When you turn age 65, you’re eligible for health insurance from the federal government through Medicare. Some Medicare options are sold by private insurance companies as well.
Read on to learn more about Medicare options in North Carolina and tips to help you choose the plan that’s right for you.
The Centers for Medicare & Medicaid Services (CMS) reported the following information on Medicare trends in North Carolina for the 2021 plan year:
- As of September 2020, there were 2,029,697 North Carolina residents enrolled in Medicare.
- The average Medicare Advantage monthly premium increased/decreased in North Carolina compared to last year decreased from $18.25 in 2020 to $17.47 in 2021.
- There are 126 Medicare Advantage plans available in North Carolina for 2021, up from 112 plans in 2020.
- All North Carolina residents enrolled in Medicare have the option to buy a Medicare Advantage plan, including plans with $0 premiums.
- There are 31 stand-alone Medicare Part D plans offered to Medicare enrollees in North Carolina for 2021, compared to 28 plans in 2020.
- All North Carolina residents with a stand-alone Part D plan have access to a plan with a lower monthly premium than they paid in 2020.
- There are 12 different Medigap plans offered in North Carolina for 2021.
Medicare includes many options for coverage. Original Medicare is offered by the federal government and includes both hospitalization and medical coverage. You can purchase other options to help cover your prescription drugs and other medical and health services.
Here is an overview of the parts of Medicare and what they may cover.
Original Medicare includes two parts, A and B.
Part A covers:
- inpatient hospital care
- limited care in skilled nursing facilities
- limited home healthcare
- hospice care
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 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
Read on for more information about Medicare Advantage.
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.
Medicare Advantage plans also have an out-of-pocket spending limit. In 2021, 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.
Insurance carriers that offer Medicare Advantage plans in North Carolina in 2021 include:
- 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.
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.
There are over 50 companies offering Medigap plans in North Carolina in 2021. You can use the Medicare find a plan tool to discover what companies offer plans in your area.
Unless you meet the qualifications for automatic enrollment, you need to sign up for Medicare during an enrollment period. These enrollment periods include:
You can enroll in parts A and B online, by calling 800-772-1213, or by visiting a Social Security office.
- Initial enrollment period (IEP). This 7-month window begins 3 months before your 65th birthday and continues through the month of your 65th birthday and three months after you turn 65. If you enroll before your birthday, coverage begins in your birthday month. If you enroll during the month of your birthday or the three months following, there is a two- to three-month delay before coverage begins.
- General enrollment (January 1–March 31). If you missed your IEP, you can enroll at the beginning of each calendar year during the general enrollment period. Your coverage begins on July 1.
- Medicare Advantage open enrollment (January 1–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.
- Medicare open enrollment (October 15-–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.
- 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.
You can enroll in Part D during your IEP. If you don’t enroll in Part D during your IEP, and you don’t have other prescription drug coverage, you’ll pay a penalty fee if you decide to enroll at a later time.
Tips for enrolling in Medicare in North Carolina
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:
- Medicare-Aid (apply online) or call 888-245-0179
- Extra Help Program for assistance with Medicare and prescription drug costs
What should I do next?
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.
- Over 2 million people in North Carolina were enrolled in Medicare in 2020.
- There are over 50 private insurance companies offering various types of Medicare Advantage and Medigap plans in North Carolina in 2021.
- Overall, monthly premium costs have decreased for 2021 Medicare Advantage plans in North Carolina.