Information about Medicare Advantage Plans in North Carolina

Quick links:

• Average 2019 Costs
• Eligibility & Enrollment
• Finding Top-Rated Plans
• List of Plans Available
  • Plans by Carrier
  • Plans by County
  • Plans by Type
• Local Resources

35 percent of Medicare beneficiaries in North Carolina were enrolled in a Medicare Advantage (Medicare Part C) plan in 2019.¹

There are 1,210 different North Carolina Medicare Advantage plans in 2019.¹ Not every plan is available in each county, so it's important to find out which ones are offered where you live.

A licensed insurance agent can help you compare the availability, benefits and costs of Medicare Advantage plans in your area of North Carolina. Read below to learn more about Medicare in your state.

Average costs of Medicare Advantage in North Carolina

The average North Carolina Medicare Advantage plan premiums 2019 were $33 per month.

That average was affected by the 625 $0 monthly premium plans that were available in North Carolina in 2019.

39 percent of North Carolina Medicare Advantage enrollees were enrolled in a $0 premium plan in 2019.

• Average monthly premium cost in 2019 (weighted): $33
• Average in-network out-of-pocket spending limit: $4,936
• Average deductible in 2019 (weighted): $152.15¹

The premiums, deductibles and out-of-pocket costs for each plan may vary greatly depending on what county you live in and the plan you have.

Read more about the 2019 average North Carolina Medicare Advantage plan monthly premiums by county, which are listed below in this guide.

A licensed insurance agent can help you compare NC Medicare Advantage plan costs in your area.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.

Medicare Eligibility & Enrollment

You may not sign up for a Medicare Advantage plan in North Carolina without first enrolling in Medicare Part A and Part B, otherwise known as Original Medicare.

To be eligible for Original Medicare at age 65, you must meet the following requirements:

• You must be a U.S. citizen or permanent legal resident who has lived in the U.S. for five continuous years.
  
  
• You or your spouse must have worked long enough to be eligible for Social Security or Railroad Retirement benefits.
  
  
• You or your spouse must be government employees or retirees who have not paid into Social Security but have paid Medicare payroll taxes.

You may also be eligible for Medicare benefits under 65 if:

• You have been receiving Social Security disability benefits or certain Railroad Retirement Board disability benefits for at least 24 months.
  
  
• You have ALS (amyotrophic lateral sclerosis, or Lou Gehrig's disease).
  
  
• You have End-Stage Renal Disease (ESRD), and you or your spouse have paid Social Security taxes for a certain length of time.

It’s important to note that if you have ESRD, you may not qualify for most Medicare Advantage plans. If you have ESRD, you may be able to enroll in a North Carolina Medicare Special Needs Plan (SNP) that is specifically designed to help meet your health care needs.

You are only eligible to enroll in Medicare Advantage plans that are offered in your local area.

How to sign up for a Medicare Advantage Plan in North Carolina

The first time you may be able to enroll in a North Carolina Medicare Part C plan is during your Medicare Initial Enrollment Period (IEP).

Your seven-month Initial Enrollment Period begins three months before your 65th birthday, includes the month of your birthday and extends for three additional months thereafter.

Additional times when you may be able to sign up for a Medicare Advantage plan include:

Medicare Advantage Open Enrollment Period: January 1 – March 31

If you're already enrolled in a Medicare Advantage plan, you may switch Medicare Advantage plans or drop your Medicare Advantage plan and return to Original Medicare from January 1 to March 31 every year.

If you return to Original Medicare during this period, you'll be able to join a Medicare standalone prescription drug plan (Medicare Part D).

Medicare Annual Enrollment Period (AEP): October 15 – December 7

From October 15 to December 7 every year, you may enroll in a Medicare Advantage plan or switch from one Medicare Advantage plan to another.

You may also drop your existing Medicare Advantage plan and return to Original Medicare.

During AEP, you may also join, switch or drop a Medicare Part D plan. 

Medicare Special Enrollment Periods (SEP)

You may potentially be granted a Medicare Special Enrollment Period (SEP) at any time throughout the year for qualifying circumstances.

Find out if you qualify for a Medicare Special Enrollment Period by calling to speak with a licensed insurance agent.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.

Top-rated Medicare Advantage Plans in North Carolina 2020

Each year, the Centers for Medicare & Medicaid Services (CMS) issues star ratings for all Medicare Advantage plans using a system of one to five stars.²

In order for a Medicare Advantage plan to be considered a top-rated plan, it must have four or more stars out of five stars.

There are 506 top-rated 2019 Medicare Advantage plans in North Carolina that are rated four stars or higher.

Medicare Advantage plans are rated according to the following five criteria:

• Preventive care and health maintenance (screenings, tests, vaccines, etc.)
• Management of chronic conditions
• Member experiences and ratings of the plan
• Member complaints, problems receiving services and member retention
• Customer service

The information for the star ratings is gathered from information that is submitted to Medicare, Medicare’s regular monitoring activities and member surveys.

List of Medicare Advantage Plans Available in North Carolina in 2020

To view a list of plans offered in your area within North Carolina, use our plan comparison tool.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.

Private insurance companies offer Medicare Advantage plans in North Carolina

Multiple private insurance companies may offer Medicare Advantage plans in North Carolina, depending on where you live.

Private insurance carriers offer Medicare Advantage plans that may be unique to the plan area they serve.

A licensed insurance agent can help you compare the Medicare Advantage plans that are sold by insurance companies in your area.

When you’re shopping for Medicare Advantage plans in North Carolina, you can compare plans from several different insurance companies by using some of the following information:

• The Medicare Star Ratings can give you an idea of a plan’s overall quality and customer service.
  
  
• Agencies like A.M. Best, Moody’s and Standard & Poor’s can provide information about an insurance company’s credit rating and financial standing.
  
  
• You can read through Medicare Advantage plan reviews and testimonials from customers.

North Carolina Medicare Advantage plans by county

Learn more about Medicare Advantage plans in some of North Carolina's most populous counties.

• Wake County Medicare Advantage plans
• Mecklenburg County Medicare Advantage plans

The chart below provides some more information about 2019 North Carolina Medicare Advantage plans by county.¹

• Guildfor County had 14 $0 premium MA plans in 2019, which was the most in North Carolina.
  
  
• Guilford County and Mecklenberg County had the highest number of Medicare Advantage plan members in 2019.

NC Medicare Advantage enrollees by plan type

This chart shows the percentage of 2019 North Carolina Medicare Advantage beneficiaries that are enrolled in each primary type of Medicare Advantage plan.¹

The major types of Medicare Advantage plans include:

• HMO
  A Health Maintenance Organization (HMO) typically requires you to visit health care providers and pharmacies that are part of your plan’s network (except in the case of emergencies), while also typically requiring a referral from a primary care doctor (PCP) in order to see a specialist.
  
  
• PPO
  Medicare Advantage beneficiaries enrolled in a Preferred Provider Organization (PPO) typically can see providers outside of their plan network, though it is often at a higher cost.
  
  Beneficiaries in a Medicare PPO 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 beneficiaries to acquire a referral before visiting with a specialist.
  
  
• PFFS
  A Private Fee-For-Service (PFFS) plan determines how much it will pay to doctors and other providers at the point 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 (SNP) is a type of Medicare Advantage plan that is limited to people who have 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 of emergency or urgent care and when someone who has End-Stage Renal Disease (ESRD) needs out-of-area kidney dialysis.

Not all of these types of plans may be available in your area. A licensed insurance agent can help you compare the types of 2019 NC Medicare Advantage plans that are available where you live.

Local health insurance resources in North Carolina

• 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.
  
  
• North Carolina Prescription Drug Assistance Programs
  The state of North Carolina has a number of programs designed to help with the cost of prescription drugs. There are programs for both Medicare beneficiaries and non-Medicare beneficiaries alike that can cover the cost of premiums and cost-sharing or even lower the cost of the drugs themselves.

¹ MedicareAdvantage.com's The Best States for Medicare in 2021 report. (Oct. 27, 2020).

² Medicare evaluates plans based on a 5- star rating system.