Out of 10 million North Carolina residents, about 2.1 million leverage Medicare plans to lower out-of-pocket hospital bills.
Medicare is a well-established fee-for-service health insurance program based in the US. The federal government manages Medicare, and the Federal Insurance Contributions Act funds it.
Medicare plans are designed to meet the ever-growing healthcare needs of senior adults aged 65 and above, those with certain disabilities, and people with end-stage renal disease (ESRD).
Since 19.60% of the population makes use of Medicare plans, it is vital to look into the various plans available in the region. Medicare beneficiaries in North Carolina can enroll themselves in Medicare Advantage plans to access additional benefits.
Medicare features different plans that vary from State to State. Let’s examine the available plans in North Carolina and how they benefit residents.
Medicare Advantage Plans in North Carolina
The State of North Carolina, with more than ten million residents, is home to 1.8 million people aged 65 and above. Since North Carolina’s life expectancy is 76, resources such as Medicare are vital for accommodating senior adults.
Increasing medical needs with age are inevitable. As senior adults approach the age of 65, managing healthcare costs becomes challenging. In addition to this, the annual price increments for prescription drugs, medical equipment, and utilities have made it difficult to seek routine checkups in the State.
These factors make services such as Medicare necessary in the region to lower expenses for inpatient and outpatient care. Recently, Medicare Advantage plans, also known as Part C, have gained popularity in North Carolina, with over 52% of Medicare beneficiaries having Medicare Advantage.
Medicare Advantage plans consolidate the benefits of Medicare Part A and B with supplemental benefits, including hearing, vision, and dental care. Hence, these plans work as bundled coverage for all your healthcare needs.
In 2022, North Carolina had 142 plans, which increased to 150 by 2023. As of 2024, North Carolina is served by a total of 163 Medicare Advantage plans. Medicare Advantage plans in North Carolina cost an average of $17.10 per month.
As there are numerous Medicare Advantage plans available in the State, you should look into the benefits each plan offers and the premiums, costs, and deductibles associated with it to choose the right plan for yourself.
Medicare Advantage Networks
The Medicare Advantage plans in North Carolina feature networks available in certain areas of the State. Each plan option is based on a ZIP code. These plans have varying copayments, premiums, and deductibles.
However, the standard plan starts at $0 premium. Every Medicare-eligible person in North Carolina has access to this $0 premium Medicare plan.
Since Medicare Advantage plans consist of networks, they have one restriction—a limited choice of healthcare providers. Medicare Advantage plans have contracts with certain healthcare professionals and hospitals. Due to this, beneficiaries cannot seek treatment outside of the network of choice.
If they want to consult a physician outside their network, they must have pre-authorization or a referral from their primary healthcare provider.
General Analysis | Ratings of Medicare Plan Providers in North Carolina
| Insurance Company | Medicare Rating | A.M. Best Rating | Better Business Bureau (BBB) Rating | J.D. Power Ranking |
| Aetna | 4 stars | A+ | A+ | 6th out of 9 |
| Anthem Blue Cross Blue Shield | 4 to 4.5 stars | A+ | A+ | 5th out of 9 |
| Humana | 4 stars | A- | A+ | 2nd out of 9 |
| UnitedHealthcare | 3.5 stars | A- | A- | 4th out of 9 |
Types of Medicare Advantage Plans
The State of North Carolina has four types of Medicare Advantage plans. You can enroll in any of the following plans depending on your healthcare needs.
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Special Needs Plans (SNPs)
- Private Fee-For-Service Plans (PFFS)
Let us look into the details of these Medicare Advantage plans to help you make an informed decision.
Health Maintenance Organizations (HMOs)
An in-network provider, typically called an HMO, is an approved healthcare expert within the plan’s network.
In an HMO plan, beneficiaries receive care from a doctor, healthcare physician, or hospital within their network of choice.
In emergencies, beneficiaries require pre-authorization or referral from their primary healthcare provider to consult another specialist outside their network. HMO plans mostly include prescription drug coverage.
Preferred Provider Organizations (PPOs)
PPO, another type of Medicare Advantage plan, allows you to receive medical care from both in-network and out-of-network providers.
However, seeking out-of-network care typically costs more than your standard plan. This plan doesn’t restrict you to your primary care doctor.
You also don’t require a referral from your primary care physician to consult physicians outside your network. However, you incur relatively lower costs for medical experts and hospitals within the plan’s network.
Special Needs Plans (SNPs)
SNPs are ideal for beneficiaries with specific diseases who require specialized healthcare. Individuals with chronic conditions, living in nursing homes, or those who have both Medicaid and Medicare receive tailored benefits.
Generally, beneficiaries are limited to the plan’s network of providers. Pre-authorization is required to consult physicians outside the network. SNPs also include prescription drug coverage.
Private Fee-For-Service Plans (PFFS)
PFFS allows you to consult any Medicare-approved provider within North Carolina. Hence, you’re not obligated to see a specific healthcare expert. Thus, PFFS plans work the same as Original Medicare, but you can visit any doctor at any hospital if they agree with the plan’s payment terms and conditions. These plans have fewer restrictions.
However, this plan establishes the pay rate for the doctor, the hospital, and the healthcare provider, as well as your out-of-pocket expense for the care you receive.
In some PFFS, you have a network of providers where you incur lower costs. However, your plan may not always have prescription drug coverage.
Comparison of the Top-Rated Medicare Advantage Plans in North Carolina
As of 2024, the following are the best Medicare Advantage plans in North Carolina. Here’s a comparison.
| Medicare Advantage insurance company | Medicare rating | A.M. Best rating | Better Business Bureau (BBB) rating | J.D. Power ranking |
| Aetna | 3.9 stars | A | A+ | 6th out of 9 |
| Blue Cross Blue Shield | 3.9 stars | A | B | 5th out of 9 |
| Humana | 4.2 stars | A- | A+ | 2nd out of 9 |
| United Healthcare | 4.2 stars | A | Not rated | 4th out of 9 |
| WellCare Healthcare | 3.7 stars | Not rated | A- | Not ranked in the top 9 |
Benefits of Medicare Advantage Plans in North Carolina
Medicare Advantage plans provide a range of additional benefits with your standard coverage options.
These benefits include coverage for wellness programs, hearing services, dental care, vision care, transportation services, meal accommodation, telehealth services, OTC benefits, chronic condition management, etc. Hence, Medicare Advantage plans work as a bundled coverage option for beneficiaries seeking an all-in-one solution.
Since North Carolina has about 160 Medicare Advantage plans, it’s crucial to look into the supplemental benefits your plan of choice offers before enrolling yourself to choose the best available health coverage in your region.
Here are the common benefits offered to North Carolina residents with Medicare Advantage plans.
Hospital and Medical Insurance
Medicare Advantage plans in North Carolina combine hospital and medical insurance, providing the same coverage as Original Medicare Parts A and B. This ensures that you receive primary coverage with your healthcare services.
Prescription Drug Coverage (Part D)
Most Medicare Advantage plans include prescription drug coverage to lower the out-of-pocket costs of prescription medications. Therefore, in most cases, you don’t require additional prescription drug coverage with a Medicare Advantage plan in North Carolina.
Dental Care
Medicare Advantage plans also offer preventive dental services, including routine checkups, scaling, and medically deemed necessary dental procedures.
Vision Care
Comprehensive Medicare Advantage plans also provide coverage for routine eye examinations, eyeglasses, and contact lenses, promoting better eye health.
Hearing Services
Some Medicare Advantage plans offer coverage for hearing exams. These plans typically cover hearing aids and other necessary equipment.
Wellness Programs
Many Medicare Advantage plans include wellness programs, such as gym memberships, fitness classes, and yoga classes, with the primary aim of bettering beneficiaries. Such plans help older adults achieve a healthy lifestyle and combat healthcare problems that arise from a lack of fitness.
Transportation Services
Various Medicare Advantage plans offer assistance with transportation services. These plans ensure you access medical care at facilities more conveniently since you don’t have to worry about transportation to and from a hospital.
Over-the-Counter Benefits
OTC benefits allow beneficiaries to purchase over-the-counter items, non-prescription medications, drugs, and health-related products.
Chronic Condition Management
Chronic condition management includes specialized care for individuals with long-term health problems. Medicare Advantage plans with this benefit are ideal for individuals who require comprehensive healthcare. However, such plans may have a higher premium.
Cost of Medicare Advantage Plans in North Carolina
As of 2024, the average monthly premium for a Medicare Advantage plan in North Carolina is $17. However, some Medicare Advantage plans require you to pay out-of-pocket premiums, deductibles, copayments, and coinsurance for certain additional benefits.
These costs may vary from provider to provider. Therefore, you must familiarize yourself with deductibles, copayments, and coinsurance to avoid higher out-of-pocket premiums.
- Deductibles are expenses that you cover before Medicare provides coverage for health services. Thus, deductibles apply to all Medicare plans, including the standard Original Medicare.
- A copayment is a fixed payment for a doctor’s visit or a prescription drug. This amount is paid after you pay your deductibles, thus covering certain supplemental benefits.
- Coinsurance is a cost-sharing method in which you pay a percentage of the total amount for specific services after paying your deductibles. Your insurance plan covers the rest of the cost.
Medicare Advantage plans usually charge a copayment instead of the 20% coinsurance you pay under Original Medicare. These plans significantly vary from provider to provider and plan to plan. Therefore, it is best to look into your plan’s requirements before signing up.
Medicare Eligibility and Enrollment in North Carolina
What makes you eligible for Medicare in North Carolina, and how can you enroll? Medicare has the same eligibility criteria across all the States. You qualify for Medicare if:
- You are 65 years old or above
- You have a medical disability
- You have end-stage renal disease (ESRD)
- You have amyotrophic lateral sclerosis (ALS)
You also require approval from the Social Security Administration for your age or disability, as it is an essential prerequisite to qualify for Medicare.
Enrolment Period in North Carolina
You can enroll in a Medicare plan during the initial enrollment period or wait until the general enrollment period.
However, if you have been receiving your Social Security benefits four months before your 65th birthday, you will automatically get enrolled into Medicare. Otherwise, you must apply through mail or by contacting a local Social Security office.
Medicare has an initial enrolment period (IEP) and a general enrolment period (GEP). The initial enrollment period is 7 months, starting 3 months before your 65th birthday.
However, if you miss your IEP, you can access Medicare by applying for it during the general enrollment period (GEP) between January 1st and March 31st every year.
Why Is Medicare Vital for North Carolina Residents?
About 18% of the population in North Carolina is aged 65 and above. This emphasizes the importance of healthcare plans such as Medicare to provide senior adults with comprehensive medical coverage.
The State’s subtropical and humid climate proliferates diseases in the region, which can complicate matters for immunosuppressed older adults.
Diseases such as pneumonia and influenza are common in North Carolina. Seasonal changes in the region also cause respiratory diseases such as asthma, allergies, COPD, etc. If these diseases are aggravated in older adults, they cause numerous health risks.
Regular healthcare services, such as Medicare facilities, are vital to lowering the costs associated with routine checkups.
These plans provide extensive coverage for both inpatient and outpatient care. Therefore, Medicare Advantage plans in North Carolina are vital for providing comprehensive coverage that goes beyond the basic provisions of Original Medicare.
This holistic healthcare approach lowers hospital bills and enhances the quality of life for senior adults residing in the State.
Resources for Medicare in North Carolina
Several organizations in North Carolina provide counseling and guidance to senior adults. These organizations have licensed advisors or volunteers to provide information regarding Medicare plans to effectively resolve Medicare queries for senior adults.
| Organization | How you can get help | Website & Contact Info |
| North Carolina Senior Law Project | The North Carolina Senior Law Project supports Legal Aid of North Carolina, which assists senior adults aged 60 and older with their Medicare applications. Their legal experts can help seniors sort out problems with bills and rejected claims. | Website | (877) 579-7562 |
| North Carolina Department of Insurance | The North Carolina Department of Insurance regulates health insurance, ensuring applicants get fair coverage. | Website | (855) 408-1212 |
| Medicare and Seniors’ Health Insurance Information Program (SHIIP) | The North Carolina Medicare and Seniors’ Health Insurance Information Program (SHIIP) aims to connect senior residents with industry experts to help resolve Medicare queries. This program provides counseling and guidance for various Medicare programs. Seniors can opt for in-person or on-call counseling. | Website | (855) 408-1212 |
| North Carolina Area Agencies on Aging | There are 16 Area Agencies on Aging in North Carolina, providing free Medicare assistance to local seniors aged 60 and above. Any of the offices can connect North Carolina residents to a SHIIP counselor for confidential, unbiased health insurance guidance. | Website | (800) 662-7030 |
Secure Your Health in the State of North Carolina With Silveredge
Healthcare insurance programs such as Medicare aim to lower hospital bills for senior adults in North Carolina. This service is essential not only due to its numerous benefits but also because of its cost-efficient plans.
Medicare Advantage plans can provide long-term surety for senior adults by safeguarding their health and peace of mind.
With Medicare plans, routine checkups at medical facilities don’t cost you a fortune. Therefore, you and your loved ones must look into the available plans in your region to make informed healthcare decisions.
For first-time applicants, it’s crucial to know that you can only sign up for Medicare during the open enrollment period or general enrollment period. You can streamline the application process by seeking professional advice from licensed advisors at Silveredge.
Our advisors can also help you compare different Medicare Advantage plans in North Carolina to help you enroll in a plan ideal for your needs. Take a step towards a carefree future with Silveredge!
