The state of North Carolina is home to 104 different Medicare Advantage plans available for sale in 2022.1
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.
Speak with a licensed insurance agent
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.
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 2022, 95% of Medicare Advantage beneficiaries in North Carolina have access to at least one HMO plan.
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 2022, 97% of North Carolina Medicare Advantage plan beneficiaries have access to at least one local PPO plan.
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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. PFFS plans are much less common in North Carolina than HMO and PPO plans.
With most Medicare PFFS plans, you aren’t required to designate a primary care doctor.
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:
More than 26 million people in America are enrolled in a Medicare Advantage plan in 2022.1
Individual plan costs and premiums may vary.
Every year, Medicare evaluates plans based on a 5-star rating system. 53.8 percent of plans across North Carolina are rated four stars or higher by the Centers for Medicare & Medicaid Services (CMS) in 2022.2 A plan that has four or more stars is considered a highly rated Medicare Advantage plan.
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:
Connect with a licensed insurance agent today to explore your North Carolina Medicare Advantage plan options.
Speak with a licensed insurance agent
1 Freed M, et al. (Nov. 2, 2021). Medicare Advantage 2022 Spotlight: First Look. https://www.kff.org/report-section/medicare-advantage-2022-spotlight-first-look-appendix.
2 The Best States for Medicare annual report.
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: