Medicare in North Carolina

Resources for North Carolina Medicare Beneficiaries 

Do you have questions regarding the many parts of Medicare, the enrollment processes and applications, or selecting a Medicare plan? Explore our resources to learn more about Medicare’s components, enrollment, or Medicare plan selection advice. 

Medicare Basics         Choosing the Right Medicare Plan         Enrolling in Medicare

When making decisions about Medicare, most can benefit from a bit of advice. As a resident of North Carolina, you have a variety of resources available to you, such as the State Health Insurance Program (SHIP), also known as the Seniors’ Health Insurance Information Program in NC (SHIIP). To help assist people in North Carolina with Medicare information, SHIIP has counselors located all across the state who work with regional nonprofits, public health organizations, and Area Agencies on Aging (AAAs) unique to your county. 

Medicare Plan Options in North Carolina  

There are various Medicare options available to residents of North Carolina. You can apply for Original Medicare if you are at least 65 years old or have a disability and are eligible for Medicare. A Medicare Advantage plan with a variety of options in North Carolina can be a better choice if you prefer more extensive coverage. Prescription drug plans and Medicare Supplement Insurance are both examples of other Medicare plan possibilities. 

Original Medicare (Parts A & B)  

Let’s talk Original Medicare. Medicare Part A covers hospitalization costs, while Part B covers services like outpatient care, lab tests, and preventative services like cancer screenings, flu vaccines, and annual wellness checkups. The deductibles for services covered by Medicare Part A and Part B are separate. For instance, before Original Medicare begins to pay for services if you are admitted to the hospital, there is a Part A inpatient hospital deductible per benefit period (each time you are admitted), whereas you must meet the Part B annual deductible for any services.  

Things to think about if you plan to stick with Original Medicare: 

• You need the flexibility to see any doctor in the country who accepts Medicare. 
• There are no restrictions due to the presence of pre-existing conditions, no waiting periods, no copayments, and no networks.  

Medicare Advantage (Part C)  

Medicare Part C, also known as Medicare Advantage plans, is a private insurance company-provided alternative to Original Medicare coverage. These plans cover, at a minimum, what Medicare Parts A and B would, and they frequently include additional benefits. Most services are administered by a network of providers, which may require you to have a primary care physician, a referral to see a specialist, and prior approval for certain services, treatments, and medications, similar to how a Health Maintenance Organization (HMO) plan functions. Other insurance products available include Preferred Provider Organization (PPO), Health maintenance Organization-Point of Service (HMO-POS) this is a hybrid model of an HMO and a PPO plan, and a Private Fee for Service (PFFS) plan. 

Explore our Medicare Part C Resource Page to learn more about Medicare Advantage. 

Medicare Prescription Drug Plan (Part D)  

Medicare-approved private insurance companies cover Medicare Part D. A pre-selected list of covered prescriptions may have an annual deductible, copay, or coinsurance, depending on the plan. Many Medicare Advantage plans already include Part D drug coverage. But if you aren’t a Medicare Advantage beneficiary, you can always add a stand-alone PDP to Original Medicare or Medicare Supplement Insurance. 

Medicare Supplement Insurance (Medigap)  

Some North Carolina residents who are Medicare-eligible buy Medigap, which is also called Medicare Supplement Insurance. The goal of these plans is to help pay for what Original Medicare doesn’t. Some of these gaps include coverage for medical care outside of the U.S., Medicare Parts A & B deductibles, and coinsurance depending on the plan selected. 

Furthermore, the North Carolina Department of Insurance (NCDOI) provides guidance on how Medicare Supplement Insurance coverage can offset out-of-pocket costs because Original Medicare does not cover all of your medical bills. 

Just note, you can’t have both a Medicare Advantage Plan and a Medigap policy at the same time. If you already have a Medicare Advantage plan and want to buy a Medigap policy, the start date of your Medigap policy should start the day after the end date of your Medicare Advantage plan.  

Medicaid 

Medicaid is a public insurance program that has been around since 1965, and both the state and federal governments both pay for it. In line with federal rules, each state runs its own Medicaid program. The federal regulations are quite broad, so states have a lot of room to make and run their own programs. Medicaid eligibility and benefits can and often do vary from one state to the next. Medicaid was designed to help people who qualify with low incomes get access to health care, including children, parents, pregnant women, older people, and people with disabilities. 

How and when to sign up for Medicare in North Carolina

When reaching the age of 65, the vast majority of Americans are eligible to join Medicare. The following criteria also make someone eligible for Medicare: 

• You are under the age of 65, permanently disabled, and have been receiving disability benefits from the Railroad Retirement Board or Social Security for at least 24 months. 
• Been diagnosed with End-Stage Renal Disease (ESRD). 
• Been diagnosed with Lou Gehrig’s disease, also known as Amyotrophic Lateral Sclerosis (ALS).

Medicare Advantage Enrollment Periods in North Carolina and nationwide  

Here is a quick overview of the Medicare enrollment periods in which you can elect or change your Medicare Advantage plan.  

Tar Heelers, never fear. We’re almost done. At Healthpilot, we know that figuring out Medicare can be tricky and that adding deadlines for enrollment can add to the stress. 

Want some good news? We would be more than happy to do the hard work for you. After you respond to a few questions, we will offer the best plan based on your healthcare needs and lifestyle. You may even quickly and safely enroll online. 

As long as you are a Healthpilot customer, we can take care of this for you each and every year. Update your profile with any healthcare and/or prescription changes and we will provide you an updated recommendation to verify which plan best meets your needs. Easy! Enrollment windows don’t need to be committed to memory when Healthpilot is on your side. 

Visit our resource center’s Enrollment Periods Page for more details on Original Medicare and Medicare Supplement Insurance enrollment periods.

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Key Stats

Some interesting facts about Medicare coverage in North Carolina:   

• 2,035,577 people in North Carolina are on Medicare. This makes the coverage rate 19%, which is the same as the national average. 
• About 48% of Medicare customers in North Carolina are enrolled in a private Medicare Advantage program, beating the national average of 45%. 
• In 2023, North Carolina will have 150 Medicare Advantage plans, up from 142 plans in 2022. This is an increase of 5.6% in the number of plans available. 
• $4.20 is the lowest monthly premium for a North Carolinian stand-alone Medicare Part D plan. 
• And since we promised you a fun fact about NC: The North Carolina Outer Banks is called the “Graveyard of the Atlantic” and is where Pirate Blackbeard died. 

Excited to see your recommended Medicare plan? Heck yes, you are.

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