 requires all Medigap insurers in the state to offer at least Plan A to people under age 65 who are enrolled in Medicare due to a disability.

North Carolina - Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t cover outpatient prescription drugs. However, Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan. Medigap plans don’t cover prescription drugs unless they’re covered under Part B.

As of May 2020, There are 782,001 Medicare beneficiaries in North Carolina enrolled in stand-alone Part D prescription drug plans and 764,852 enrolled in Medicare Advantage Prescription Drug plans. For 2020 coverage, there are 28 stand-alone Part D plans available in North Carolina, with premiums ranging from about $15 to $97 per month. About 28% of people with a stand-alone Medicare prescription drug plan get Extra Help (also called the low-income subsidy, or LIS). When deciding on a Part D plan, it’s important to evaluate several factors such as each plan’s premium, formulary, and copays since every plan is different. Learn how you can save money on your out-of-pocket costs with a Medicare Advantage, Part D, or Medigap plan, fill out this form or give us a call.

Local Medicare Health Plan Resources in North Carolina

  • Medicare and Seniors’ Health Insurance Information Program (SHIIP) provides free, unbiased guidance to help Medicare beneficiaries and caregivers understand Medicare health care products. Counselors in every county meet with seniors by appointment only. Through the NC Senior Medicare Patrol Program, counselors help seniors recognize and avoid Medicare billing errors, fraud, and abuse.
    Contact: Call 1-855-408-1212 or email ncdoi.ncshiip@ncdoi.gov.

  • Options Counseling provides guidance to individuals as they make informed choices about long-term services and supports. This service helps people think through the pros and cons of the various options while taking into consideration their situation, values, resources, and preferences. The Options Counselor can also assist with making an Action Plan for the individual to implement.
    Contact: Email Jan.Moxley@dhhs.nc.gov.

  • The Long-Term Care Ombudsman Program consists of an Office of the State Long Term Care Ombudsman and 16 Offices of the Regional Long Term Care Ombudsman that are housed in Area Agencies on Aging. Long Term Care Ombudsmen assist residents of long term care facilities in exercising their rights and attempt to resolve grievances between residents, families, and facilities. The regional ombudsmen help support the efforts of Adult Care Home and Nursing Home Community Advisory Committees.
    Contact: Email Victor.orija@dhhs.nc.gov, renee.kea@dhhs.nc.gov, or lakendra.dixon@dhhs.nc.gov.

  • North Carolina’s Area Agencies on Aging (AAAs) are offices established through the Older Americans Act that facilitate and support programs addressing the needs of older adults in a defined geographic region and support investment in their talents and interests. North Carolina AAAs are located within regional Councils of Government.
    Contact: AAAs are dispersed throughout the state of North Carolina. A list of locations and contact information can be found on their website.

The licensed agents that are partnered with Timefor65 can help you compare the availability, benefits, and costs of Medicare plans in your specific region of North Carolina. Our process makes it easier for you to access your Medicare eligibility in North Carolina so that you receive personalized, affordable, and easy-to-use coverage options and solutions. Fill out the form or give us a call at (866) 327‑0148 anytime to get a free quote or to ask any questions.

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