Have you started looking into what Medicare can offer you? You might be wondering if you qualify for Medicare, what the best companies are or what Medicare can offer you. Benzinga’s guide to the best Medicare in North Carolina can help you learn more.
The Best Medicare in North Carolina:
- Best Overall in North Carolina: Humana
- Most Affordable in North Carolina: Humana
- Best for Low Out-of-Pocket Maximum: Care N’ Care Insurance Company of North Carolina
- Best for Dual Eligibility: Cigna
- Best for Medicare Part D Plan: WellCare
What is Medicare?
Medicare is a health insurance program offered by the federal government. You may qualify for Medicare if you:
- Are 65 or older
- Have a disability
- Need dialysis or a transplant due to end-stage renal disease
Medicare coverage is offered in separate parts. Each part provides a specific area of your Medicare coverage:
Part A covers hospital insurance. You can use Part A for inpatient hospital stays, hospice care and care in a skilled nursing facility. In some cases, you may also be able to use it for home health care.
Part B provides medical insurance coverage. You can use this for outpatient care, medical supplies, preventive care and other medical services.
Part C is an alternative option called Medicare Advantage that combines both Medicare Part A and Part B. Medicare Advantage plans are offered by private insurance companies.
Part D offers prescription drug coverage. It’s offered as a supplemental plan that can be added to other parts of Medicare. Some Medicare Advantage plans already include prescription drug coverage.
Legalities of Medicare in North Carolina
Medicare is a health insurance program offered and regulated by the federal government. If you enroll in Original Medicare, you can see any doctor that accepts Medicare insurance.
Medicare Advantage plans are not part of Original Medicare and are not held to the same regulations. These plans are offered by private insurance companies and are controlled by the company that owns the plan you enroll in. These companies can restrict the doctors and specialists that are covered by your plan. You may also need to receive a referral before it offers coverage for a specialist visit. Some Medicare Advantage plans offer prescription drug coverage. You may be able to use generic drug treatments as opposed to brand-name options.
You can also get Medicare supplemental insurance. This is a supplemental plan — also known as Medigap coverage — designed to fill gaps in Medicare coverage. If you have a Medicare Advantage plan, you will be unable to carry supplemental insurance.
Types of Medicare Advantage Plans
You can choose from a few different types of plans. Each plan type offers its own unique benefits. Here’s a quick overview of the 2 plan types that you will likely see as you review your options:
Health Maintenance Organization (HMO)
Health maintenance organization (HMO) plans include both Part A and Part B of Medicare insurance. It may also include Medicare Part D plans, as well as vision, dental and hearing benefits. Each insurance company you come across will have its own network of participating providers. HMO plans only offer coverage for visits with in-network medical service providers. It may also require you to receive a referral from a primary care doctor before it will cover a visit with a specialist.
Preferred Provider Organization (PPO)
Preferred provider organization (PPO) plans include Part A and Part B of Medicare insurance. You may also be able to get benefits like vision, dental, hearing and prescription drug coverage. Insurance companies that offer PPO plans also work with a network of participating providers but you’re not restricted to in-network providers. You can expect to pay more for visits with out-of-network providers.
PPO plans typically do not require a referral from your primary care doctor before you can receive coverage for a specialist visit. No matter which plan type you prefer, there are a few key terms you should know. These terms will help you better understand all of the costs associated with your plan:
Deductible: Your health insurance plan will come with a deductible. This is the amount of money that you must pay out-of-pocket for your covered medical services before your insurance kicks in toward your medical bills.
Coinsurance: Once you have met your deductible, your plan may require coinsurance payments. Coinsurance payments are a percentage of each covered medical visit that you pay out of pocket. Your insurance company will pay the remaining percentage to your medical provider.
Copay: Your plan may also require copayments instead of coinsurance. If this is the case, once you have met your deductible you will have to pay a set amount of money out of pocket for each covered medical service you receive. Your insurance company will pay the medical provider the remaining amount of your medical bill.
Premium: You will also see a premium listed with your health insurance plan. The premium is the amount of money you’ll pay to keep your health insurance plan active. Your premium payments will most likely be due monthly.
Out-of-pocket maximum: Your plan will come with an out-of-pocket maximum. Each time you pay for your covered medical services out-of-pocket, it will count toward this amount. Once you have met your plan’s out-of-pocket maximum, your insurance company will pay 100% of your covered medical costs until your plan expires or a new plan year begins.
How to Sign Up for Medicare in North Carolina
There are a few ways you can sign up for Medicare Part A and Part B coverage in North Carolina:
- Enroll online.
- Call Social Security Monday through Friday from 7 a.m. to 7 p.m. at 800-772-1213.
- Visit a Social Security office near you.
If you’re interested in a Medicare Advantage plan, you can review the plans available in your area online. Be sure to enter your ZIP code to find the most accurate information.
If you’ve found a Medicare Advantage plan that you’d like to enroll in, you can:
- Visit the insurance company’s website to see if it offers online enrollment.
- Contact the insurance company to request a paper enrollment form.
- Call 800-MEDICARE (800-633-4227).
Average Cost of Medicare Advantage Plans in North Carolina
The cost of Medicare Advantage plans can vary based on the level of coverage and where you live. Some plans may have low premiums and a high deductible. You should take the time to carefully review all of the costs associated with your plan to find the best one for you. Here are just a few examples of Medicare Advantage plans in North Carolina.
| Plan Name | Company | Plan Type | Health and Drug Costs |
|---|---|---|---|
| Humana Gold Plus H6622-058 | Humana | HMO | $22 |
| Teal Premier Pro | Care N’ Care Insurance Company of North Carolina | PPO | $50.93 |
| Cigna-HealthSpring Preferred | Cigna | HMO | $59.40 |
| Blue Medicare Essential Plus | Blue Cross and Blue Shield of North Carolina | HMO | $61.05 |
| Aetna Medicare Premier Plan | Aetna Medicare | PPO | $110.00 |
Best Medicare Insurance Providers in North Carolina
Here are some of Benzinga’s top choices for Medicare providers in North Carolina.
- Medicare Advantage Plans
1. Best Overall in North Carolina: Humana
Humana has offered Medicare Advantage plans for a long time and can give you a lot of health care options.
You can select from a number of Humana plans and expect to be able to find in-network doctors even if you travel away from home. Humana also provides additional benefits and affordable plans.
2. Most Affordable in North Carolina: Humana
Humana offers some of the most affordable Medicare Advantage plans in North Carolina. It offers monthly premiums as low as $0 and low prescription drug costs. Humana also offers deductibles as low as $0. You can expect to receive additional benefits from Humana, including vision, hearing, dental and even fitness benefits. Some plans offer $0 copays on primary doctor visits as well.
3. Best for Low Out-of-Pocket Maximum: Care N’ Care Insurance Company of North Carolina
Do you receive medical services and prescription drugs frequently throughout the year? If so, you may be concerned about your out-of-pocket costs. Care N’ Care Insurance Company of North Carolina offers plans that can help. It offers monthly premiums and deductibles as low as $0. You can also expect low copays. This company offers an out-of-pocket maximum as low as $3,400 in-network and $5,100 out-of-network. This can be very helpful if you’re looking for an affordable plan that can help you keep within your budget even if medical issues arise.
- Easy access to benefits
4. Best for Dual Eligibility: Cigna
Cigna offers affordable Medicare Advantage plans with additional benefits as well. It offers premiums and deductibles as low as $0. Cigna’s out-of-pocket maximums also tend to be on the lower side. Like many Medicare Advantage plans, you can receive vision, hearing and dental coverage from Cigna. Cigna also offers plans for individuals who are eligible for both Medicaid and Medicare. This can help you save even more money on health care.
- Medicare Prescription Drug Plans
5. Best for Medicare Part D Plan: WellCare
In some cases, you may just want to find the best prescription drug coverage. WellCare offers a Part D plan with monthly premiums as low as $13.70. You can choose between filling your prescriptions at a retail pharmacy near you or at a mail-order pharmacy. In some cases, the prices you will pay are lower if you choose to use a mail-order pharmacy. You will also need to pay a deductible for a Part D plan.
What’s Next?
Explore the options that are available to you if you’re eligible for Medicare. It’s important to consider each part of Medicare to decide which ones can offer you the best coverage for your situation. You may not need prescription drug coverage and may find that Original Medicare can offer you the coverage you need. However, if you prefer to bundle your health care, it might be worth looking into Medicare Advantage plans.
Remember, Medicare Advantage plans are offered by private insurance companies. This means that each plan may not be available to you, depending on where you live. Search for plans within your county. You can also add in your prescription drugs to see how much your estimated monthly payment would be for both your premium and drug costs.
Take advantage of online tools available to you and you should be able to find the health care option that’s right for your needs.
Frequently Asked Questions
1) Q: What are the different parts of Medicare?
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
2) Q: Is Medicare free?
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
3) Q: Do I need to sign up for Medicare?
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.
About Ashley Hart
Ashley Hart is a personal finance writer passionate about helping people feel empowered to take control of their finances. She has more than eight years of writing experience, focused on insurance.