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How Do You Qualify for Medicare?

Medicare is a federally-funded health insurance program. American citizens living in the United States qualify for Medicare once they turn 65. They may also qualify if they are under 65 and meet one of the following conditions:

  • Receive Social Security disability insurance (SSDI) for at least 24 months
  • Have End-Stage Renal Disease (ESRD)
  • Have amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig's disease)
  • Receive Railroad Retirement Benefits

There is no income requirement to qualify for Medicare.

What Medicare Plans Are Available in North Carolina?

Medicare enrollees have multiple options to receive their benefits.

  • Original Medicare includes Part A (hospital insurance) and Part B (medical insurance)
  • Medicare Advantage MA) plans, also known as Part C, cover the same services as Original Medicare, with most MA plans offering additional coverage
  • Medicare Part D plans provide prescription drug coverage
  • Medicare Supplement Insurance plans, also known as Medigap, help pay for some of the costs not covered by Original Medicare

Private insurance companies provide Medicare Advantage, Part D, and Medigap plans. Coverage and costs vary according to each plan and provider. However, beneficiaries still pay their Part B premium, even if they have an MA plan.

North Carolina does not require Medigap providers to offer plans to beneficiaries who are under age 65.

Medicare Savings Programs in North Carolina

Although Medicare is a federally-funded program, there are state-level programs to help North Carolinans pay their Medicare costs. These are known as Medicare Savings Programs (MSPs) and include:

  • Qualified Medicare Beneficiary (QMB) Program
  • Special Low-Income Medicare Beneficiary (SLMB) Program
  • Qualifying Individual (QI) Program
  • Qualified Disabled and Working Individuals (QDWI) Program

While Medicare has no income requirements, MSPs do. Refer to the table below to see the income and resource limits for each program. If you are still employed, you may qualify even if your income exceeds these limits. It's always worth applying to see if you qualify.

Medicare Savings Program Requirements (North Carolina)

Program Name

QMB Program

SLMB Program

QI Program

QDWI Program

Individual Income

$1,153 Per Month

$1,379 Per Month

$1,549 Per Month

$4,615 Per Month

Married Income

$1,546 Per Month

$1,851 Per Month

$2,080 Per Month

$6,189 Per Month

Individual Resources

$8,400

$8,400

$8,400

$4,000

Married Resources

$12,600

$12,600

$12,600

$6,000

Helps Pay

All out-of-pocket costs

Part B Premiums

Part B Premiums

Part A Premiums

Additional North Carolina Medicare Resources

You can also call ClearMatch™ Medicare toll-free at 1-888-992-0738. Our licensed agents are happy to answer your questions and guide you through the Medicare program. The best part? Working with ClearMatch™ Medicare is always free!

Find a Medicare Plan in your area

It’s FREE with no obligation

The ClearMatch Medicare website is operated by HealthPlanOne, LLC a licensed health insurance agency based in Connecticut; in California d/b/a ClearMatch Insurance Agency, license #OF30784, in Florida d/b/a ClearMatch Insurance Agency, license #L003887, and in New York d/b/a ClearMatch Insurance Agency, license #LA-1024797. HealthPlanOne represents Medicare Advantage [HMO, PPO, PFFS, and PDP] organizations that have a Medicare contract. ClearMatch™ Medicare is not affiliated with the federal government. Enrollment in any plan depends on contract renewal .

We do not offer every plan available in your area. Currently we represent 36 organizations nationally which offer more than 4,135 products nationally. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.

PLEASE NOTE: Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability, ALS (Amyotrophic Lateral Sclerosis also known as Lou Gehrig’s disease) or End-Stage Renal disease.

Medicare supplement plans cannot be held with Medicare Advantage plans.

The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.

Medicare supplement plans are not connected with or endorsed by the U.S. Government or the federal Medicare program.

The Centers for Medicare and Medicaid Services (CMS) does not review or approve Medicare Supplement plan information.

*Since 2019, we’ve had over 4 million unique customers.

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Last Updated 09/26/2024