Medicare Advantage Plans in North Carolina

Medicare Advantage lets seniors and other eligible individuals combine their Medicare Part A and Medicare Part B benefits into one single plan. The plan is also known as Medicare Part C and includes varying levels and types of coverage because it’s provided by private insurers instead of by the federal government, which provides Original Medicare. In fact, Medicare Advantage plans are required to cover the same health care services as Original Medicare at a minimum, with the exception of hospice care. In most cases, insurers extend these benefits to provide extra coverage for health care services, such as eye care, dental care and nutrition programs.

Prescription drug coverage is frequently included in Medicare Advantage plans as well, ensuring that seniors can access the medications they need without subscribing to extra coverage. Plan providers do have the option to set their own costs, network regulations and rules for referrals, so it’s important to consider these factors prior to purchasing a Medicare Advantage plan. In 2020, 1 little more than 2 million residents of North Carolina are eligible for Medicare and of those who are, more than half are enrolled in Medicare Advantage, which is above the U.S. average of 42%.

In this guide, you can gain a better understanding of North Carolina’s available Medicare Advantage plans, including coverage options, eligibility requirements and how to enroll for coverage.

The Top 10 Medicare Advantage Plans in North Carolina

North Carolina has a variety of Medicare Advantage plans available, each offering varying levels of coverage, copays, deductibles and premiums.

The table below lists the state’s 10 most popular Medicare Advantage plans based on enrollment numbers. In some cases, providers may offer multiple Medicare Advantage plans. When this occurs, cost information may be listed as a range instead of an average price, and a sum of enrollment numbers for each of those plans is listed, providing information about the provider’s total enrollment numbers throughout the state.

This table is accurate as of April 2022. For more accurate and up-to-date information, visit Medicare.gov to view the plans that are available across North Carolina.

How Medicare Advantage Plans Work in North Carolina

There are several types of Medicare Advantage plans in North Carolina, and before you select one, it’s important to ensure that you know how each one works. 

Plan types include health maintenance organizations (HMOs), preferred provider organizations (PPOs) medical savings accounts (MSAs) and special needs plans (SNPs), each of which are subject to different rules and regulations when it comes to referrals, out-of-network care and primary care providers. Further descriptions of these options are outlined below.

What Medicare Advantage Plans Cover in North Carolina

While every plan varies, all Medicare Advantage plans in North Carolina are required to provide coverage for all services covered by Original Medicare, except for hospice care. That means seniors who are enrolled in Medicare Advantage have coverage for services such as X-rays, primary care, laboratory testing and hospital care. Medicare Advantage also typically includes additional coverage for services such as eye care and hearing tests.

*Select plans offer this coverage

** Most plans offer this coverage

Eligibility for Medicare Advantage in North Carolina

Those wanting to enroll in a Medicare Advantage plan must meet the Medicare eligibility requirements. That means they must be aged 65 or older and a United States citizen or legal permanent resident.

They also must already be enrolled in Medicare Part A and Medicare Part B, and they must reside within their provider’s and plan’s service area. 

Medicare plans have limited enrollment periods, meaning that seniors may only initiate coverage at specific times throughout the year. The list below further explains how enrollment periods work, when they are and what to do when you miss your initial enrollment period.

• Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
• Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
• Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.

Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.

How to Find & Choose a Medicare Advantage Plan in North Carolina

Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.

First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.

State-Wide Medicare Advantage Resources

Local Medicare Advantage Resources