Medicare Advantage Plans In NC

Updated: Jul 18, 2022

With low monthly premiums and over 100 plans to choose from statewide, North Carolina’s Medicare Advantage landscape is competitive with national averages.

Key Takeaways:
  • 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.
Health Maintenance Organization
Preferred Provider Organization
Special Needs Plans
Medical Savings Account
Prescription drug coverage?
Yes for most plans
Yes for most plans
Yes for some plans and prescriptions
Do doctors and other providers have to be in-network to be covered?
Depends on the type of service
Yes if your plan has a network
Depends if your plan covers out-of-network services
Depends on the plan
Is a referral needed to see a specialist?
Yes for most plans
No for most plans
Yes for most plans
Depends on the plan

The most popular Medicare providers in North Carolina are: 

Even though Medicare Advantage plans are offered in all North Carolina counties, not all of these providers operate across the state. As such, availability varies from county to county.

Benefits and coverage will depend on your zip code. You can check to see what plans are available in your county on the NC Department of Insurance website.

Enrollment Dates and Things to Keep in Mind

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. Medicare Advantage plans put a cap on your out-of-pocket Medicare Part A and Part B-approved services. After surpassing the limit, your MA plan will pay for those costs through the end of the year. 

If you regularly take prescription medication, you should make sure your MA plan is bundled with a Part D prescription drug plan (most plans are). You should also double-check to see if your prescriptions are listed in the plan’s formulary

With most MA plans, you’ll have to see a doctor that’s inside your insurance company’s network. Otherwise, you’ll have to pay out-of-pocket costs. You might need a referral for specialist appointments. 

You can enroll in a Medicare Advantage plan during certain enrollment periods: 

  • Initial Enrollment Period: The seven-month timeframe before and after you become eligible for Medicare upon turning 65 years old. This period starts three months before your 65th birthday, includes the month of your birthday, and continues three months after that. 
  • Special Enrollment Period: A period for enrollment given to people who missed their Initial Enrollment Period. Your eligibility for this allowance depends on your individual circumstances. 
  • Medicare Open Enrollment Period: Every year from October 15 to December 7, MA enrollees can switch to another MA plan or switch back to Original Medicare. 
  • Medicare Advantage Open Enrollment Period: Every year from January 1 to March 31, MA enrollees can make changes to their plan or switch to another MA plan. 

To find a Medicare Advantage plan in North Carolina that best fits your needs, click here and enter your zip code to compare the available plans in your area.

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