Medicare in North Carolina

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If you live in North Carolina and are nearing age 65, you may be wondering if you are eligible for Medicare, what health services Medicare covers, and how it works. Understanding your Medicare coverage and options in North Carolina can help you make an informed decision about how you receive your Medicare benefits.

Original Medicare for North Carolina beneficiaries

Original Medicare is the federal health program run by the Centers for Medicare & Medicaid Services (CMS), and it is available in North Carolina and nationwide. Original Medicare consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). In North Carolina as elsewhere, you’re usually eligible for Medicare if:

  • You’re 65 or older, and
  • You’re a US citizen or a legal permanent resident of at least five continuous years, or
  • You receive disability benefits, or have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).

If you have end-stage renal disease (ESRD), you might qualify for Medicare before you turn 65, but you need to enroll with the Social Security Administration – you’re not likely to be enrolled automatically when you become eligible.

Medicare plan options in North Carolina

There are other Medicare plan options in North Carolina besides Original Medicare – some that can work alongside Medicare Part A and Part B, and some that deliver your Part A and Part B benefits through a private, Medicare-approved plan.

Types of Medicare plans in North Carolina that work along with Original Medicare

If you decide to stay with Original Medicare (Part A and Part B), you may have the option to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. In North Carolina and other states, Medicare Supplement plans are offered by private insurance companies. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.

You can also sign up for Medicare Part D prescription drug coverage offered by Medicare-approved private insurance companies to complement your medical coverage (Part A and/or Part B). In 2017, 22 Medicare Part D Prescription Drug Plans are available in North Carolina, according to the Centers for Medicare & Medicaid Services (CMS). Stand-alone Medicare Part D Prescription Drug Plans in North Carolina may have different costs, but most plans require payment of a monthly premium, annual deductible, and copayment or coinsurance. Each Medicare Part D Prescription Drug Plan has its own formulary, which is a list of drugs covered by the plan. So, it may be a good idea to check the formulary to make sure your medications are included if you decide to enroll in a Medicare Part D Prescription Drug Plan.

Medicare Advantage in North Carolina

Medicare Advantage (Medicare Part C) offers an alternative way to get your Original Medicare benefits. Medicare Advantage plans are offered by private insurance companies contracted with Medicare. According to CMS, all North Carolinians with Medicare have access to at least one of the 49 Medicare Advantage plans available in the state in 2017.

A Medicare Advantage plan must offer at least the same benefits as Original Medicare, Part A and Part B (except for hospice care, which continues to be covered by Part A). Many Medicare Advantage plans offer extra coverage, such as vision, dental and hearing benefits. Furthermore, if you’re seeking health and prescription drug coverage through a single health plan, you may be able to enroll in a Medicare Advantage Prescription Drug plan available where you live. If you enroll in a Medicare Advantage plan, you continue to pay your Medicare Part B premium in addition to the plan’s premium (if any) and any applicable deductible, copayment and coinsurance.

To learn more about Medicare plans where you live, simply type your zip code in the plan finder located on this page.

North Carolina: Trends in Medicare coverage

More than 1.8 million people residing in North Carolina have Medicare. Some beneficiaries choose to enroll in Medicare health plans or Medicare Prescription Drug Plans, described above. According to a CMS (Center for Medicare & Medicaid Services) study:

  • Medicare Advantage and other Medicare plans offered by private insurers has gained steady popularity among North Carolina Medicare beneficiaries.
    • In 2012, 20% of beneficiaries chose Medicare Advantage plans or other Medicare health plans over Original Medicare. By 2016, 31% of people with Medicare in North Carolina enrolled in Medicare health plans.
  • The number of Medicare beneficiaries in North Carolina who enroll in Medicare Prescription Drug Plans continues to rise—from 982,719 in 2012 to 1,370,150 in 2017.
  • In 2017, 39% of North Carolina Medicare beneficiaries with prescription drug coverage were enrolled in Medicare Advantage Prescription Drug plans, up from 28% in 2012.

North Carolina resources for Medicare beneficiaries

Several resources designed to help North Carolina Medicare beneficiaries are available in the state, including –

North Carolina Department of Health and Human Services provides information and services to help protect the elderly and disabled through its Aging and Adult Services agency.

North Carolina Department of Insurance is a source for information about Medicare plans in North Carolina. In addition, the Department of Insurance oversees the Senior Medicare Patrol (SMP) program, which promotes fraud prevention through education and awareness.

North Carolina Seniors’ Health Insurance Information Program (SHIIP) provides assistance with questions you may have about Medicare.

Statistical data from the Centers for Medicare & Medicaid Services, “2017 MA Part D Landscape State-by-State Fact Sheet,“ September 22, 2016 and “Medicare Dashboard,“ Office of Enterprise Data & Analytics (OEDA), April 2017.

Data in this article was checked when the article was written and might not be updated as newer data becomes available.

Your Medicare coverage choices. Medicare.gov. Centers for Medicare & Medicaid Services. Accessed April 4, 2017 at https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/your-medicare-coverage-choices.html

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.


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