The Best Medicare Supplement (Medigap) Plans in North Carolina
- North Carolina Medigap plans help beneficiaries cover Medicare copays, deductibles and other costs. Be sure to read our review of North Carolina Medicare supplement plans before selecting a policy.
Because Original Medicare doesn’t typically reimburse for 100% of covered services and supplies, more than 41% of Part A and B beneficiaries in North Carolina purchase Medicare supplement insurance (Medigap) to help with the remaining costs.1 These plans, which are sold by private insurers in the state, are meant to help defray the cost of Medicare-related expenses such as copays, coinsurance and deductibles.
If you want to join the 500,000+ North Carolina beneficiaries who have a Medigap plan to help manage the expense of medical care, it’s important to first learn the ins and outs of this supplemental coverage. In this article, we’ll explore available coverage options, popular plans and enrollment dos and don’ts, so you can find and purchase a plan that’s right for you.
You can find Medicare Supplement plans where you live by comparing plans from several different insurance companies online.
What Are the Best North Carolina Medicare Supplement Plans?
With 10 different types of Medigap plans to choose from, North Carolina beneficiaries have plenty of coverage options. Each plan type is distinguished by a letter between A and N, and the plans are standardized regardless of where you purchase insurance, so the main difference among insurers is the premium you'll pay for your policy. That means although different insurers may charge different amounts for plans of a certain letter, those plans still provide the same coverage amounts and range of benefits.
All 10 plans include a foundation of core benefits, such as reimbursement for Part A and B coinsurance and 365 days of in-hospital care after Original Medicare benefits have been exhausted. Other benefits vary by plan type and may include up to 100% of coverage for the following services and supplies:
- Part A and B deductibles
- Skilled nursing facility services coinsurance
- Medical treatment received in a foreign country
- The cost of outpatient treatment that exceeds Part-B-approved amounts.
A more complete comparison of covered benefits broken down by plan letter is detailed in the chart below.
|Medicare Supplement Benefits||A||B||C1||D||F1||G||K||L||M||N|
|Part A coinsurance and hospital costs||✓||✓||✓||✓||✓||✓||✓||✓||✓||✓|
|Part B coinsurance or copayment||✓||✓||✓||✓||✓||✓||50%||75%||✓||✓|
|First 3 pints of blood||✓||✓||✓||✓||✓||✓||50%||75%||✓||✓|
|Part A hospice care co-insurance or co-payment||✓||✓||✓||✓||✓||✓||50%||75%||✓||✓|
|Co-insurance for skilled nursing facility||✓||✓||✓||✓||50%||75%||✓||✓|
|Medicare Part A deductible||✓||✓||✓||✓||✓||50%||75%||50%||✓|
|Medicare Part B deductible||✓||✓|
|Medicare Part B excess charges||✓||✓|
|Foreign travel emergency||80%||80%||80%||80%||80%||80%|
|1. Plans C and F are not available to new beneficiaries who became eligible for Medicare on or after January 1, 2020.
2. Plans F and G also offer a high deductible plan which has an annual deductible of $2,700 in 2023. Once the annual deductible is met, the plan pays 100% of covered services for the rest of the year. The high deductible Plan F is not available to new beneficiaries who became eligible for Medicare on or after January 1, 2020.
3. Plan K has an out-of-pocket yearly limit of $6,940 in 2023. Plan L has an out-of-pocket yearly limit of $3,470 in 2023.
4. Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to $50 for emergency room visits that don’t result in an inpatient admission.
View an image version of this table.
Important Facts About Medigap Coverage
Before you decide on a Medigap plan, there are other things you should know about these supplemental policies:
- Purchasers with pre-existing conditions may have wait times. Although you may still enroll in any Medigap plan if you have a diagnosed medical condition, wait times may apply before reimbursement begins.
- Many plans don’t have annual out-of-pocket limits. If you have a condition that requires expensive treatments, you may want to consider the annual out-of-pocket spending limit. Most Medigap plans don’t limit what you can spend in a calendar year, which means seniors who are undergoing regular treatments may incur high out-of-pocket costs despite their supplemental coverage. However, Plans K and L pay 100% of covered services after certain criteria has been met.
- Not every insurer sells the same plans. All insurance companies that sell Medigap plans must sell Plans A, C and F, but they aren’t required to sell other plans, so the selection may vary between providers.
- Some plans are more popular with U.S. seniors. Plans F, G and N are the most popular Medigap plans currently being offered, likely because they can be purchased at a lower price. However, despite their more affordable premiums, these three plans often come with high deductibles. That means you’ll have to spend more before your coverage kicks in.
- Not all plans are available to everyone. Plans C and F are only available to seniors who were Medicare eligible prior to the beginning of 2020.
When shopping for a policy, it’s important to remember that one plan isn’t necessarily better than another. Ultimately, the best Medigap policy is the one that suits your unique medical and budgetary needs.
How Do I Enroll in a North Carolina Medigap Plan?
Seniors who are 65 and enrolled in Original Medicare may purchase a Medigap policy to supplement Part A and B coverage. Although this insurance is offered through private insurance companies, plans must follow federal guidelines. These guidelines extend a standard six-month open enrollment period to all Medicare beneficiaries, typically beginning as soon as you are at least 65 years old and enrolled in Part B.
Seniors who are still employed and receiving company- or union-sponsored health benefits at age 65, may be able to apply for Medigap plans after they retire and enroll in Medicare Part B. At this time, they’ll typically have the standard six-month Medigap open enrollment period to apply for a plan without undergoing medical underwriting.
Under the federal guidelines governing Medigap, insurers may not use medical underwriting processes to determine an applicant’s eligibility during their open enrollment period. That means if you’re 65 or older and enrolled in Medicare Part B, you can’t be denied coverage or charged more for a plan due to health risks regardless of the company you’re purchasing a plan from if you apply during your Medigap open enrollment period or another time when you have guaranteed issue rights.
However, if you want Medicare supplement insurance and have an underlying medical condition, it’s important to purchase a plan during your open enrollment period because you’re no longer guaranteed coverage once it ends. After your Medigap open enrollment period closes, companies are legally permitted to use medical underwriting processes to assess an applicant’s risk profile. If you're approved for coverage, you may be charged a higher premium depending on the outcome of the underwriting process.
In certain circumstances, seniors may be protected under guaranteed issue rights after their open enrollment period ends. These federal protections grant seniors the right to purchase a Medigap policy outside their open enrollment period, without being at risk for denial of coverage or going through medical underwriting.
Guaranteed issue rights may apply in the following common situations:
- Losing a Medicare Advantage plan: If your MA plan was discontinued or no longer covers your region of residence and you chose to revert to Original Medicare, you may be covered under a guaranteed issue right.
- Losing a prior Medigap plan: If you were previously enrolled in Medicare supplement insurance but lost it through no fault of your own, you may be entitled to select a new plan under a guaranteed issue right.
- Losing employer- or union-sponsored supplemental coverage: If you lost supplemental coverage that was supplied through an employer, a union or COBRA, you may be able to invoke a guaranteed issue right.
Guaranteed issue rights don’t apply to beneficiaries who’ve lost North Carolina Medicare Advantage coverage but who opt to enroll in another MA plan or prior Medigap policyholders who’ve lost coverage due to a failure to pay premiums.
AHIP. (Feb. 2023). The Sate of Medicare Supplement Coverage Trends in Enrollment and Demographics. https://www.ahip.org/documents/202301-AHIP_MedicareSuppCvg-v03.pdf.