- Around 37% of Medicare beneficiaries in North Carolina are enrolled in Medicare Advantage.
- In 2020, the average Medicare Advantage premium in North Carolina is less than $20.
- There are 117 Medicare Advantage plans offered across the state.
- Plan availability varies from county to county. Some providers only cover a few clusters of counties, while others span the whole state.
- You can only sign up for Medicare Advantage during certain enrollment periods
There were nearly 2 million Medicare enrollees across North Carolina in 2019, according to Centers for Medicare and Medicaid Services data. Out of that number, 738,530 enrolled in Medicare Advantage.
In this guide, we’ll cover the types of Medicare Advantage plans offered in the state, the benefits of each, and the average costs involved.
Overview of Medicare in NC
Medicare Advantage (or MA) is a health care insurance plan offered by private companies to Medicare beneficiaries. It covers the basic level of services covered through Original Medicare, which includes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). However, MA plans offer more than this baseline, including extra perks like hearing, vision, and dental benefits. Most MA plans also offer prescription drug coverage in their package.
With Medicare Advantage, you may have to pay a premium for the plan, as well as a premium for Medicare Part B coverage. This is because most MA plans offer extra features not offered by Original Medicare.
In 2019, the average monthly Medicare Advantage premium in North Carolina was $23.22, slightly lower than the national average of $26.87. In 2020, the average MA premium has decreased even more, to $19.30. That said, the lowest monthly premium for MA plans in North Carolina is $0, and all Medicare beneficiaries in the state have access to a MA plan with no monthly premium.
Prescription drug coverage is included in most MA plans, but you can sign up for a standalone Medicare Part D prescription drug plan. There are currently 28 standalone Part D plans available in North Carolina. The lowest monthly Part D premium is $13.20.
North Carolina’s Medicare Advantage participation rate matches national averages. In 2019, 37% of all national Medicare enrollees had Medicare Advantage plans, while 63% had Original Medicare plans. This ratio is the same for North Carolina’s MA enrollment trends.
According to CMS data, standardized Medicare spending across North Carolina is about 5% lower than the national average. Specifically, North Carolina spends $9,564 per capita for inpatient care, post-acute care, hospice, testing and imaging, medical equipment, Part B drug coverage, and ambulance services. The national per-capita spending average is $10,096.
Overview of Medicare Advantage Plans in NC
There are 117 Medicare Advantage plans available in North Carolina this year, according to CMS. All of the roughly 1.9 million North Carolina beneficiaries enrolled in Medicare are provided access to MA plans.
When considering Medicare Advantage, you should weigh your health care needs with the plan’s cost-sharing options, including copayments, coinsurance, and any deductibles you have to meet.
There are five different MA plans to choose from:
- Health Maintenance Organization (HMO) plans only cover in-network doctors and health care providers. You’ll usually have to pay a higher cost for out-of-network providers.
- Preferred Provider Organization (PPO) plans only cover in-network doctors and health care providers. You’ll usually have to pay a higher cost for out-of-network providers, but emergency and urgent care are always covered services.
- Private-Fee-For-Service (PFFS) plans decide how much a subscriber pays for services through “Annual Notice of Change” and “Evidence of Coverage” statements issued every year.
- Special Needs Plans (SNP) plans provide coverage to patients with specific conditions and needs, with coverage tailored to the needs of these groups.
- Medical Savings Account (MSA) plans deposit money into a bank account selected by the provider. You can then use the deductible to pay for your health care services.