When you turn age 65, you’re eligible for health insurance from the federal government through Medicare. Medicare plans in North Carolina include:
- Original Medicare (parts A and B)
- Medicare Advantage (Part C)
- Prescription drug plans (Part D)
- Medicare supplement insurance (Medigap)
Read on to learn more about Medicare options in North Carolina and tips to help you choose the plan that’s right for you.
Original Medicare includes Medicare parts A and B.
Part A is available to anyone age 65 and older. You can also qualify if are under 65 and:
- receive Social Security Disability Insurance (SSDI)
- receive Railroad Retirement Board benefits
- have end stage renal disease (ESRD)
- are the recipient of a kidney transplant
- have amyotrophic lateral sclerosis (ALS)
Most people don’t need to pay a premium for Part A, but if you don’t meet the qualifications for premium-free coverage, you can still get coverage by paying a premium.
Part A covers:
- inpatient hospital care
- limited care in skilled nursing facilities
- limited home health care
- hospice care
Part B is also available to anyone eligible for Medicare. There is a monthly premium to pay for Part B coverage.
Part B covers:
- doctor’s visits
- preventive care
- laboratory and imaging services
- outpatient treatments
- durable medical equipment
Part D provides coverage for prescription drugs. It’s not automatically included with original Medicare and must be purchased through a private insurance carrier.
Many Medicare Advantage plans include Part D, but not all of them do, so read the plan documents carefully.
Medicare supplement insurance (Medigap)
Under original Medicare, you will owe deductibles for hospital stays and other outpatient care. Medigap cover gaps in original Medicare to help pay deductibles, copays, coinsurance, and other out-of-pocket costs.
These plans are offered through private insurance companies. Coverage and premiums vary, so review the plan documents carefully before signing up.
Medicare Advantage (Part C)plans are offered through private insurance carriers that contract with Medicare. They bundle coverage for parts A and B, and sometimes Part D, into a single policy, and may offer additional coverage for things not included in original Medicare.
You must initially enroll in Part A to sign up for Medicare Advantage plans.
These plans cover:
- all the services in Part A
- all the services in Part B
- some include prescription drug benefits
- some include coverage for things like dental or vision
Medicare Advantage plans also have an out-of-pocket spending limit. Out-of-pocket limits for Medicare Advantage plans are $6,700, although some plans may offer even lower limits. Once you reach that limit, your plan will cover any additional costs for the year.
Medicare Advantage plans fall under five categories:
- Health Maintenance Organization (HMO). An HMO requires you to select a primary care provider (PCP) from a network of doctors and hospitals and get referrals from your PCP to see a specialist.
- Preferred Provider Organization (PPO). PPO plans offer a network of care providers and hospitals and don’t require a referral to see a specialist. Care outside the network, however, may cost more or may not be covered.
- Medicare savings accounts (MSAs). MSAs are for people with a high-deductible Medicare Advantage plan. The federal government deposits a certain amount into your account each year. These funds are tax deductible as long as you use them for qualified medical expenses.
- Private fee-for-service (PFFS). PFFS plans are private insurance plans that negotiate directly with care providers on reimbursement rates. Not all doctors or hospitals accept PFFS plans, so check if yours will before you sign up.
- Special needs plans (SNPs). SNPs are private insurance plans available to people who meet specific criteria, such as having a chronic health condition or being dual-eligible for Medicare and Medicaid.
These insurance carriers offer Medicare Advantage plans in North Carolina:
- Aetna Medicare
- Alignment Health Plan
- Blue Cross and Blue Shield of North Carolina
- Care N’ Care Insurance Company of North Carolina
- Experience Health, Inc.
- FirstMedicare Direct
- Lasso Healthcare
- Troy Medicare
Medicare Advantage plan offerings vary by county, so enter your specific ZIP code when searching for plans where you live.
You may be eligible for Medicare in North Carolina if you’ve been a U.S. citizen or resident for 5 or more years and are:
- 65 years old or older
- under age 65 and received SSDI for 24 months or Railroad Retirement Board benefits
- under age 65 and have ESRD or ALS
Unless you meet the qualifications for automatic enrollment, you need to sign up for Medicare during an enrollment period.
Initial enrollment period
You can enroll initially during a 7-month window. The window begins 3 months before your 65th birthday and continues through the month of your 65th birthday and three months after you turn 65. This is called the initial enrollment period (IEP).
If you enroll before your birthday, coverage begins in your birthday month. If you enroll the month of your birthday or during the three months following your birthday, there is a two- to three-month delay before coverage begins.
You can enroll in parts A and B online, by calling 800-772-1213, or by visiting a Social Security office.
You can also enroll in Part D during the IEP. If you don’t enroll in Part D and you don’t have other prescription drug coverage, you’ll pay a penalty fee if you decide to enroll at a later time.
General enrollment: January 1 through March 31
If you missed the initial enrollment, you can enroll at the beginning of each calendar year during the general enrollment period. Coverage doesn’t begin until July 1.
You may owe a penalty for your Part B premiums for each year that you delay enrollment unless you have a qualifying plan through an employer. Talk to your employer to learn more.
Medicare open enrollment: October 15 through December 31
During Medicare’s annual open enrollment period, you can switch between original Medicare and Medicare Advantage plans, and add, drop, or switch your Part D coverage.
Medicare Advantage open enrollment: January 1 through March 31
You can make changes to your Medicare Advantage plan during the Medicare Advantage open enrollment if you were already enrolled in one of these plans.
Special enrollment period
If you lose coverage, like after leaving a job or moving to an area that your previous plan doesn’t cover, you can enroll in Medicare during a special enrollment period. How long you have to enroll varies based on the reason you lost coverage.
Before you decide on a plan, consider whether:
- you want to enroll in original Medicare (Part A and Part B)
- you want additional coverage or convenience from a Medicare Advantage plan
- you need a Medigap plan to help with deductibles, copays, and coinsurance costs
- you need to add Part D prescription drug coverage to original Medicare or a Medicare Advantage plan
There are specific times when you can sign up, so pay close attention to the enrollment windows to avoid missing them.
If you have questions about Medicare North Carolina enrollment and available plans, you can contact:
- NCDOI Seniors Health Insurance Information Program, or SHIIP (855-408-1212)
- NC 2-1-1 information online or by calling 2-1-1
- Medicare.gov or 800-MEDICARE
If you need help paying for Medicare, you can also reach out to:
To take the next steps to enroll in Medicare, take care to:
- Review available plan types and decide whether original Medicare or a Medicare Advantage plan is right for you.
- Contact SHIIP to get any questions you have answered.
- Mark enrollment dates on your calendar so you don’t miss the deadline.
This article was updated on October 2, 2020 to reflect 2021 Medicare information.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.