Medicare in North Carolina

In this article...
  • Don't let your Medicare options confuse you. Find out what the options are for Medicare in North Carolina and when you might be able to enroll.

What North Carolina Medicare Plans Are Available? 

Those who are approaching 65 years of age in North Carolina should consider how they plan to pay for health care for the rest of their lives. Knowing what is covered and your financial responsibility will help you plan accordingly and make informed choices about the plans you decide to sign up for. In North Carolina, you have access to Medicare Part A and B, Medicare Advantage, Medicare Part D and privately offered Medicare Supplement plans. Here are the benefits of each plan offered in your state. 

  • Medicare Part A: People commonly refer to this as traditional Medicare, and it covers the cost of emergency room visits, extended hospital stays, nursing home care, home health care and hospice services.  
  • Medicare Part B: The second part of traditional Medicare is Part B, and this covers your routine care, medical transportation, medical supplies, medical devices, diagnostic testing and physical exams.  
  • Medicare Advantage: If you would rather be insured by a private company than by the government, you can select a Medicare Advantage plan. These plans cover everything that Medicare Part A and B cover, but people usually select these plans because they offer coverage for things that traditional Medicare does not. You may be able to find a plan that offers vision, dental and prescription drug coverage, for example. 
  • Medicare Part D: You can receive prescription drug coverage through Medicare Part D, and it doesn't matter if you are enrolled in a Medicare Advantage plan. Some Advantage plans don't offer prescription coverage, so this plan will cover you in the event that your selected plan lacks this benefit.  
  • Medicare Supplement Plans: While Medicare greatly reduces your medical expenses, you still need to meet a deductible and pay 20% of the cost of medical care you receive. For some people, this is still extremely expensive, and they may wish to sign up for a policy that will offset some of the difference. These plans are administered by private insurance companies instead of Medicare. 

Traditional Medicare plans are a little more popular than Medicare Advantage plans in North Carolina. In 2020, 1.2 million residents enrolled in a traditional Medicare plan while 800,000 people chose Medicare Advantage instead. You may not require all of the additional coverage options provided by an Advantage plan, but if you do, you'll want to investigate your options with private insurers that offer Medicare Advantage. Medicare Supplement plans can significantly reduce your bills, so if you require ongoing care or fear not being able to afford expensive treatment in the future, one of these plans may work for you. 

Who Is Eligible for North Carolina Medicare? 

In short, everyone is able to enroll in Medicare in North Carolina. Your costs will vary based on different factors, however. If you turn 65 and have been collecting your Social Security benefits for four months, you are going to be enrolled in Medicare Part A and B automatically on your 65th birthday. However, if you are not receiving your retirement benefits or did not contribute enough to Social Security over your lifetime, you will need to enroll yourself. 

If you meet the criteria for automatic enrollment, Medicare Part A will be considered a part of your Social Security benefits. Part B is not free, however, and could cost up to $150 a month. This is not a fixed rate, so it could change over time. You do not need to worry about paying your premium from month to month, as it will be deducted automatically from your Social Security payments. 

Since Medicare Advantage plans are not all the same, your coverage and monthly premium could vary depending on the plan you select. A portion of your costs is subsidized by the government, which will reduce the cost of your plan. If you enroll in Medicare Part D, you will need to pay a monthly premium. The cost will depend on how much coverage you decide you would like. 

Your initial enrollment period begins three months before you turn 65. You have 90 days following your birthday to enroll if you were not enrolled automatically. Failure to do so could result in penalties that will increase the cost of Medicare Part B coverage. You will be exempt from this penalty if your reason for missing the deadline was due to remaining with your employer’s health plan, you suffer from a disability or you were out of the country for volunteer work or in service to the nation. Make sure to look for a special enrollment period if you qualify for an exemption. 

Medicare Supplement plans are not part of Social Security, and they aren't administered through Medicare. You do have the right to enroll in one of these plans within six months of your birthday without being charged extra due to your age or health status. The law prohibits a private insurer from denying you coverage as long as you enroll within this time. 

How Do I Enroll for Medicare in North Carolina? 

Everything that you need to enroll in Medicare can be found on Medicare.gov. If you follow the prompts, you can learn more about each plan, enroll online and change your plan during open enrollment periods. Because Medicare does not provide any Medicare Supplement plans itself, you will need to speak with a private insurance company that offers one of these plans to sign up. 

Contact Information for North Carolina Medicare, Medicaid and Insurance Help 

If you need more information about Medicare or help finding the right insurance company, you may find the following resources useful:

Seniors’ Health Insurance Information Program 

Medication Assistance Program 

North Carolina Medicaid Eligibility and Enrollment 

Health Insurance Options for People on Medicare Due to Disability