Medicare in North Carolina

Since Medicare Advantage plans are offered by private insurers, plan availability varies from one area to another. There are Medicare Advantage plans in all 100 counties in North Carolina for 2023, but plan availability ranges from 13 plans in Onslow County, to 51 plans in Guilford County.²

As of 2018, a little more than a third of all Medicare beneficiaries nationwide were enrolled in Medicare Advantage plans, and North Carolina’s Medicare Advantage enrollment was very much in line with the national average, with 33% of the state’s Medicare beneficiaries covered by Advantage plans.

By Apirl 2023, total Medicare enrollment in North Carolina (not counting people with supplemental coverage like Medicare Part D prescription drug coverage and Medigap) had grown to over 50% percent of the state’s Medicare population¹  (slightly higher than the national average at that point),⁶ with 1,126,179 people enrolled in Medicare Advantage plans. The other 1,022,236 Medicare beneficiaries had Original Medicare coverage as of April 2023.⁹

Medicare Advantage plan enrollment is an option when people are initially eligible for Medicare, and during the Medicare Annual Election Period (October 15 to December 7 each year) allows Medicare beneficiaries the chance to change between Medicare Advantage and Original Medicare (and add, drop, or switch to a different Medicare Part D prescription drug plan). The Medicare Advantage open enrollment period, which runs from January 1 to March 31, gives people who already have a Medicare Advantage plan an opportunity to change to a different one or switch to Original Medicare.

Original Medicare does not limit out-of-pocket costs, so most enrollees maintain some form of supplemental coverage. Nationwide, over 80% of Original Medicare beneficiaries get their supplemental coverage.¹⁰ But for those who don’t, Medigap plans (also known as Medicare supplement insurance plans, or MedSupp) will pay some or all of the out-of-pocket costs they would otherwise have to pay if they had Original Medicare on its own.

According to a 2022 American Health Plans (AHIP) analysis, there were 494,578 North Carolina Medicare beneficiaries enrolled in Medigap plans as of 2020.⁴ This was down slightly from 2019, when there were 510,098 Medigap enrollees in the state. As Medicare Advantage plan enrollment growth outpaces overall Medicare enrollment growth, Medigap enrollment tends to decrease. This is because people do not need (and cannot use) Medigap coverage if they have Medicare Advantage plans.

Medigap plans are sold by private insurers, but they’re standardized under federal rules and regulated by state laws and insurance commissioners. There are 42 insurers that offer Medigap plans in North Carolina.¹¹ The state’s plan comparison tool displays the plans based on how much they cost, to make it easy to compare the various options. Since the plan benefits are standardized (ie, Plan G has the same benefits regardless of which insurer sells it), consumers can make their plan selection based on premiums and less tangible factors like customer service. North Carolina’s Medigap shopping guide is a useful resource for consumers.

North Carolina allows Medigap insurers to pick their own rating approach, so nearly all of the plans for sale in the state use attained-age rating, which means that an enrollee’s premiums will increase as they get older, regardless of how old they were when they first enrolled. The other two approaches to Medigap premiums are issue-age rating, in which premiums are based on the age the person was when they enrolled, and community rating (sometimes called “no age” rating), which means premiums don’t vary based on age; some states require one of these approaches, but North Carolina does not.

Federal rules require Medigap insurers to offer plans on a guaranteed-issue basis during an enrollee’s Medigap Open Enrollment Period, which begins when the person is at least 65 years old and enrolled in Medicare Part B (and Medicare Part A; you have to be enrolled in both to obtain Medigap).¹² But federal rules do not guarantee access to Medigap plans for people under age 65. But North Carolina is among the majority of the states that have enacted rules to ensure access to Medigap plans for disabled enrollees under age 65.

North Carolina law (see North Carolina statute § 58-54-45) requires all Medigap insurers in the state to offer at least Plan A to people under age 65 who are enrolled in Medicare due to a disability. And if the insurer also offers either Plan C or Plan F to people who are 65+, they must also make that plan available to beneficiaries under age 65 who were eligible for Medicare prior to 2020. If the insurer offers either Plan D or Plan G to people who are 65+, they must also offer that plan to people who are under 65 and eligible for Medicare (under federal rules, as a result of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Medigap Plans C and F cannot be sold to people who become eligible for Medicare in 2020 or later).¹²

North Carolina Medicare beneficiaries under age 65 are granted a one-time six-month Medigap Open Enrollment Period that begins when they’re enrolled in Medicare Part B (or when they find out they’ve been retroactively enrolled in Part B). So they essentially have the same enrollment period as people who are turning 65, but it applies regardless of age, and it only guarantees access to Plan A and, in some cases, Plan C and Plan F or Plan D and Plan G.

But while state law in North Carolina guarantees access to Medigap plans for disabled beneficiaries under age 65, the insurers may charge significantly higher premiums for these enrollees.¹³ Medigap Plan A rates in 2023 for a person aged 55 range from $260 per month to $1,387 per month. In comparison, the same Plan A for a person aged 65 ranges in price from $98 per month to $338 per month. And for Plan G, premiums for a 55-year-old range from $230 per month to $1,485 per month, whereas a 65-year-old would pay between $108 and $256 per month for the same plans.

Disabled Medicare beneficiaries have access to the Medigap open enrollment period when they turn 65. At that point, they have access to any of the available Medigap plans in their state, at the standard age-65 rates.

Disabled Medicare beneficiaries have the option to enroll in a Medicare Advantage plan instead of Original Medicare. Medicare Advantage plan monthly premiums are not higher for those under 65.¹⁴ But Medicare Advantage plans may have more limited provider networks than Original Medicare, and total out-of-pocket costs can be as high as $8,300 in 2023 for in-network care,¹⁵ plus the out-of-pocket cost of prescription drugs. New in 2025, a Medicare Part D prescription drug plan will feature a $2,000 out-of-pocket spending cap.¹⁶

Original Medicare does not provide coverage for outpatient prescription drugs. Nationwide, over 80% of Original Medicare beneficiaries nationwide have some type of supplemental coverage.¹⁰

But Medicare Part D, created under the Medicare Modernization Act of 2003, provides prescription drug coverage for Medicare beneficiaries who do not have another source of coverage for prescription costs. Medicare beneficiaries can enroll in Medicare Part D prescription drug plans on a stand-alone basis, or obtain Part D coverage integrated with a Medicare Advantage plan (not all Medicare Advantage plans include Part D coverage, but most do).

There are 24 stand-alone Medicare Part D plans in North Carolina for 2023, with monthly premiums starting at $4.20 per month.⁵

644,401 North Carolina beneficiaries were enrolled in stand-alone Medicare Part D prescription drug plans (which are called prescription drug plans or PDPs) as of early 2023.⁹ Another 1,051,534 beneficiaries had Medicare Advantage plans that included integrated Medicare Part D coverage. Together, that’s more than three-quarters of the state’s Medicare beneficiaries with Part D coverage.

Medicare Part D prescription drug plan enrollment is available when a person is first eligible for Medicare, and also during the Medicare Annual Enrollment Period that runs from October 15 to December 7.

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums and services Medicare doesn’t cover – such as long-term care.

Our guide to financial assistance for Medicare enrollees in North Carolina includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

Do you have questions about Medicare eligibility in North Carolina or need help selecting the best options for your specific situation? These resources provide free assistance and information.

• You can contact North Carolina’s Seniors’ Health Insurance Information Program (SHIIP) with questions related to Medicare enrollment in North Carolina. Visit the website or call 855-408-1212.
• North Carolina’s Senior Medicare Patrol Program (NCSMP) strives to “reduce Medicare error, fraud, and abuse” by educating Medicare beneficiaries and their caregivers about Medicare benefits, statements, explanations of benefits, etc.