North Carolina Medicare Advantage plan enrollment by the numbers

There were over 587,000 people in the state of North Carolina with a Medicare Advantage plan in 2017.¹

There are several major types of Medicare Advantage plans. In the state of North Carolina, there are 49 different plans available as of 2018.² Not every plan is available in each county, so it's important to find out which ones are offered where you live.

North Carolina’s Medicare Advantage enrollment was closely split among local PPO plans (50 percent of enrollees) and HMO plans (42 percent) in 2017. The major types of Medicare Advantage plans include:

HMO

A Health Maintenance Organization usually requires patients to use health care providers and pharmacies that are part of the plan’s network (except in the case of emergencies) while also typically requiring a referral from a primary care doctor in order to see a specialist.

PPO

Medicare Advantage beneficiaries in a Preferred Provider Organization are able to see providers outside of their plan’s network, often at a higher cost. Beneficiaries in this type of plan typically pay less out of pocket if they choose to receive medical services from providers within their plan’s network. PPO plans typically do not require patients to acquire a referral before visiting with a specialist.

PFFS

A Private Fee-For-Service plan determines how much it will pay to health care providers and how much the patient will pay when care is received. With a PFFS plan, you can typically receive care from any doctor, hospital or health care provider that accepts your plan’s terms. Not all providers will accept these terms, however.

SNP

A Special Needs Plan is a type of Medicare Advantage plan limited to people with certain chronic conditions and  other specific characteristics. Typically, you must receive care from health care providers and hospitals within your SNP network, except for in cases when you need emergency or urgent care and when someone who has End-Stage Renal Disease (ESRD) needs out-of-area kidney dialysis.

Medicare Cost Plans, Medical Savings Accounts (MSA) and HMO Point-of-Service (HMO POS) plans are 3 additional types of Medicare Advantage plans that are less popular in most states. Enrollment in these plans makes up fewer than 1 percent of all Medicare Advantage plan enrollment in North Carolina.

Total number of Medicare Advantage enrollees in North Carolina: 587,632 as of 2017¹

NC Medicare Advantage enrollees by plan type:

Data reflects Medicare Advantage enrollment in the state of North Carolina as of 2017, as obtained from the Kaiser Family Foundation Medicare Advantage 2017 Spotlight: Enrollment Market Update¹

North Carolina’s Seniors Health Insurance Information Program (SHIIP)

The Seniors Health Insurance Information Program in North Carolina provides assistance to Medicare beneficiaries and caregivers who have questions about Medicare coverage. SHIP volunteers can also help identify instances of errors and Medicare fraud. The program may be reached at 855-408-1212.

You can also explore more information about the insurance industry in North Carolina by visiting the state’s Department of Insurance website.

¹Kaiser Family Foundation. Medicare Advantage 2017 Spotlight: Enrollment Market Update. Retrieved from https://www.kff.org/report-section/medicare-advantage-2017-spotlight-enrollment-market-update-appendices.

²Kaiser Family Foundation. State Health Facts: Medicare Advantage Plans. Retrieved from https://www.kff.org/medicare/state-indicator/plans/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.