PolicyScout’s Guide to Medicare Advantage Plans in North CarolinaFind out which Medicare Advantage plans are available in North Carolina and how you can apply.
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In North Carolina, Medicare Advantage and private health care plans are becoming more popular each year.
However, all the different pricing options, health insurance providers, and plan types can make it difficult to find a plan that is right for you.
This article will explore Medicare Advantage and how to find the best private health care in North Carolina.
What Is Medicare?
Medicare is a federal government health scheme for people over 65, individuals with disabilities, and those that suffer from ESRD (End-Stage Renal Disease) and ALS (Lou Gehrig’s disease).
The Medicare Parts Explained
Medicare is divided into different “parts” that separate expenses and coverage for medical services, tests and items.
Medicare Part A is hospital insurance and covers hospital expenses or treatment you receive as an inpatient.
Medicare Part B insurance pays for outpatient or general medical expenses as well as preventative services.
Medicare Part C, also known as Medicare Advantage, are private health insurance plans that offer the same coverage as Original Medicare (Part A and B cover).
These policies often include prescription drug coverage and offer additional benefits, such as dental, hearing, and vision cover.
Medicare Part D insurance covers the costs of self-administered prescription drugs. For example, medication for blood pressure, back pain, or chronic conditions.
Your Medicare Coverage Options in North CarolinaHere are the different Medicare options:
Medicare Supplement Insurance Plans offer their members additional coverage for out-of-pocket costs that Original Medicare doesn’t cover.
Part D Plans, also known as Prescription Drug Plans (PDPs), are stand-alone drug plans that cover prescription drug costs.
Terms you should know:
Monthly Premium is a fee you pay to be a member of Part D drug plans, Medicare Advantage, or Medicare Supplement Plans.
Deductibles are amounts that beneficiaries have to pay before their Medicare insurance starts to cover medical expenses.
Coinsurance amounts are portions of medical costs that beneficiaries have to pay for treatments, services, and tests.
Copayments are set amounts that beneficiaries pay for medical services, tests, and items.
Out-of-pocket costs are expenses that Medicare or a private health insurance company won’t cover.
Medicare Advantage (previously known as Medicare Part C) is private health insurance with the same benefits as Original Medicare. Most Medicare Advantage plans also include prescription drug costs and dental, hearing, and vision expenses.
There are two main types of Medicare Advantage plans in North Carolina:
MA Plans (without Medicare prescription drug coverage) - These private health plans do not offer prescription drug coverage (Part D) and only cover Part A and Part B expenses.
MA-PD Plans (with Medicare prescription drug coverage) - These are private health plans that cover Part A and B medical expenses and also offer prescription medication coverage for (Part D) expenses.
Understanding the different MA and MA-PD plan structures
Medicare Advantage plans also have unique structures which can influence costs, benefits, and coverage. Here are some of the different private health plan structures:
Health Maintenance Organization Plans (HMO plans) offers health insurance through a specific health care provider network. People on HMOs are usually assigned a primary care doctor and are only covered for service in-network.
HMO point-of-service Plans (HMO-POS plans) cover some health care costs outside your network, but monthly premiums and copayments are usually higher than HMO plans.
Preferred Provider Organization Plans (PPO plans) allow you to see any provider that accepts insurance. You don’t need a referral from your primary care doctor to see a specialist.
Private Fee-for-Service Plans (PFFS plan) allows members to see any health care provider enrolled in Medicare who accepts your plan.
Special Needs Plans (SNPs) are for people with specific needs or diseases. For example, these can be people who live with chronic conditions or live in assisted living facilities.
Private Medicare Coverage in North Carolina
In North Carolina, Medicare Advantage plans are becoming more popular every year. This can be seen in the state penetration rate, which is the ratio of Medicare-eligible people who have joined a Medicare Advantage plan.
For example, if ten people are eligible for Medicare and six have a Medicare Advantage plan, the penetration rate is 60% (6 out of 10 people).
MA and MA-PD plans in North Carolina had a 43.9% penetration rate in 2021, which means that for every 100 Medicare-eligible people, around 43 to 44 have a Medicare Advantage plan.
This graph shows how Medicare Advantage membership has grown in North Carolina.Total Number of Medicare Advantage Beneficiaries in North Carolina, 2014 - 2020
According to the Kaiser Family Foundation, the number of Medicare Advantage plan members in North Carolina has increased from 475,432 to 802,645 in the last six years.
Similarly, the number of Medicare Advantage plans offered by health care companies has increased:
In 2021, there were 126 Medicare Advantage plans available in North Carolina.
In 2022, there will be 145 Medicare Advantage plans offered in the state.
If you don’t know which plan is right for you, speak to PolicyScout’s expert advisors at 1-888-912-2132 for assistance with your Medicare Advantage questions in North Carolina. If you want to get started with finding Medicare Advantage plans in your county, simply enter your ZIP code below.
Key Facts about Medicare Advantage in North Carolina
Learning about Medicare in your state can help you understand what you can expect when joining a private health plan.
Here are some key takeaways you should consider about Medicare in North Carolina:
Monthly premiums for private health plans are going down. In 2021, the average monthly premium cost for Medicare Advantage plans in North Carolina was $16.51. In 2022, the average monthly premium will be $15.22.
According to the Centers for Medicare and Medicaid Services (CMS), as of November 2021, there are 2,082,459 Medicare beneficiaries in North Carolina. Approximately 943,277 are members of an MA or MA-PD plan.
In North Carolina, all Medicare-eligible individuals can join a Medicare Advantage plan and purchase a $0 monthly premium Medicare Advantage plan. These are plans that do not charge members a monthly price to join.
- Just remember, when you enroll in a $0 monthly premium plan you will still have to pay your Medicare Part A and Part B monthly premiums.
You should be able to find health care providers that will treat you at Medicare rates because the majority of medical professionals in North Carolina accept Medicare. Of the 26,758 registered physicians in the state, only 258 opted out of Medicare (that's under 1% of physicians).
Which Health Insurance Companies Offer Medicare Advantage in North Carolina?
North Carolina will have 145 MA and MA-PD plans in 2022. North Carolina Medicare beneficiaries can purchase policies from a variety of providers, including:
Alignment Health Plan
Blue Cross and Blue Shield of North Carolina
Care N' Care Insurance Company of North Carolina
Terms you should know:
Monthly Premium is the monthly fee you pay to be a member of Part D drug plans, Medicare Advantage, or Medicare Supplement Insurance Plans.
Deductibles are amounts that beneficiaries have to pay before their Medicare insurance starts.
Coinsurance is the portion of medical costs that beneficiaries have to pay for medical treatment, services, and tests.
Copayments are set amounts that people have to pay for services, tests, and items.
Out-of-pocket costs are any expenses that aren’t covered by Medicare or private insurance companies.
How to Choose Medicare Advantage Plans in North Carolina
If you want to get a Medicare Advantage plan in North Carolina, use these tips to find the best coverage:
1. Choose whether you want a plan that includes prescription drug coverage (MA-PD) or one that only covers Part A and B expenses (MA-only).
2. Check to see if your insurance carrier offers plans in your area. Many people are unaware that Medicare Advantage providers have different plans depending on where you live.
For example, in Guilford County, there were 34 Medicare Advantage plans to choose from in 2021. However, in Pamlico County, there were only 13 Medicare Advantage plans.
3. Look at the costs associated with the plan you would like to sign up for and check if you can afford your plan if the price goes up because of inflation.
4. Make sure you can afford the monthly premiums and out-of-pocket charges (costs that your plan does not cover), like deductibles, coinsurance, and copayments.
5. You should also research the plan and the health insurance company's Medicare Star Rating. For good measure make sure you find out what other third-party reviewers, such as ConsumerAffairs and JD Power, say about the health insurance company and plans you’re interested in.
What are Medicare Star Ratings?
The Centers for Medicare & Medicaid Services releases an annual report on the quality and performance of each private Medicare plan and provider. They do this through a scoring system called the Medicare Star Ratings.
Each plan and provider will receive a score of out five, which tells beneficiaries how well the plan performed in the year.
Here’s what the different star ratings mean:
⭐⭐: Below average
If you want to learn more, read our guide to Medicare Star Ratings. You can check out your plan’s current star rating by visiting the Medicare.gov website. Simply search your county’s ZIP code, find your plan, and check the number of stars it received.
6. Ask around and check with friends or family who have Medicare about their experiences using particular private insurance companies or Medicare Advantage plans.
7. Speak to a licensed Medicare insurance agent about the plan’s benefits, perks, and coverage. You’ll be able to see if the plan is the right one for you.
8. Compare your options before making a final purchase. Check to see if there are other providers that offer similar plans.
Important Enrollment Dates for Medicare in North Carolina
Once you've found a plan, it's essential to understand when you should apply. Here are some important enrollment dates you should keep in mind if you want to join a Medicare Advantage plan in North Carolina:
Initial Enrollment Period
This is your first chance to sign up for Medicare once you are eligible and begins three months before your 65th birthday. During the Initial Enrollment Period you can sign up for Medicare Part A and B, or join a Medicare Advantage plan or a Prescription Drug Plan.
General Enrollment Period
From January 1st to March 31st, you can sign up for Medicare Parts A and B, as well as a Medicare Advantage Plan if you missed your Initial Enrollment Period.
Special Enrollment Period
These are periods when you can enroll outside the regular enrollment periods. There are specific circumstances when someone qualifies for a special enrollment period. For example, if you move states or if your union healthcare coverage ends.
For more information, feel free to read our guide to Medicare Open Enrollment Period 2022.
How Can I Find Out More about My Health Care Options?
PolicyScout’s Medicare Hub has articles on Original Medicare, Medicare Supplement Plans, costs, enrollment, coverage, and benefits.
Our experienced Medicare consultants are ready to answer your Medicare questions.