Medicare in North Carolina

Medicare enrollment in North Carolina

As of January 2026, there were 2,300,288 residents with Medicare in North Carolina.¹ For most of them, Medicare coverage enrollment was triggered by turning 65. But more than 10% of North Carolina Medicare beneficiaries – almost 245,000 people – were under age 65 as of January 2026.¹

Nationwide, there are more than 6 million people under the age of 65 who are covered by Medicare.² This is because individuals also become eligible for Medicare  after receiving Social Security disability benefits for two years or if they’ve been diagnosed with end stage renal disease or amyotrophic lateral sclerosis (ALS).

• Understand the difference between Medigap, Medicare Advantage, and Medicare Part D (including tips for picking the best coverage combination to meet your needs).
• Learn how Medicaid can provide assistance to North Carolina Medicare beneficiaries who have limited financial resources.

Medicare Advantage plan availability and enrollment 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 marketed in all counties in North Carolina for 2026,³ and the average Medicare beneficiary in North Carolina can choose from among 33 Medicare Advantage plans for 2026.⁴

The average 2026 Medicare Advantage premium in North Carolina is $12.86/month (in addition to the premium for Part B, which is $202.90/month for most enrollees), but all Medicare beneficiaries in North Carolina have access to at least one $0-premium Medicare Advantage plan in 2025⁵ (meaning they would only pay the Part B premium).

As of January 2026, 1,332,540 North Carolina residents were enrolled in Medicare Advantage plans while the other 967,748 Medicare beneficiaries had Original Medicare coverage.¹

Learn more about Medicare Advantage, Medicare’s annual open enrollment period, and the Medicare Advantage open enrollment period.

Medicare supplement (Medigap) enrollment and regulations in North Carolina

According to an AHIP analysis, there were 463,867 North Carolina Medicare beneficiaries enrolled in Medigap plans (also known as Medicare supplement insurance plans, or MedSupp) as of 2023.⁶

Medigap plans are sold by private insurers, but they’re standardized under federal rules and regulated by state laws and insurance commissioners.

Forty-eight insurers offered Medigap plans in North Carolina as of late 2025.⁷ 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 (so for example, 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,⁸ 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. (An individual must be enrolled in Medicare Part A and Part B  both to enroll in  Medigap).⁹ 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.

Medicare Part D plan availability and enrollment in North Carolina

There are 12 stand-alone Medicare Part D prescription drug plans available for purchase in North Carolina for 2026, with monthly premiums starting at $3.60 per month.¹⁴

As of January 2026, 827,940 North Carolina beneficiaries were enrolled in stand-alone Medicare Part D prescription drug plans (which are called prescription drug plans or PDPs).¹ Another 1,058,946 beneficiaries had Medicare Advantage plans that included integrated Medicare Part D coverage.¹

Learn how Medicare Part D prescription drug coverage works, what it pays for, how and when to enroll.