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North Carolina Medicare Insurance

Medicare in North Carolina

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 2015, 1,769,074 people are enrolled in Medicare in North Carolina, accounting for 18% 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.

Local Medicare Resources

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.

Types of Medicare Coverage

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.

North Carolina 2017 Medicare Advantage Plans at a glance

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”.

Sources:

Data on Medicare eligibility, enrollment, and spending by state from Kaiser Family Foundation

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North Carolina Medicare Insurance Companies

There are 20 Medicare insurance providers that offer affordable and comprehensive Medicare insurance in North Carolina. Of these, the companies that offer the largest variety of plans to choose from are Humana, UnitedHealthcare, and Aetna. In North Carolina,. The following are all medicare insurance providers in North Carolina:

Humana

14 Plans

Aetna

8 Plans

FirstMedicare Direct

6 Plans

WellCare

3 Plans

Blue Cross Blue Shield of Georgia

3 Plans

Members Health Insurance Company

2 Plans

HealthTeam Advantage

2 Plans

Gateway Health Medicare Assured

2 Plans

BlueCross BlueShield of South Carolina

2 Plans

Blue Cross Blue Shield of Alabama

2 Plans

Magellan Rx Medicare

1 Plans

MII Life, Inc.

1 Plans

FirstMedicare Direct

1 Plans

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2018 Best Medicare Plans in North Carolina

There are 72 medicare plans in North Carolina. The following are the 10 highest rated medicare plans in North Carolina based on their CMS rating for the plan's overall quality.

Monthly CostPlan NameCMS Rating
from $0Humana - Humana Gold Plus H1036-233 (HMO) - Wake County
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from $0Humana - Humana Gold Plus H1036-138 (HMO) - Alamance County
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from $0HealthTeam Advantage - HealthTeam Advantage Plan I (PPO) - Alamance County
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from $0Humana - Humana Gold Plus H1036-263 (HMO) - Anson County
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from $19Humana - Humana Gold Plus H1036-137 (HMO) - Anson County
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from $36UnitedHealthcare - Erickson Advantage Freedom (HMO-POS) - Mecklenburg County
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from $43UnitedHealthcare - Erickson Advantage Signature with Drugs (HMO-POS) - Mecklenburg County
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from $57HealthTeam Advantage - HealthTeam Advantage Plan II (PPO) - Alamance County
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from $0Aetna - Aetna Medicare Premier Plan (PPO) - Alamance County
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from $0Humana - Humana Gold Plus H6622-025 (HMO) - Buncombe County
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Best North Carolina Medicare Plans for Managing High Blood Pressure

The following are the 5 highest rated medicare plans in North Carolina based on their CMS rating for the plan's ability for controlling high blood pressure.

Monthly CostPlan NameCMS Rating
from $0Cigna-HealthSpring - Cigna-HealthSpring Preferred (HMO) - Alexander County
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from $44FirstMedicare Direct - FirstMedicare Direct Healthy State HMO Plus (HMO) - Buncombe County
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from $37FirstMedicare Direct - FirstMedicare Direct HMO Plus (HMO) - Chatham County
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from $31Humana - HumanaChoice R1390-002 (Regional PPO)
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from $30FirstMedicare Direct - FirstMedicare Direct preferredPLUS (HMO) - Wake County
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Best North Carolina Medicare Plans for Managing Diabetes

The following are the 5 highest rated medicare plans in North Carolina based on their CMS rating for the plan's ability for diabetes care including: eye exam, kidney disease monitoring, blood sugar controlled and cholesterol controlled.

Monthly CostPlan NameCMS Rating
from $57HealthTeam Advantage - HealthTeam Advantage Plan II (PPO) - Alamance County
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from $43UnitedHealthcare - Erickson Advantage Signature with Drugs (HMO-POS) - Mecklenburg County
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from $36UnitedHealthcare - Erickson Advantage Freedom (HMO-POS) - Mecklenburg County
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from $0HealthTeam Advantage - HealthTeam Advantage Plan I (PPO) - Alamance County
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from $26Aetna - Aetna Medicare Value Plan (PPO) - Alleghany County
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Best North Carolina Medicare Plans for Managing Rheumatoid Arthritis

The following are the 5 highest rated medicare plans in North Carolina based on their CMS rating for the plan's ability for rheumatoid arthritis management.

Monthly CostPlan NameCMS Rating
from $57HealthTeam Advantage - HealthTeam Advantage Plan II (PPO) - Alamance County
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from $0HealthTeam Advantage - HealthTeam Advantage Plan I (PPO) - Alamance County
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from $29UnitedHealthcare - AARP MedicareComplete Choice (PPO) - Alamance County
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from $0Aetna - Aetna Medicare Prime Plan (HMO) - Durham County
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from $0Aetna - Aetna Medicare Value Plan (HMO) - Cabarrus County
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Best North Carolina Medicare Plans for Managing Osteoporosis

The following are the 5 highest rated medicare plans in North Carolina based on their CMS rating for the plan's ability for osteoporosis management.

Monthly CostPlan NameCMS Rating
from $81Blue Cross Blue Shield of North Carolina - Blue Medicare PPO Enhanced (PPO) - Alexander County
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from $44FirstMedicare Direct - FirstMedicare Direct Healthy State HMO Plus (HMO) - Buncombe County
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from $37FirstMedicare Direct - FirstMedicare Direct HMO Plus (HMO) - Chatham County
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from $31Humana - HumanaChoice R1390-002 (Regional PPO)
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from $30FirstMedicare Direct - FirstMedicare Direct preferredPLUS (HMO) - Wake County
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Most Popular Medicare Doctors in North Carolina

The following are the most popular medicare doctors in North Carolina based on the provider utilization and payment data published by the U.S. Department of Health & Human Services.

NameSpecialtyLocation
SurgeryLENOIR, NC
Internal MedicineFAYETTEVILLE, NC
SurgeryWILMINGTON, NC
Internal MedicineFAYETTEVILLE, NC
Internal MedicineRALEIGH, NC
Thoracic Surgery (Cardiothoracic Vascular Surgery)WINSTON SALEM, NC
SurgeryHIGH POINT, NC
Neurological SurgeryWINSTON SALEM, NC
SurgeryRALEIGH, NC
RadiologyCARY, NC
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Browse Medicare Plans by Cities

  1. Charlotte, NC
  2. Raleigh, NC
  3. Greensboro, NC
  4. Winston Salem, NC
  5. Durham, NC
  6. Fayetteville, NC
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