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Medicare in North Carolina

If you’re looking into North Carolina Medicare, then you may wish to familiarize yourself with every available option. The federally funded Medicare program is sometimes called Original Medicare, and includes both Medicare Part A and Part B.

But there are alternatives to government-administered Medicare, and these plans are sold by private insurance providers. Medicare Advantage plans, also called Medicare Part C, provide at least the same amount of coverage as Part A and Part B, but many of these plans feature additional benefits as well.

Other Medicare plans function as “add-ons” for your Original Medicare, Part A and Part B, coverage. For example, prescriptions are not generally covered by Original Medicare (except while you’re in the hospital). You can enroll in a Medicare Part D Prescription Drug Plan to get this benefit. There are also Medicare Supplement plans, which provide coverage for Original Medicare’s out-of-pocket costs, and other “gaps” in Part A and Part B coverage but do not include drug coverage.

The availability of private Medicare insurance plans in North Carolina may vary depending on your location.

Original Medicare for North Carolina beneficiaries

Original Medicare, Part A and Part B, is run by the federal government and is available to U.S. citizens age 65 and older, and to younger people with qualifying disabilities. Part A covers inpatient hospital care, while Part B covers physician services, preventive screenings, and durable medical equipment. This type of Medicare is available to all eligible beneficiaries who live in the U.S.

Medicare beneficiaries in North Carolina may be enrolled automatically at the age of 65, if they receive retirement benefits through either the Social Security Administration (SSA) or the Railroad Retirement Board (RRB). If you get SSA disability benefits, or certain RRB disability benefits, for 24 months in a row, you’re also enrolled automatically, even if you’re under age 65.

The red, white, and blue Medicare card is mailed out to you about three months before your coverage begins. This card will display your Medicare number, along with whatever parts of the Medicare program you have. The program also mails you a “Welcome to Medicare” packet containing educational information.

Beneficiaries in North Carolina who are not enrolled automatically can apply for Medicare during the Initial Enrollment Period (IEP). This is a seven-month period that begins three months before you turn 65, includes the month you turn 65, and ends three months later. If you miss the IEP, you can sign up during the General Enrollment Period (January 1 to March 31 each year), but you might have to pay late enrollment penalties.

In some situations you might qualify for a Special Enrollment Period, during which you can enroll in Part A or Part B outside the IEP without a penalty. A common example of a situation that would qualify for the SEP is a beneficiary over 65 whose employment or union coverage ends.

If you have end-stage renal disease (ESRD), you’re not enrolled automatically. Contact the SSA for details (see contact information below).

If you’re not automatically enrolled, sign up by visiting your local SSA office or by registering online. You can also do so over the phone:

  • Call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. SSA representatives are available Monday through Friday, from 7AM to 7PM.
  • If you worked for a railroad, call the RRB at 1-877-772-5772. TTY users can call 1-312-751-4701. RRB representatives are available Monday through Friday, from 9AM to 3:30PM.

Medicare private insurance in North Carolina

There are plans offered by private companies that contracts with Medicare to offer Original Medicare, Part A and Part B benefits to people with Medicare who enroll in the plan. These Medicare options may be available from plan providers in your area. Pricing and availability can vary depending on your zip code. You can sign up for any of these plans during your Initial Enrollment Period.

  • Medicare Part C, also called Medicare Advantage, takes the place of your Original Medicare coverage. While Part C plans must provide at least the same amount of coverage as Original Medicare (excluding hospice care, which remains covered through Medicare Part A), they may also offer vision, dental, or hearing coverage.Not every Medicare Advantage plan includes prescription drug coverage, but if they do, they are known as. Medicare Advantage Prescription Drug plans (MAPD), and they provide all of your coverage through a single Medicare plan. If you sign up for a Part C plan, you continue paying your Part B premium.

    If you don’t sign up for a Medicare Advantage plan during your IEP, you can do so during the Annual Election Period, from October 15 to December 7 every year.

  • Medicare Supplement plans, more commonly known as Medigap, may cover some of the out-of-pocket costs associated with Original Medicare: Part A and Part B premiums, deductibles, copayments, and coinsurance. They do not include prescription drug coverage. Most states, including North Carolina, offer up to 10 Medicare Supplement plans, although not every plan is available through each private carrier.The plans are standardized by letter, but benefits vary among the standardized plans (for example, Plan G offers the same coverage no matter where you buy the plan, but its coverage is different from Plan D).

    Medicare Advantage and Medicare Supplement plans don’t work together, so you don’t need to buy both.

  • Medicare Part D is a stand-alone benefit offering prescription drug coverage. Medicare Prescription Drug plans are sold by private insurance companies, but the coverage works alongside your Part A and Part B coverage.If you don’t sign up for a Medicare prescription drug plan during your IEP, you can do so during the Annual Election Period, from October 15 to December 7 every year. You may have to pay a late enrollment penalty.

North Carolina resources for Medicare beneficiaries offers a list of educational resources for health organizations in North Carolina, although you can also refer to the list of local and informational Medicare resources below.

  • State Health Insurance Assistance Program (SHIP): Toll-free number 1-855-408-1212 | Local 1-919-807-6900 | Office hours Monday through Friday, 8AM to 5PM | Website
  • National Institute on Aging Information Center: Toll-free number 1-800-222-2225 | TTY users call 1-800-222-4225 | Monday through Friday, 8:30AM to 5PM ET | Website

Learn more about how Medicare plans work in North Carolina including: