Medicare, a well-established health insurance program based in the US, is managed by the federal government and funded by the general revenue and contributions under the Federal Insurance Contributions Act. This health insurance program provides comprehensive coverage to all US citizens, including more than 2 million North Carolina residents alone.
Eligibility for Medicare programs includes all legal US citizens aged 65 and older, individuals with certain disabilities, and those being affected by end-stage renal disease (ESRD).
North Carolina residents can enroll in Medicare through their Social Security office or through the Medicare.gov online portal.
Medicare offers extensive healthcare benefits covering a wide range of services, including inpatient and outpatient medical care. Through these services, Medicare significantly lowers out-of-pocket healthcare expenses, ensuring beneficiaries receive the right care without the burden of unmanageable hospital costs.
These health insurance programs vary from State to State. If you’re residing in North Carolina, it’s best to look into the available plans in your region to make an informed decision. Let us look into the available plans in your region and how they benefit residents.
Medicare in North Carolina
As the population continues to expand, North Carolina now boasts over 10.6 million residents. This southeastern State is home to over 1.8 million senior adults aged 65 and above, representing a whopping 17% of the total population.
With such demographics, healthcare services such as Medicare have become crucial in the region to aid senior residents in managing their healthcare expenses effectively.
Over 2.1 million North Carolina residents are enrolled in Medicare plans. More than 13% of beneficiaries are under age 65. However, they are eligible due to a disability, including end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS). Hence, 17% of the population in the region utilizes Medicare programs for cost-efficient healthcare decisions.
If you’re looking for Medicare plans in North Carolina, you have several options. Let us explore the various Medicare plans in North Carolina and what they offer to residents.
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 |
Medicare in North Carolina by the Numbers
According to the 2024 demographics, the total number of Medicare beneficiaries in each plan is as follows.
| Total number of people enrolled in Medicare | Medicare Advantage plans | Medicare Supplement Plan (Medigap) | Medicare Part D (Prescription Drug Coverage) |
| 2.1 million beneficiaries | Over 52% of North Carolina Medicare beneficiaries are enrolled in Medicare Advantage plans. | Over half a million Medicare beneficiaries have Medigap. | About 38.64% (811,388) of Medicare beneficiaries have access to Part D prescription coverage. |
Type of Medicare Plans in North Carolina
Residents of North Carolina have a range of Medicare programs to choose from. The two basic types of Medicare plans are Original Medicare, and Medicare Advantage plans.
However, before choosing a Medicare plan, you must look into your healthcare concerns and what each plan offers to make cost efficient coverage decisions.
If you fulfill the eligibility criteria, you can enroll yourself into any of the following Medicare plans in North Carolina.
- Original Medicare (Part A and Part B)
- Medicare Advantage (Part C)
- Medicare Part D (Prescription Drug Coverage)
- Medicare Supplement Plan (Medigap)
Let us discuss each plan in detail.
Original Medicare (Part A and Part B)
Original Medicare is the foundational Medicare plan, a fee-for-service program comprising two Parts. Medicare Parts A and B are designed to mitigate the financial impact of skyrocketing hospital bills.
Medicare beneficiaries can enroll themselves in Original Medicare to access coverage for inpatient and outpatient care.
Medicare Part A primarily focuses on hospital insurance, providing coverage for inpatient care, including hospital stays, skilled nursing facilities, hospice, and home healthcare. Thus, Part A covers expenses related to your hospital needs, such as meals, medications, and access to semi-private rooms.
Part A insurance covers 80% of medical costs, while you’re responsible for covering the remaining 20% as deductibles and copays. Part A premium is free, but if you do not pay your Medicare tax, it may cost as much as $506 per month.
In contrast, Medicare Part B focuses on medical insurance, providing coverage for outpatient care, including doctors’ visits, emergency care, lab tests, diagnostic testing, medical supplies, medical equipment, and preventive care.
Medicare Part B may also cover screening for tumors, cancer, or other related medical issues if deemed medically necessary. But you must remember that Part B premium is income-based; thus, it varies from person to person.
Original Medicare enrollment requires paying for deductibles along with any expenses incurred from inpatient and outpatient care. It’s best to enroll yourself in Original Medicare if you’re looking for a flexible coverage plan that has a wide network of healthcare providers across the State.
Medicare Advantage (Part C)
Besides Original Medicare, Medicare Advantage plans provided by private health insurance companies are another type of standard coverage.
Recently, Medicare Advantage plans, also known as Part C, have gained popularity in North Carolina, with over 52% of Medicare beneficiaries having Medicare Advantage. In 2022, North Carolina had 142 plans, which increased to 150 by 2023.
These popular coverage plans consolidate the benefits of Medicare Part A and B with supplemental benefits, including hearing, vision, and dental care. Some of these plans also provide coverage for wellness programs and gym memberships. Hence, Medicare Advantage plans work as bundled coverage for all your healthcare needs.
However, Part C plans come with one downside—a restricted choice of healthcare providers as it only collaborates with a specific network. Enrollees cannot seek medical treatment from healthcare providers outside of their network. To consult a specialist outside your network, you require pre-authorization or a referral from a healthcare physician within your network.
Medicare Advantage plans are an excellent coverage choice for North Carolina residents looking for a bundled coverage option. In North Carolina, Medicare Advantage plans cost an average of $17.10 per month.
Types of Medicare Advantage Plans in North Carolina
Medicare Advantage plans are of various types. These different insurance plans include the following.
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Special Needs Plans (SNPs)
- Private Fee-For-Service Plans (PFFS)
Ratings of North Carolina Medicare Advantage Plans
| 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 |
Medicare Part D (Prescription Drug Coverage)
Medicare Prescription Drug Coverage, popularly known as Part D, is designed to lower the cost of prescription medications. If you have Original Medicare, you are eligible for Part D coverage.
All Medicare enrollees are offered enrollment into Part D plans. You may face a late enrollment penalty if you do not enroll on time. You can enroll yourself into a low premium Part D coverage to avoid this penalty.
Some private health insurance companies in North Carolina also provide stand-alone Part D coverage. These plans require deductibles. Part D coverage is ideal for beneficiaries enrolled in Original Medicare or Medicare Advantage plans that lack drug coverage.
In 2023, there were 24 stand-alone Part D prescription plans available in North Carolina, with premiums starting at $4.20 per month.
Medicare Supplement Plan (Medigap)
Medicare Supplement plans, also known as Medigap, are optional plans that provide coverage for what’s not covered under Original Medicare Parts A and B.
Medigap plans aim to provide additional health insurance for out of pocket expenses. In North Carolina, there are 42 insurers offering Medigap plans. Over half a million Medicare beneficiaries have access to stand alone Medigap coverage.
There are ten standardized plans available for North Carolina residents. These plans are denoted with alphabets ( (A, B, C, D, F, G, K, L, M, and N). Plans C and F are only available to those who became eligible for Medicare prior to January 2020. A Plan G for a 65-year-old nonsmoking person ranges from $86 to $302 monthly.
However, all of these plans are standardized by the federal government due to the fact that they don’t offer the same benefits. Consequently, you have to look into your provider’s supplement plan before enrolling.
Cost of Medicare Plans in North Carolina 2024
The cost of Medicare plans in North Carolina varies from provider to provider. The cost also depends on your chosen coverage plan and whether you have been paying your Medicare taxes.
For example, you pay deductibles and premiums for Original Medicare Part A, while the cost of Part B depends on your income. These factors affect the cost of Medicare plans from State to State.
In contrast, Medicare Advantage plans have costs solely depending on the provider, coverage, and supplemental benefits.
In North Carolina, the average monthly premium for the Medicare Advantage plan is $17 in 2024. 2023, the premium decreased by 7.82% from $15.26 to $14.05. Thus, prices significantly vary from plan to plan and provider to provider. Let us look into the estimated costs for Medicare plans in North Carolina in 2024.
| Original Medicare | Medicare Advantage | Medigap | Part D |
| Part A premium: $0 to $506 per month. Deductible: $1,600 for each benefit period. Part B premium: $164.90 monthly and up (income-based) Deductible:$233 for each plan period. | Average monthly premium in 2024 for a Medicare Advantage plan in North Carolina is $17. | Plan G cost for a non-smoking person aged 65 is $86 to $302 per month. | The lowest monthly premium starts at $4.20. |
Eligibility and Enrollment for Medicare in North Carolina
What determines the eligibility criteria for Medicare in North Carolina? The eligibility criteria for Medicare are consistent across all the States. You are eligible 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)
To qualify for Medicare, you must also have approval from the Social Security Administration for your age or disability status.
Enrolment Period for Medicare Plans in North Carolina
You can join, switch plans, or drop your coverage plans from October 15 to December 7 each year. This period is called the Medicare open enrollment period.
In addition, Medicare has two enrollment periods: your initial enrolment period (IEP) and a general enrolment period (GEP).
The initial enrollment period is 7 months, starting 3 months before your 65th birthday and ending 3 months after you turn 65. You can enroll during this period if you haven’t had Medicare before.
If you miss your IEP, you can access Medicare by applying for it during the general enrollment period (GEP), which occurs every year between January 1 and March 31.
During this period, you can choose Original Medicare, Medicare Advantage, Medigap, or Part D. You can also change your current Medicare plans. For example, if you have Original Medicare and you want to switch to a Medicare Advantage plan, you can do so during this period.
Applying for Medicare in North Carolina
Applying for Medicare in North Carolina may seem daunting. However, you’d be delighted to know that it’s a straightforward process offering convenient ways to apply. You can apply for Medicare online, by mail, or in person at your local Social Security Office.
However, if you’ve already been paying your Medicare taxes, you automatically enroll in Medicare Part A and B. You receive your Medicare ID in the mail.
For first-time applicants, it’s vital to know that you can only sign up for Medicare within the open enrollment period or general enrollment period. If you wish to streamline your application process, you can seek advice from licensed advisors at Silveredge.
Seek Guidance Through Resources for Medicare in North Carolina
Before enrolling in a Medicare plan, you must become familiar with each and every aspect of a Medicare coverage program.
In North Carolina, numerous organizations provide guidance for Medicare programs. Contacting these agencies can help you make a cost-efficient decision suitable for all your healthcare needs.
| 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 |
Securing Your Health in the State of North Carolina With Silveredge
With growing healthcare needs and skyrocketing hospital bills, programs such as Medicare have become essential to manage healthcare expenses.
Enrolling in Medicare can provide you with long-term surety for you and your loved ones. Medicare not only safeguards your health but also provides you with peace of mind. Therefore, it’s crucial to look into the available plans in your region to make informed decisions.
Before you enroll yourself into a Medicare plan, it’s best to seek professional guidance to look into the available options to make the most of your Medicare coverage.
Silveredge has industry experts to counsel you regarding Medicare plans in your area. Our licensed advisors can also help compare different plans in your region, assisting you in choosing a coverage option that suits all your needs. Build a carefree future together with Silveredge!
