Medicare offers healthcare coverage to North Carolina residents age 65 or older, or to those North Carolina residents that suffer from certain medical disabilities. In 2016, 1,803,000 people are enrolled in Medicare in North Carolina, accounting for 18.1% of the population in North Carolina. Approximately $9,741 was spent per Medicare enrollee in North Carolina in 2009, about 6.02% lower than the national average of $10,365. Between 2015 to 2030 the senior population in North Carolina is expected to increase by an estimated 58.08% according to calculations based off of the 2000 Census. Therefore the number of Medicare beneficiaries is also expected to increase.
Like other states North Carolina Medicare beneficiaries and caregivers can receive free one-on-one, unbiased counseling from the Senior’s Health Insurance Information Program (SHIIP). Another program called the North Carolina Senior Medicare Patrol (SMP) helps individuals recognize, avoid, and prevent Medicare billing errors, fraud, and/or waste.
When you are eligible for Medicare you may sign up for Original Medicare (Part A & Part B), which cover hospital services and medical services, respectively, or you may enroll in a Medicare Advantage Plan (Medicare Part C). Keep in mind that you must be eligible for Original Medicare in order to enroll in a Medicare Advantage plan. If you sign up for Original Medicare you also have the option to purchase a separate or stand alone prescription drug plan (Part D). Original Medicare offers its beneficiaries flexibility in choosing their providers and you are not limited to a network. However, there is no limit on out-of-pocket medical expenses and you must always pay 20% coinsurance for medical service costs. For most Medicare beneficiaries, Part A is already paid through paycheck deductions during their working years (or their spouse's) but most Medicare beneficiaries pay premiums for Part B unless they qualify for financial assistance. Medicare Advantage plans require you to stay in network but some plans will also cover out-of-network care at a higher cost. Many Medicare Advantage plans also include additional health benefits such as vision, dental, or hearing coverage and you have the option to purchase a Medicare Advantage plan with prescription drug coverage (MAPD) in almost all states.
Using CMS data HealthPocket found that:
- The average total monthly premium for a 2017 Medicare Advantage plan in North Carolina is $37.33, 40.25% less than the national average of $62.48. 39.38% of 2017 Medicare Part C insurance plans in North Carolina have a $0 monthly premium.
- The maximum possible annual drug deductible in any 2017 Medicare Advantage plan with a drug component is $400, but in North Carolina the average annual drug deductible for Medicare Part C insurance plans with drug components is $211.89. 23.95% of 2017 Medicare Part C insurance plans with a drug component in North Carolina have a $0 annual drug deductible.
- The average total monthly premium for a 2017 Medicare Advantage plan without a drug component in North Carolina is $0.13. 99.57% of 2017 Medicare Part C insurance plans without a drug component in North Carolina have a $0 monthly premium.
- The average medical out-of-pocket limit for 2017 Medicare Part C insurance plans in North Carolina is $5701.31. 4.12% of 2017 Medicare Advantage plans in North Carolina had a medical out-of-pocket limit of $3,400 or less.
To assist seniors in choosing Medicare plans, CMS assigns star ratings to Medicare Part C and Part D plans each year based on preventive care, chronic condition management, customer service, member satisfaction, and drug pricing. Ratings range from 1 star (a poor plan) to 5 stars (an excellent plan).
- The average overall CMS star rating assigned to Medicare Part C insurance plans in North Carolina was 3.4 stars in 2017.
- Among North Carolina's 2017 Medicare Advantage plans with CMS star ratings:
- 28.36% earned a score of 4 or 4.5 stars
- 61.62% earned a score of 3 or 3.5 stars
- 9.12% earned a score of 2 or 2.5 stars
- 0.89% of plans are “Not enough data available” or “Too new to be measured”.
Data on Medicare eligibility, enrollment, and spending by state from Kaiser Family Foundation