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Medicare in North Carolina

October 6, 2016

If you’re looking into 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 offered by private insurance companies contracted with Medicare. Medicare Advantage plans provide at least the same coverage as Part A and Part B (except hospice care, which remains covered by Part A) and many of these plans feature additional benefits as well.

Other Medicare plans function as complements to 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 receive this benefit. Medigap (Medicare Supplement) plans are also offered by private insurance companies and can help you pay your out-of-pocket costs for services covered under Original Medicare. The availability of Medicare plan options in North Carolina may vary depending on your location.

Original Medicare for North Carolina beneficiaries

Original Medicare, Part A and Part B, is administered by the federal government. Part A covers inpatient hospital care, skilled nursing facility and nursing home care, home health care, and hospice care. Part B covers physician services, preventive screenings, durable medical equipment, and outpatient services.

To be eligible for Original Medicare, you must be 65 or older and a U.S. citizen or legal permanent resident of at least five continuous years. People who are younger than 65 may be eligible for Medicare if they have certain health conditions such as amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease) or if they’ve collected disability benefits for 24 continuous months or more from the Social Security Administration (SSA) or the Railroad Retirement Board.

Most people enroll in Original Medicare during the Initial Enrollment Period. This seven-month period begins three months before the month you turn 65, includes your birthday month, and ends three months after your birthday month. You’re also allowed to enroll in Medicare during the annual General Enrollment Period, which runs from January 1 to March 31, but if you miss your seven-month Initial Enrollment Period, you may have to pay a late-enrollment penalty in the form of higher monthly premiums.

In some situations you might qualify for a Special Enrollment Period, during which you can enroll in Part A or Part B outside the Initial Enrollment Period without incurring a penalty. For example, a person over the age of 65 might have delayed enrollment in Part B because the individual was covered under an employer-sponsored group health plan. When the group health plan coverage ends, the person qualifies for an eight month Special Enrollment Period to enroll in Medicare Part B (without a late enrollment penalty).

If you’re not automatically enrolled in Medicare, you may 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 plan options in North Carolina

There are plans offered by private insurance companies that contract with Medicare to provide Medicare coverage to beneficiaries. 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, is an alternative way to receive your Original Medicare benefits from a Medicare Advantage plan offered by a Medicare-approved private insurance company. While Medicare Advantage plans must provide at least the same coverage as Original Medicare (excluding hospice care, which remains covered through Medicare Part A), they may also offer extra benefits such as routine vision, dental, or hearing coverage. Many Medicare Advantage plans include prescription drug coverage; they are known as Medicare Advantage Prescription Drug plans (MAPD), providing health and prescription drug benefits in a single plan. If you sign up for a Part C plan, you continue paying your Part B premium. You may enroll in a Medicare Advantage plan during your Initial Enrollment Period, or during the Annual Election Period, which occurs  October 15 to December 7 every year.
  • Medicare Supplement plans are offered by private insurance companies and can help you pay out-of-pocket costs for services covered under Medicare Part A and Part B. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. Keep in mind that Medigap only works with Original Medicare. You can’t use these plans to pay for Medicare Advantage costs.
  • Medicare Part D is a stand-alone benefit offering prescription drug coverage. Medicare Prescription Drug plans are offered by private insurance companies. A stand-alone Medicare Part D Prescription Drug Plan works alongside your Part A and/or Part B coverage. If you don’t sign up for a Medicare Prescription Drug Plan during your Initial Enrollment Period, you can do so during the Annual Election Period, from October 15 to December 7 every year. You may have to pay a Part D late enrollment penalty, however, if you delay enrollment in a Medicare plan providing prescription drug coverage and you do not have creditable prescription drug coverage (i.e., prescription drug coverage that is as good as Medicare Part D coverage) for 63 or more consecutive days after your Initial Enrollment Period.

North Carolina resources for Medicare beneficiaries

Medicare.gov is a valuable educational resource for additional information about Medicare and health organizations. You may also contact the organizations listed below for assistance.

  • 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:

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