Medicare Advantage Plans in North Carolina

Medicare Advantage in North Carolina offers a different way to receive Medicare coverage. Private insurance companies contract with and receive funding from Medicare to provide all the benefits from Original Medicare (Medicare Part A and Part B).

In addition to the Original Medicare benefits, Medicare Advantage plans offer additional coverage and benefits that meet their members' specific needs.

Medicare Advantage Plan members still have to pay the Part B premium to maintain their eligibility for health plans. For 2022, the standard monthly premium for Part B is $64.90. The annual deductible for Part B is $226.

Facts about North Carolina Medicare Advantage Plans:

  • Medicare Advantage Plans in North Carolina are becoming more popular every year
  • A specific network of hospitals, doctors (including primary care physicians), and facilities provide the most plan benefits
  • Advantage plans described as “MAPD” include prescription drug benefits
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Top-rated Medicare Advantage Plans in North Carolina

  • Humana
  • Cigna
  • Care Improvement Plus
  • Aetna Medicare Select
  • Day Break HMO
  • Patriot
  • Blue Medicare HMO
  • WellCare Advance
  • Kaiser Permanente

Popular Medicare Advantage Plan Types in North Carolina

Best network freedom: Medicare Advantage PPO

North Carolina PPO plans offer a larger group of network providers and require no referrals.

PPO monthly premiums range from $0 to $100.

Best for lowest out-of-pocket: Medicare Advantage HMO Plan

HMO plans generally offer premiums of $0 per month.

There are lower out-of-pocket costs because it uses the HMO referral network.

Best plan for low-income or health conditions: Medicare Advantage D-SNP

Medicare Advantage D-SNP (dual eligible special needs) plans are best for people with minimal income or chronic health conditions.

Beneficiaries with a Medicare Advantage D-SNP plan can have Medicare and Medicaid to decrease out-of-pocket costs on copays, coinsurance, premiums, and more. Deductibles may also be affected by income level.

North Carolina Enrollment facts

1. Number of people enrolled in Medicare Advantage in North Carolina

More than 2,021,000 North Carolina residents are enrolled in Medicare.

Of that number, about 40% chose a Medicare Advantage Plan.

2. Number enrolled by plan, specifically the three plans below.

  • Local PPO: 325,827
  • Local HMO: 267,560
  • Regional PPO: 35,878
  • PFFS (private fee for service): 4,384

3. Percentage of Medicare beneficiaries enrolled in Medicare Advantage in North Carolina

Statistics show that about 40% of North Carolina residents enrolled in Medicare Advantage plans in 2021, an increase of 12% from 2020.

4. Number of lives enrolled in Medicare Advantage nationwide

Experts expect 29.5 million people to enroll in Medicare Advantage in 2022.

5. Percentage of Medicare beneficiaries enrolled in Medicare advantage Nationwide

Nationwide, 42% of Medicare beneficiaries are enrolled in Medicare Advantage plans.

How much does Medicare Advantage in North Carolina cost?

Most States offer an HMO plan with a $0 monthly premium.

Some states offer a PPO with a $0 monthly premium.

It is becoming increasingly common for PPOs to have premiums.

North Carolina’s average Part C premium for a plan that also has drug coverage is $19.47

How much do Advantage Plans cost in North Carolina?

PPO Plan $0.00 to $19.47

HMO Plan $0.00

When can I enroll in a Medicare Advantage plan?

Initial Enrollment Period

The first opportunity to enroll in a North Carolina Medicare Advantage plan is during your Initial Enrollment Period. This seven-month period begins three months before the month you turn 65, includes your 65th birthday month and ends three months after your birthday month.

Other options during your Initial Enrollment Period include:

  • Enrolling in Original Medicare (Medicare Part A and Part B insurance plans)
  • Purchasing a Medicare Supplement plan (Medigap) to work alongside Original Medicare to help cover out-of-pocket costs
  • Enrolling in a Medicare Part D prescription drug plan

Open Enrollment Period – AKA Annual Election Period

The Annual Election Period lasts from October 15 to December 7 each year. People ages 65 and over and legal residents who have lived in the United States for at least five years can enroll in Original Medicare, purchase a Medicare Supplement Plan, enroll in a Medicare Advantage Plan, or enroll in a Part D drug plan.

Medicare Advantage Open Enrollment Period

An Open Enrollment Period held each year from January 1 to March 31 provides another opportunity to sign up for a Medicare Advantage Plan or change from one Part C plan to another. Changes made during this enrollment period take effect on July 1 of the same year.

Special Enrollment Periods for Special Circumstances

Special circumstances may allow for enrolling in a Medicare Advantage Plan outside a scheduled enrollment period if you:

  • Move outside your Medicare Advantage Plan’s service area
  • Move to a location within the same service area that offers more MA plans
  • Have lived outside the US and move back
  • Currently live in or just moved into or out of a skilled nursing or some other long-term facility
  • Lose your current coverage, which may be employer-based, Medicaid, or other

5-star Special Enrollment Period

In comparing Medicare plans, it is helpful to check out the star ratings issued by Medicare each year.

Each Medicare plan is rated by member satisfaction surveys, plan ratings, and healthcare providers to determine the overall star rating.

If you find a 5-star Medicare Advantage plan, Medicare cost plan, or Medicare Part D prescription drug plan in your service area, you can exchange your current plan for the 5-star plan of your choice during the 5-Star Enrollment Period. You can make this change only one time between December 8 and November 30.

Some things you need to be aware of when considering signing up for a 5-star Medicare plan are:

  • If you have a Medicare Advantage plan and enroll in a 5-star stand-alone prescription drug plan, you will be dropped from your Medicare Advantage plan
  • With the above, you will return to Original Medicare for your healthcare coverage
  • When leaving your current MA plan that is not 5-star for a 5-star plan, you may lose your prescription drug coverage and wait until another enrollment period to sign up again with possible penalties.

Special Enrollment Periods if you get “Extra Help.”

During the Special Enrollment Period for people with ‘extra help paying for Medicare drug coverage, you can join, switch, or drop Medicare drug plans.

Most Medicare beneficiaries have specific times they can make changes to their prescription drug coverage. Those on Medicaid or with Extra Help may be able to make changes to their coverage once during each of these periods:

  • January through March
  • April through June
  • July through September

Changes will begin on the first day of the following month. No new changes can be made until the next period.

These special enrollment periods do not include October through December, but all Medicare beneficiaries can make changes yearly from October 15 to December 7.

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