Table of Contents

Medicare Plans by State

STATE -Select-
  • Alabama
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
Page Reviewed / Updated – September 17, 2022

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.

Name

Total Enrollment

Star Rating

Min Cost

Max Cost

Plan Types

Humana

373,348

4

$0

$136

HMO, PPO, PFFS

UnitedHealthcare

330,544

#N/A

$0

$199

HMO, PPO

Aetna Medicare

139,598

4

$0

$24

HMO, PPO

Blue Cross and Blue Shield of North Carolina

87,432

4.5

$10

$49

HMO, PPO

Wellcare

21,971

3

$0

$99

HMO, PPO

Cigna

19,315

3.5

$0

$29

HMO, PPO

CARE N’ CARE INSURANCE COMPANY OF NORTH CAROLINA

13,982

5

$75

$75

PPO

FirstMedicare Direct

5,470

4

$35

$149

HMO, PPO

Experience Health, Inc.

3,898

4

$0

$0

HMO

Blue Cross Blue Shield of Michigan

3,161

0

$0

$0

PPO

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.

Medicare Advantage Plan Types Graphic

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.



Coverage Available With Medicare Parts A & B?

Coverage Available With Medicare Advantage?

Preventive Screenings

Yes

Yes

Hospital Care

Yes

Yes

Durable Medical Equipment

Yes

Yes

Prescription Drugs

No

Yes**

Vision Care

No

Yes*

Dental Care

No

Yes*

Hearing Aids

No

Yes*

*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.

Start Date

End Date

Initial Coverage Election
Period

3 Months Before One’s
65th Birth Month

3 Months After One’s
65th Birth Month

Annual Election Period
(AEP)

October 15th

December 7th

Medicare Advantage Open
Enrollment Period

January 1st

March 31st

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.

Choose a Medicare Advantage Plan



State-Wide Medicare Advantage Resources

Medicare and Seniors’ Health Insurance Information Program (SHIIP)

SHIIP provides free, unbiased guidance to help Medicare beneficiaries and caregivers understand Medicare health care products. Counselors in every county meet with seniors by appointment only. Through the NC Senior Medicare Patrol Program, counselors help seniors recognize and avoid Medicare billing errors, fraud and abuse. SHIIP also offers information on its website, including this fact sheet, which discusses Medicare Advantage terms, enrollment periods and questions to ask when comparing plans. This program is available for current Medicare clients, people looking to enroll soon and their caregivers.

Contact Info

SHIIP can be contacted by phone at 1-855-408-1212 or by email at [email protected]. Seniors can consult this list of contacts for local counseling by county. They can also reach counselors through local Area Agencies of Aging.

Visit Website Email
Options Counseling

Options Counseling helps seniors make informed decisions regarding long-term services and supports. This free service guides seniors through assessing the benefits and drawbacks of different options in light of their situation, values, preferences and resources. The program can benefit those who do not know how to take advantage of long-term services and supports, such as Medicare Advantage, or are unaware of existing local supports and resources. Options Counselors can also assist seniors with planning for future needs and help them formulate an individualized Action Plan.

Contact Info

Options Counseling is expanding throughout the state, so it may not be available in all areas yet. To see if there is an Options Counselor in their county, seniors can contact the program manager by email at [email protected].

Email
Long-Term Care Ombudsman

The Long-Term Care Ombudsman Program (Advocacy for Residents in Long- Term Care Facilities) is made up of the State Long-Term Care Ombudsman and 16 Regional Long-Term Care Ombudsmen. These officials help long-term care facility residents secure their rights and work through grievances between residents, families and facilities. They explain long-term care options and investigate financial concerns, including Medicaid, Medicare and Social Security. Guidance is offered for Medicaid and Medicare, particularly on coverage conditions, the application process and the services covered. The ombudsmen also educate long-term care providers and community groups on residents’ rights, care planning and new legislation.

Contact Info

The Office of the Long-Term Care Ombudsman Program can be reached by email at [email protected],[email protected] or [email protected]

Email

Local Medicare Advantage Resources

Area Agencies on Aging

Established through the Older Americans Act, North Carolina’s Area Agencies on Aging (AAAs) are local programs that connect seniors and their caregivers with a wide range of local services and resources. These agencies develop, enhance and support systems designed to preserve dignity and promote independence for seniors. North Carolina has 16 AAAs located within regional Councils of Government. These agencies are direct providers of information and referral or assistance, educating seniors about available services in their community and helping them gain access to those benefits. AAAs advocate for seniors on local and state concerns beyond the services and programs they render or fund. Available services include case management, meals, in-home services, transportation and counseling on health insurance and benefits.

Contact Info

AAAs are dispersed throughout the state of North Carolina. A list of locations and contact information can be found on their website.

Visit Website
Community and Senior Services of Johnston County

Community and Senior Services of Johnston County (CSS) is a private senior support organization in Smithfield. It provides home-delivered meals, in-home aides, housing assistance and transportation accommodations throughout the county. The nonprofit also has centers in Benson, Clayton, Harrison, Kenly and Princeton. CSS is a certified official counseling site for SHIIP and has an Options Counselor available to discuss long-term options, based on needs and preferences. The counselor acts as a liaison between seniors and services, following up with each person with status check-ins. Seniors who need help paying for Medicare coverage can ask the Options Counselor about the Extra Help Program. CSS holds SHIIP workshops at some of its senior centers, by appointment only, for seniors and caregivers looking for information about Medicare. Seniors can consult the bi-monthly newsletter on the CCS home page to find events near their location.

Contact Info

CSS is located at 1363 West Market Street in Smithfield. To make an appointment with an Options Counselor, seniors can call 1-919-934-6066. 

Resources for Seniors, Inc.

Resources for Seniors provides information and support for seniors and adults with disabilities in Wake County. This private organization coordinates direct services, including adult day care, home care and senior centers to foster independence, security and comfort. It publishes a free annual directory of resources for the Triangle area, available in print or by PDF download.

Contact Info

Information Services at Resources for Seniors is available weekdays by phone, email and fax. Seniors can call 1-919-872-7933 to reach an Information and Referral Specialist who can assess their situation, help them identify the services they need and point them to the appropriate programs and resources.