Medicare Advantage (MA) enrollment has nearly doubled over the past decade. The growing popularity is mostly due to expanded plan offerings and more robust coverage. In 2023, over 30 million people had Medicare Part C (more commonly known as Medicare Advantage). This page explains the program and how to compare Medicare Advantage plans in North Carolina.
What is Medicare Advantage in North Carolina?
At a minimum, North Carolina Medicare Advantage plans must provide the same coverage you would get with Original Medicare. This includes Medicare Part A, hospital insurance, and Medicare Part B, medical insurance.
Prescription drug coverage is not included with Original Medicare. For that, you need Medicare Part D.
In addition to services covered by Parts A and B, most Advantage plans provide additional benefits. Common "extras" include prescription drug coverage, routine vision services, fitness benefits, and hearing aids.
North Carolina Medicare Advantage plans with prescription drug coverage
Medicare Advantage Prescription Drug plans (MA-PD) combine your Parts A, B, and D benefits. These all-in-one plans are a popular choice for beneficiaries looking to simplify their Medicare coverage.
How do you qualify for Medicare Advantage in North Carolina?
You qualify for Medicare Advantage in North Carolina if you have Medicare Parts A and B.
American citizens and permanent legal residents become eligible for Medicare when they turn 65. If you begin collecting Social Security at least 4 months before your 65th birthday, enrollment is automatic.
You can qualify before turning 65 if you collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months. Enrollment occurs automatically in month 25.
When can you join a Medicare Advantage plan in North Carolina?
There are five Medicare Advantage enrollment periods:
- Initial Enrollment Period: Your IEP begins 3 months before your Medicare eligibility month and lasts for 7 months. For example, if your 65th birthday or 25th month of collecting disability is in August, your IEP starts on May 1 and ends on November 30.
- General Enrollment Period: If you missed your IEP, you may enroll in Parts A and B during General Enrollment from January 1 through March 31. Your window to join a Medicare Advantage plan opens April 1 and closes June 30.
- Annual Enrollment Period: You can join an Advantage plan any time during AEP, which starts on October 7 and ends December 15.
- Medicare Advantage Open Enrollment Period: People who already belong to a Medicare Part C plan may either change to a new one or return to Original Medicare from January 1 through March 31.
- Special Enrollment Periods: People who experience special circumstances, like moving or losing their current coverage, can join an Advantage plan during a Special Enrollment Period. Guidelines are available on Medicare.gov.
Types of Medicare Advantage plans in North Carolina
The four most common types of Medicare Advantage plans in North Carolina are:
- Health maintenance organizations (HMO) plans require members to use a provider network, choose a primary care doctor, and obtain a referral to consult with a specialist. HMO plans typically do not cover out-of-network services except in cases of emergency.
- Preferred provider organizations (PPO) plans also have provider networks but allow members to visit an out-of-network provider for a higher copay. You do not need to choose a primary doctor or get a referral to see a specialist if you have a PPO plan.
- Private fee-for-service (PFFS) plans set fees for all covered services, including your out-of-pocket cost. Out-of-network providers may refuse to treat you if they do not accept the plan (and it is not a medical emergency).
- Special needs plans (SNPs) limit membership to certain populations. One of the following must apply to you before you may join an SNP: have a chronic condition, qualify for both Medicare and Medicaid (dual eligible), or live in a nursing home/require home healthcare. All services covered by an SNP are geared toward the plan's target population.
How to choose a Medicare Advantage plan in North Carolina
Before joining a Medicare Advantage plan in North Carolina, compare your options carefully to be sure you get the best plan for your particular needs. Metrics you should review include:
- Coverage (including the drug formulary if it is an MA-PD plan)
- Provider network
- Plan ratings
Comparing North Carolina Medicare Advantage plans is easy with our Find a Plan tool. Just enter your location information and coverage start date to review Medicare plans in your area.
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