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Medicare Plans in North Carolina – Coverage and Benefits

Any senior citizen 65 and over should be preparing to enroll in Medicare, if they have not done so already. This comprehensive federal health insurance program was designed to help retired individuals on a fix income be able to enjoy their golden years in relative comfort and good health. However, as seniors’ medical needs change and evolve, this program has developed some coverage gaps which, if not addressed, could become very expensive later on in life.

To begin with, Medicare Parts A and B cover the majority of treatment needs, whether you’re in a hospital or require outpatient care. Parts A & B are also often referred to as Original Medicare. In order to keep costs down and make sure everyone remains insured, Part B has certain monthly premiums and annual deductibles which must be paid (you can find out your required costs here). Part A might also come with fees, but that is based on your employment history. Anything less than ten years (or fewer than 40 quarters), and you might be required to pay certain deductibles for Part A benefits as well.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Run by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

Supplemental Medicare Plans in North Carolina

More than 1.5 million North Carolina residents are currently receiving some type of Medicare benefits. And fewer than half of them (49%) either aren’t supplementing those benefits, or they have an alternative source of supplemental coverage – usually through an employer. Those who desire the peace of mind that a supplement policy offers, 28% (439,160 beneficiaries) prefer to go with a Medicare Advantage policy. Almost equally as popular, though, are Medigap supplemental insurance policies, with 23% of retired seniors purchasing them to protect their savings from surprise medical bills.

For current Medicare recipients, shopping around for a supplement is easy. If you are not yet enrolled in Medicare, clicking the provided link can help get you started on the process.

The Rising Popularity of Medicare Supplement Insurance Policies

As discussed earlier, supplementing your Medicare benefits with additional coverage wasn’t always necessary. For many seniors, your relative youth and good health might make additional coverage seem like a superfluous expense. But if the unthinkable happens, and you suddenly find yourself in the midst of a medical emergency, these are just a few of the out-of-pocket expenses you might be responsible for:

Medicare Part A Costs Medicare Part B Costs
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

But there are solutions. The two most frequently purchased coverages are Medigap, and Medicare Advantage policies. We’ll go into detail on each one below so that you can make a well-informed decision on how to manage your health care needs.

Medicare Supplement Plans in North Carolina

Medicare Supplement insurance, more commonly known as Medigap, is a separate, private insurance policy which protects you from the “gaps” in Medicare coverage and benefits. These policies were specifically designed for this purpose, and each of the ten plans outlined below promises the exact same coverage and benefits regardless of which state you live in. Therefore, all you have to worry about is finding an affordable policy from a reliable health insurance company.

[chart category=”supplement” name=”planTypes” state=”NC” zipcode=”28269″]

North Carolina Medicare Advantage Plans

Unlike their counterpart, Medigap, Medicare Advantage can get a little more complicated. But we will try to present the information on these policies as clearly as possible. The one thing most people don’t understand is that Medicare Advantage effectively replaces your current Original Medicare benefits; it doesn’t supplement them the way Medigap does. And while these policies might be sold at attractively low prices in certain areas, this usually comes as the result of restricted medical networks. It is not uncommon for seniors to have to switch doctors when switching to Medicare Advantage.

However, there are some benefits to taking on a Medicare Advantage policy. Even though you are giving a private health insurance company permission to take control of your Medicare benefits, you are legally protected – they must offer you “equal or greater” coverage, and nothing less. Sometimes, the “or greater” part of that statement comes in the form of vision, or dental, or prescription drugs. Granted, this will result in a more expensive Advantage policy, but the prices may still be relatively affordable compared to Original Medicare alone.

Medicare Advantage networks provide care through either a Preferred Provider Organization (PPO) or a Health Maintenance Organization.

[chart category=”advantage” name=”topHMOPlans” zipcode=”28269″ state=”NC”]

[chart category=”advantage” name=”topPPOPlans” zipcode=”28269″ state=”NC”]

Major Differences between Medicare Advantage and Medigap

For more information about some significant differences between these two supplemental insurance plans, please refer to the chart below. It answer some of the most common questions regarding these two policies:

Questions Medicare Advantage Medicare Supplement
How are the plans funded? Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company. Your monthly premium takes care of the majority of your expenses.
Do I continue paying for Part B? Yes Yes
What does it cost me? Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly. While each plan does require a monthly premium, many of them are affordably priced.
What does the plan cover? Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be. All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.
Can I budget my health care expenses? It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket. Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.
Can my plan be cancelled? Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage. No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.
Are pre-approvals or pre-certifications required? Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care. No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.
Can I use any doctor or hospital? Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time. Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.
Can drug, vision, or dental coverage be included in the policy? Yes. No. These forms of coverage must be purchased separately.
Who is this plan type generally best suited for? If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you. If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

Additional Resources and Information

For more information, feel free to take advantage of the North Carolina directory we’ve included on this page. When you search it, you’ll find useful contact information for local offices and Medicare experts who can answer any additional questions you may have.

[chart category=”general” name=”usefulContacts”]

Important Medicare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.

Compare Medigap Plans Online

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