List of Medicare Advantage Plans in North Carolina 2020
- February 5, 2021
The state of North Carolina had 63 different Medicare Advantage plans available for sale in 2019.1
Plan selection varies by county or zip code. Call to speak with a licensed insurance agent who can help you determine your eligibility to enroll and compare the Medicare Advantage plans that are available in your area of North Carolina.
Find Medicare Advantage plans in your area
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Types of North Carolina Medicare Advantage plans
There are several different types of Medicare Advantage plans that may be available, though not each type of plan may be available where you live.
The 2019 breakdown of Medicare Advantage plan enrollment in North Carolina is illustrated in the chart below.1
| Plan type | Percentage of North Carolina enrollees (2019) |
|---|---|
| HMO | 75.7% |
| Local PPO | 24.1% |
| Regional PPO | <1% |
| PPFS | <1% |
| Other Plans | <1% |
North Carolina Health Maintenance Organization (HMO) plans
A Health Maintenance Organization (HMO) plan features a network of participating doctors, pharmacies and other health care providers.
With a Medicare HMO plan, you typically choose a primary care physician (PCP) who coordinates your health care and provides a referral when you need to see a specialist.
Typically only care that is received within the network of participating providers will be covered by an HMO plan.
In 2019, 75.7% of Medicare Advantage beneficiaries in North Carolina were enrolled in HMO plans.
North Carolina Preferred Provider Organization (PPO) plans
A Preferred Provider Organization (PPO) plan also typically includes a network of participating providers, but you may be able to receive partial coverage for care you receive outside of your plan network.
If you receive medical services outside of your Medicare PPO plan network, however, you will typically pay higher out-of-pocket costs than you would if you visited an in-network provider.
You typically aren't required to get a referral from a physician in order to visit a specialist when you have a PPO plan, but individual restrictions may vary.
In 2019, 24.1% of North Carolina Medicare Advantage plan beneficiaries were enrolled in Local PPO plans.
North Carolina Private Fee-For-Service (PFFS) plans
Private Fee-For-Service (PFFS) plans allow members to receive care from any provider who agrees to the terms and conditions of the plan and who accepts Medicare.
With most Medicare PFFS plans, you aren’t required to designate a primary care doctor.
Less than 1% of North Carolina Medicare Advantage plan beneficiaries in 2019 were enrolled in a PFFS plan.
Special Needs Plans (SNPs)
Medicare Advantage Special Needs Plans (SNPs) feature benefits that are designed for people with certain medical conditions or who are dual eligible for Medicare and Medicaid.
Medicare SNPs aren’t available in all areas. Depending on where you live and what type of special needs you may have, a licensed insurance agent can help you find a Medicare SNP that may fit your needs, if one is available.
You can also learn more about additional Medicare plans in North Carolina, such as:
Medicare Advantage plans in North Carolina
More than 727,000 people in North Carolina were enrolled in a Medicare Advantage plan in 2019. That accounted for 35 percent of all Medicare beneficiaries.1
- There were a total of 63 different plans available across the state, and those plans were available in 21 different counties. Alamance County was home to the most plans, with 13.
- The average weighted premium for a Medicare Advantage plan in North Carolina was $33 per month in 2019.
- 32 Medicare Advantage plans in North Carolina featured $0 premiums in 2019.
$0 premium plans may not be available in all areas, so be sure to check with a licensed insurance agent who can help you find any $0 premium plans in your area. - The weighted average deductible for a Medicare Advantage plan in North Carolina was $152.15 per year in 2019.
Individual plan costs and premiums may vary.
39 plans across North Carolina were rated four stars or higher by the Centers for Medicare and Medicaid Services (CMS) in 2019.2 A plan that has four or more stars is considered a highly rated Medicare Advantage plan.
North Carolina Medicare Advantage plans at a glance
- Number of unique plans: 63
- Number of $0 premium plans: 32
- Number of plans rated four stars or higher: 39
- Average weighted monthly premium: $33
- Average weighted annual deductible: $152.15
- Percentage of Medicare beneficiaries enrolled in a Medicare Advantage plan: 35
- Number of people enrolled in a Medicare Advantage plan: 727,446
How to enroll in a Medicare Advantage plan in North Carolina
Call today to speak with a licensed insurance agent who can help you determine your eligibility to enroll and compare Medicare Advantage plans where you live. A licensed agent may also be able to:
- Verify your Medicare Advantage eligibility
- Ensure that you enroll during a qualified Medicare enrollment period
Connect with a licensed insurance agent today to explore your North Carolina Medicare Advantage plan options.
Find Medicare Advantage plans in your area
Compare PlansOr call TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!
About the author
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
Where you've seen coverage of Christian's research and reports:
