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Medicare Advantage in North Carolina

Medicare Advantage, also known as Medicare Part C, is a plan offered by a private company that contracts with Medicare to provide Original Medicare, Part A and Part B benefits to those who enroll in it. Beneficiaries in North Carolina have this option should they decide to change their Original Medicare coverage.

Enrolling in a Medicare Advantage plan doesn’t mean that you no longer belong to Medicare Part A and Part B (in fact, you must continue paying your Part B premium if you join a private plan), only that you receive your benefits through the private health insurer, as opposed to the federal government.

The number of Medicare Advantage plans available in your area may vary, as can price and coverage details.

How Medicare Advantage works in North Carolina

Medicare Advantage plans are legally required to cover everything that Original Medicare (Part A and Part B) does, with the exception of hospice care (this remains covered by Medicare Part A). While this is the minimum amount of coverage they must provide, plans are likely to offer additional benefits, such as vision, dental, hearing, and wellness programs. Many Medicare Advantage plans also offer prescription drug coverage known as an MA-PD. Under Medicare Advantage, you continue paying your Part B monthly premium.

There are several times throughout the year when you can join a Medicare Advantage plan in North Carolina.

Initial Coverage Election Period (ICEP): This is an eligibility period for enrolling in a Medicare Advantage (Medicare Part C) plan.

  • If you enroll in Original Medicare the very first time you’re eligible for it, then you’re eligible to enroll in a Medicare Advantage plan during the same time period. In this case, the ICEP is a seven-month period that starts three months before the month where you turn 65. The ICEP then runs through your birth month, and for the three months following it.
  • If you delay enrollment in Original Medicare (for example, some people delay Part B enrollment if they’re covered through employment), your ICEP is the three-month period before your effective Part B start date. For example, if you enrolled in Part B during the General Enrollment Period (January 1 to March 31), your Part B effective start date is July 1, so your ICEP would be April 1 to June 30.

Annual Election Period (AEP): Recurring every year from October 15 through December 7. This is for Medicare beneficiaries who would like to go from Original Medicare to a private Medicare Advantage plan, from one Medicare Advantage plan to another, or from a Medicare Advantage plan back to Original Medicare.

Medicare Advantage Disenrollment Period: Goes from January 1 to February 14 of each year. During this period, the only changes a Medicare beneficiary can make are to leave Medicare Advantage in favor of going back to Original Medicare (Part A and Part B), and then add a Medicare Part D Prescription Drug Plan. You cannot go from one Medicare Advantage plan to another during this time.

Special Enrollment Period (SEP): Provides an opportunity to can enroll in a Medicare Part C plan outside the normal enrollment periods in some cases. For example, if you move to or from a skilled nursing facility (or if you’re living in one), or if you had Medicaid but are no longer eligible for it, you can qualify for a Special Enrollment Period (SEP). For other examples and for more information, see Medicare Special Enrollment Periods.

Types of Medicare Advantage plans in North Carolina

There are numerous choices of Medicare Advantage plans. It’s important to understand the differences so that you can find one that works best for you.

HMO (Health Maintenance Organization plan): These plans have an established network of doctors and health-care providers. You may wish to check whether your doctor is in the HMO network before you join. Otherwise, you could have to switch doctors to one inside the HMO network. Going out-of-network to receive care could be costly, as your HMO may not cover it at all.

HMO-POS (Health Maintenance Organization – Point of Service plan): A plan that covers network and out-of-network health services. Visiting doctors, physicians, and other health providers who are in the plan’s network is usually cheaper. You generally have the option to go outside of the network, but maybe at a higher cost to you.

PPO (Preferred Provider Organization plan): There tends to be a little more freedom with PPOs, as both in-and out-of-network providers are covered. With a PPO, you may not have to choose a primary care provider up front, so these plans tend to offer more flexibility than HMOs.

PFFS (Private Fee-for-Service plan): These plans are not necessarily limited to a network. Payment terms are set by the health insurer, not by Medicare. There is no need to choose a primary care provider, although a doctor or medical services may choose not accept the plan’s payment terms.

SNP (Special Needs Plans): Those with chronic conditions such as end stage renal disease (ESRD), diabetes, or HIV/AIDs may be able to join a plan designed specifically to meet those needs. Others who are eligible for an SNP are Medicare beneficiaries living in institutions or those who are dual-eligible for Medicaid and Medicare.

MSA (Medical Savings Account plan): Includes both a high deductible and a bank account to help you pay for Medicare Part A and Part B services. The amount deposited into the account varies from plan to plan. The money is tax-free as long as you use it on IRS-qualified medical expenses, but you need to file a special form with your taxes.

MAPD (Medicare Advantage Prescription Drug) plan: This is simply a Medicare Part C plan that includes drug coverage. Any of the plans described above can be MAPD plans; in fact, most Part C plans do include this coverage. An MAPD plan can give you all the types of Medicare coverage available, all in one plan.

Comparing Medicare Advantage plans available in North Carolina

As you can see, there are many things to consider when deciding on a Medicare Advantage plan. In North Carolina, not every plan may be available in every county, and pricing and plan coverage details can vary by provider.

You may find that some Medicare Advantage plans may offer premiums as low as $0. Keep in mind that this may not automatically make them the cheapest option, as these plans could have higher deductible and copayment amounts to offset the $0 premium price point. Also, if you need coverage for your medications, you might want to consider a Medicare Advantage Prescription Drug plan, and make sure the plan you choose covers the medications you take. No matter how much your Medicare Advantage premium costs, you will continue paying your Part B premium.