Medicare enrollment is simple, but there are many moving parts, and piecing together the different Medicare components can take time. But believe us, putting time into your research ensures you get the best package for your budget!
As a North Carolina resident, you benefit from having a flourishing Medicare market with an abundance of plans and insurers. The sooner you pick a plan, the sooner you can enjoy Medicare’s benefits.
Remember, you’ve been paying into your Medicare fund your entire working life – it’s time for you to reap the rewards. Read on as our experts explore Medicare Supplement Insurance and Medicare Advantage plans in North Carolina.
North Carolina Medicare Insurance Trends
The Centers for Medicare & Medicaid Services (CMS) reported the following information on 2021 Medicare trends in North Carolina:
- 2,029,697 North Carolina residents are enrolled in Medicare.
- The average Medicare Advantage monthly premium decreased in North Carolina from $18.25 in 2020 to $17.47 in 2021.
- There are currently 126 Medicare Advantage plans available in North Carolina.
- All North Carolina residents enrolled in Medicare can purchase a Medicare Advantage plan, including those with $0 premiums.
- There are 31 stand-alone Medicare Part D plans offered.
- All North Carolina citizens with a stand-alone Part D plan can purchase plans with a lower monthly premium than those they paid for in 2020.
- There are 12 different Medigap plans offered in North Carolina.
Medicare Offered in North Carolina
Medicare is coverage offered by the federal government. You can get Original Medicare, which provides both hospitalization and medical coverage, or you may want an option that covers prescription drugs along with other services such as surgery.
North Carolina laws guarantee those under 65 who qualify for Medicare can purchase a Medigap policy A, D, and G effective January 1, 2020. This change occurred due to changes in federal legislation regarding Medigap Plans A, C, and F. (source)
Two parts make up Original Medicare: Medicare Part A and Medicare Part B. Medicare Part A, also known as hospital insurance, provides coverage for Medicare inpatient care; this may include care received during hospital admittance, a skilled nursing facility, and in specific situations care received at home.
In General, Services Covered under Medicare Part A:
- Hospital care (inpatient)
- Limited home health services
- Care in a skilled nursing facility (SNF), provided that custodial care not be the only care required
- Hospice care
Medicare Part B, or medical insurance, covers medical services and supplies for the diagnosis or treatment of a health condition. This policy covers outpatient and preventative services such as hospital visits and disease screenings.
Medicare Part B covers medical services and supplies your physician requires to treat a policyholder’s health condition. The following are examples of costs covered by Medicare Part B:
- Visits to a healthcare facility
- Ambulance services
- Part-time or temporary home health care
- Rehabilitation services and physical therapy
- Flu and hepatitis b shots
- Cardiovascular, cancer, and diabetes screenings
- Limited outpatient prescription drugs
- Durable medical equipment
- Clinical research
- Mental health services (inpatient, outpatient, and partial hospitalization)
- Second opinions before surgery
The Medicare Advantage Plan is a more comprehensive version of the original Medicare that includes Part A and part B coverage, offered through private insurance companies. These plans are legally obligated to provide the same benefits as Original Medicare while also providing additional services such as dental, vision or hearing aids if desired.
Insurance carriers that 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
Each of North Carolina’s 100 counties has access to Medicare Advantage plans, but availability varies from county to county because they are sold through private insurers.
In North Carolina, beneficiaries can enroll in a Medicare Advantage plan during their initial enrollment period or the annual election period (runs annually between October 15 and December 7). Enrollees can change or drop their coverage during the Medicare Advantage open enrollment period (January 1 – March 31).
Medicare Supplement Plans
Under original Medicare, you will owe deductibles for hospital stays and other outpatient care. These expenses can be covered by Medigap plans offered through private insurance companies with variable rates of coverage depending on the plan chosen. Reviewing these options carefully before signing up is important to ensure that you have enough coverage at a reasonable price. Over 50 companies are offering Medigap plans in North Carolina. Use the government Medicare find a plan tool to see which companies offer plans in your area.
North Carolina Medicare Enrollment
Those living in North Carolina are eligible for Medicare if they are a U.S. citizen and above 65 years old or are under 65 but are permanently disabled, have end-stage renal disease, or Amyotrophic Lateral Sclerosis. Use Medicare’s online eligibility tool if you are unsure if you qualify.
- You are 65 or older, and you or your spouse worked and paid Medicare taxes for at least 40 quarters.
- You are under age 65 and collect benefits from Social Security or the Railroad Retirement Board for at least 24 consecutive months.
- You have ESRD or ALS.
Enrollment Period Dates
Initial Enrollment Period
This is a seven-month window that allows you to sign up for a plan
- Begins 3 months before the month you turn 65
- Ends 3 months after the month you turn 65
Medicare Open Enrollment Period
This is when you can sign up for a plan, switch a plan or leave a plan
- Begins Starts October 15th
- Ends December 7th
Special Enrollment Period
Special enrollment periods allow you to enroll outside the regular enrollment periods under specific circumstances.
General Enrollment Period
This is when you can sign up for Medicare Part A and/or Part B if you didn’t sign up when first eligible or if you’re not qualified for a Special Enrollment Period.
- Starts January 1st
- Ends March 31st
Medicare Advantage Open Enrollment Period
This is when you can switch or leave a Medicare Advantage Plan
- Starts January 1st
- Ends March 31st
North Carolina Enrollment Tips & Advice
Before deciding on a plan, the most crucial consideration is whether you want to enroll in Original Medicare or with one of its many alternatives. Do you need additional coverage from a Medigap Plan? Do you need prescription drug coverage for your prescriptions? Whatever it may be, pay attention to the enrollment periods and speak to a licensed professional before making your purchase.
North Carolina has many resources to guide you through your Medicare enrollment:
- NCDOI Seniors Health Insurance Information Program, or SHIIP (855-408-1212)
- NC 2-1-1 information online
- Medicare-Aid (apply online) or call 888-245-0179
- Extra Help Program (assistance with Medicare and prescription drug costs)
How Do I Enroll in a Medicare Plan?
If you have any questions about North Carolina Medicare and your eligibility for financial assistance, speak to one of our licensed agents today. Our agents will discuss your Medicare options and help find a plan that works for you.