North Carolina Medicare Guide

Get free Medicare guidance from licensed North Carolina Advisors. Schedule a consultation or give us a call today at (888) 604-0055.

In this guide on Medicare in North Carolina, we’ll go over what your options are and when and how to enroll in Medicare.

Use this table of contents to jump to specific sections:

A Snapshot of Medicare in North Carolina

There are over two million Medicare beneficiaries in North Carolina, making up 20% of North Carolina’s total population. 17% of North Carolina’s Medicare beneficiaries also receive full or partial Medicaid benefits, which we’ll explain in more detail later on.

Enrollment in Medicare Advantage vs. Original Medicare in North Carolina

Medicare beneficiaries have options. One of your options is between Original Medicare and Medicare Advantage. 55% of North Carolina Medicare recipients are on Original Medicare and the other 45% are on a Medicare Advantage plan (source).

North Carolina Medicare Advantage Plans

45% of North Carolina Medicare beneficiaries have enrolled in one of the 104 Medicare Advantage plans available in the state. It’s important to note that the pricing, benefits, and availability of plans available to you depends on the county you live in. For example, in 2023, Wake County, North Carolina has 46 Medicare Advantage plans and Wilkes County has 36. To hear about Medicare Advantage plans, schedule a free consultation with one of our licensed North Carolina Medicare agents or call us today at (888) 604-0055.

What benefits do North Carolina Medicare Advantage plans offer?

Medicare Advantage plans are commonly called the all-in-one approach. They include Part A, Part B, and often Part D benefits. Additionally, these plans often come with low or no additional premiums and offer additional benefits, like:

Dental, vision, and hearing benefits
Flex cards
Fitness perks
Transportation services for doctor appointments

If you’re considering enrolling in a North Carolina Medicare Advantage plan, be careful. Many Medicare beneficiaries get excited about the additional benefits these plans offer and forget to check that all of their doctors and prescriptions are covered. You should also be aware of some of the common Medicare Advantage problems:

Limited provider networks
Preauthorization requirements
Higher out-of-pocket costs (compared to Original Medicare + a Medicare Supplement)

North Carolina Medicare Supplement Plans

Original Medicare does not provide comprehensive coverage. It doesn’t cover prescription drugs and it doesn’t cover about 20% of costs for covered services. Additionally, there’s no out-of-pocket maximum, so if you need regular or expensive treatments, you could be on the hook for thousands of dollars.

Medicare Supplement (also known as Medigap) plans pair with Original Medicare to cover the costs it doesn’t. These plans don’t provide coverage for additional healthcare services, but they significantly reduce your out-of-pocket costs! For example, with a Plan G, you don’t owe anything once you’ve met your Part B deductible.

Medigap plans have important benefits that Medicare Advantage plans don’t, including:

No restrictive networks
No need for prior authorizations
Low out-of-pocket costs

The Medigap Open Enrollment Period occurs during the first six months that you have Part B coverage. This is the best time to enroll in a Medigap plan because you have a guaranteed issue right. This means that insurance companies are legally obligated to accept your application without asking questions about your health history. Outside of this period and a handful of other guaranteed issue periods, insurance companies are allowed to ask you questions about your health history. If they don’t like your answers, they can reject your application.

North Carolina Part D (Prescription Drug) Plans

We mentioned that Original Medicare does not cover prescription drugs. Some Medicare beneficiaries get prescription coverage through a Medicare Advantage plan that includes it. Others can enroll in a stand-alone Part D plan to get their prescriptions covered. There are 24 Part D plans in North Carolina. Like with Medicare Advantage plans, pricing and availability of plans varies by county.

Each Part D plan will cover different prescriptions, so check the list of covered drugs to be sure those you need are on it! If you don’t currently take any prescriptions, we still recommend you enroll in one of the less expensive drug plans. This will help you avoid the Part D penalty later on when you do need drug coverage.

Get help paying for Medicare in North Carolina

There are three government programs for low-income individuals that can help Medicare beneficiaries pay for healthcare-related expenses.

Medicaid

Medicaid is a joint federal and state program that’s operated by individual states. Each state Medicaid program is a little different.

North Carolina has a specific Medicaid program for Aged, Blind, and Disabled citizens. You are automatically eligible if you receive Supplemental Security Income (SSI) or State/County Special Assistance for the Aged or Disabled.

Medicare Savings Programs

In addition to Medicaid for the Aged, Blind, and Disabled, Medicare beneficiaries have access to four North Carolina Medicare Savings Programs. These programs help low-income individuals by assisting with Medicare premiums, deductibles, and copays.

The Qualified Medicare Beneficiary (QMB) Program is the most comprehensive. It pays for Part A and B premiums as well as deductibles, coinsurance, and copayments.

The Specified Low-Income Medicare Beneficiary (SLMB) and Qualified Individual (QI) Programs both help pay for Part B premiums.

The Qualified Disabled and Working Individuals (QDWI) Program helps pay for Part A premiums.

If you qualify for one of these programs (aside from QDWI), you also automatically qualify for Extra Help.

Extra Help Program

If you have limited income and resources, you may be eligible for the federal Extra Help program that helps with costs tied to your prescription drug coverage. If you meet any of the following conditions, you’ll qualify for Extra Help automatically:

You receive full Medicaid coverage from North Carolina
North Carolina helps pay your Part B premium
You get Supplemental Security Income (SSI) benefits

If you don’t automatically qualify for Extra Help, you can learn more about eligibility here. If you need help, give us a call! One of our North Carolina Medicare Advisors who will help you determine if you’re eligible and how to apply.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

You are 65 and older, blind, or have a disability
You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.

North Carolina Medicare Eligibility and Enrollment Steps

All US citizens are eligible for Medicare if they meet one of the following conditions:

65 or older
Have certain disabilities, like End-Stage Renal Disease or ALS

Three key steps for North Carolina Medicare enrollment:

Enroll in Original Medicare (Part A & Part B)
Choose your supplemental coverage
- Medicare Supplement (Medigap)
- Medicare Advantage (Part C)
- Part D (drug coverage)
Find doctors, share your plan information with your pharmacy, and set up additional benefits that come with your coverage.

Most Americans become eligible for Medicare due to age. You can enroll as soon as three months before you turn 65, at the start of your Initial Enrollment Period (IEP). Your IEP is a seven-month window that starts three months before the month you turn 65 and ends three months after. If you need assistance, we’re here to help! We help you understand your options, enroll in the best coverage for your needs, and get the most value from Medicare.

Schedule an appointment with one of our licensed North Carolina Medicare Advisors or give us a call at (888) 604-0055 to get started!

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