Medicare Advantage in North Carolina

Looking for North Carolina Medicare Advantage Plans? Enter your ZIP below to compare affordable or $0 premium plans in your area.

North Carolina State

Information about Medicare Advantage Plans in North Carolina

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35 percent of Medicare beneficiaries in North Carolina were enrolled in a Medicare Advantage (Medicare Part C) plan in 2019.1

There are 1,210 different North Carolina Medicare Advantage plans in 2019.1 Not every plan is available in each county, so it's important to find out which ones are offered where you live.

A licensed insurance agent can help you compare the availability, benefits and costs of Medicare Advantage plans in your area of North Carolina. Read below to learn more about Medicare in your state.

Find other types of Medicare Health insurance plans:

Average costs of Medicare Advantage in North Carolina

The average North Carolina Medicare Advantage plan premiums 2019 were $33 per month.

That average was affected by the 625 $0 monthly premium plans that were available in North Carolina in 2019.

39 percent of North Carolina Medicare Advantage enrollees were enrolled in a $0 premium plan in 2019.

  • Average monthly premium cost in 2019 (weighted): $33
  • Average in-network out-of-pocket spending limit: $4,936
  • Average deductible in 2019 (weighted): $152.151

The premiums, deductibles and out-of-pocket costs for each plan may vary greatly depending on what county you live in and the plan you have.

Read more about the 2019 average North Carolina Medicare Advantage plan monthly premiums by county, which are listed below in this guide.

A licensed insurance agent can help you compare NC Medicare Advantage plan costs in your area.

Compare North Carolina Medicare Advantage plan costs

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Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

Medicare Eligibility & Enrollment

You may not sign up for a Medicare Advantage plan in North Carolina without first enrolling in Medicare Part A and Part B, otherwise known as Original Medicare.

To be eligible for Original Medicare at age 65, you must meet the following requirements:

  • You must be a U.S. citizen or permanent legal resident who has lived in the U.S. for five continuous years.

  • You or your spouse must have worked long enough to be eligible for Social Security or Railroad Retirement benefits.

  • You or your spouse must be government employees or retirees who have not paid into Social Security but have paid Medicare payroll taxes.

You may also be eligible for Medicare benefits under 65 if:

  • You have been receiving Social Security disability benefits or certain Railroad Retirement Board disability benefits for at least 24 months.

  • You have ALS (amyotrophic lateral sclerosis, or Lou Gehrig's disease).

  • You have End-Stage Renal Disease (ESRD), and you or your spouse have paid Social Security taxes for a certain length of time.

It’s important to note that if you have ESRD, you may not qualify for most Medicare Advantage plans. If you have ESRD, you may be able to enroll in a North Carolina Medicare Special Needs Plan (SNP) that is specifically designed to help meet your health care needs.

You are only eligible to enroll in Medicare Advantage plans that are offered in your local area.

How to sign up for a Medicare Advantage Plan in North Carolina

The first time you may be able to enroll in a North Carolina Medicare Part C plan is during your Medicare Initial Enrollment Period (IEP).

Medicare Initial Enrollment Period graphic

Your seven-month Initial Enrollment Period begins three months before your 65th birthday, includes the month of your birthday and extends for three additional months thereafter.

Additional times when you may be able to sign up for a Medicare Advantage plan include:

Medicare Advantage Open Enrollment Period graphic

Medicare Advantage Open Enrollment Period: January 1 – March 31

If you're already enrolled in a Medicare Advantage plan, you may switch Medicare Advantage plans or drop your Medicare Advantage plan and return to Original Medicare from January 1 to March 31 every year.

If you return to Original Medicare during this period, you'll be able to join a Medicare standalone prescription drug plan (Medicare Part D).

Medicare AEP graphic

Medicare Annual Enrollment Period (AEP): October 15 – December 7

From October 15 to December 7 every year, you may enroll in a Medicare Advantage plan or switch from one Medicare Advantage plan to another.

You may also drop your existing Medicare Advantage plan and return to Original Medicare.

During AEP, you may also join, switch or drop a Medicare Part D plan. 

Medicare Special Enrollment Periods (SEP)

You may potentially be granted a Medicare Special Enrollment Period (SEP) at any time throughout the year for qualifying circumstances.

Find out if you qualify for a Medicare Special Enrollment Period by calling to speak with a licensed insurance agent.

Find a North Carolina Medicare Advantage plan

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Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

Top-rated Medicare Advantage Plans in North Carolina 2019

Each year, the Centers for Medicare & Medicaid Services (CMS) issues star ratings for all Medicare Advantage plans using a system of one to five stars.2

In order for a Medicare Advantage plan to be considered a top-rated plan, it must have four or more stars out of five stars.

There are 506 top-rated 2019 Medicare Advantage plans in North Carolina that are rated four stars or higher.

Medicare Star Ratings
Star Ratings

★★★★★

Excellent

★★★★

Above Average

★★★

Average

★★

Below Average

Poor

Medicare Advantage plans are rated according to the following five criteria:

  • Preventive care and health maintenance (screenings, tests, vaccines, etc.)
  • Management of chronic conditions
  • Member experiences and ratings of the plan
  • Member complaints, problems receiving services and member retention
  • Customer service

The information for the star ratings is gathered from information that is submitted to Medicare, Medicare’s regular monitoring activities and member surveys.

List of Medicare Advantage Plans Available in North Carolina in 2019

To view a list of plans offered in your area within North Carolina, use our plan comparison tool.

Find a North Carolina Medicare Advantage plan

Compare Plans

Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

Private insurance companies offer Medicare Advantage plans in North Carolina

Multiple private insurance companies may offer Medicare Advantage plans in North Carolina, depending on where you live.

Private insurance carriers offer Medicare Advantage plans that may be unique to the plan area they serve.

A licensed insurance agent can help you compare the Medicare Advantage plans that are sold by insurance companies in your area.

When you’re shopping for Medicare Advantage plans in North Carolina, you can compare plans from several different insurance companies by using some of the following information:

  • The Medicare Star Ratings can give you an idea of a plan’s overall quality and customer service.

  • Agencies like A.M. Best, Moody’s and Standard & Poor’s can provide information about an insurance company’s credit rating and financial standing.

  • You can read through Medicare Advantage plan reviews and testimonials from customers.

North Carolina Medicare Advantage plans by county

The chart below provides some more information about 2019 North Carolina Medicare Advantage plans by county.1

  • Guildfor County had 14 $0 premium MA plans in 2019, which was the most in North Carolina.

  • Guilford County and Mecklenberg County had the highest number of Medicare Advantage plan members in 2019.
2019 NC Medicare Advantage by County
County Total of County MA Enrollees % of Medicare Beneficiaries Enrolled in MA Number of Plans Available Number of $0 Premium Plans Available % Enrolled in a $0 Premium Plan
Guilford 53122 53% 19 12 72.1%
Mecklenburg 53046 36% 17 10 41.0%
Wake 52032 34% 8 4 7.1%
Forsyth 39874 53% 13 6 25.3%
Davidson 21271 55% 8 4 5.9%
Buncombe 19277 30% 12 5 16.1%
Gaston 19147 41% 7 3 6.7%
Alamance 18820 54% 8 4 3.1%
Randolph 18314 57% 12 5 9.1%
Cumberland 16018 29% 8 4 4.0%
Durham 15966 32% 19 11 57.2%
Rowan 14398 44% 15 9 20.9%
Catawba 14154 38% 17 10 14.8%
Cabarrus 13988 39% 14 7 19.9%
Rockingham 13637 56% 5 3 60.0%
Iredell 13561 38% 3 2 66.7%
Union 11687 33% 14 7 85.7%
Johnston 11556 33% 18 10 30.1%
Brunswick 11522 23% 18 8 6.2%
New Hanover 10835 22% 10 5 50.0%
Henderson 10549 30% 8 4 5.3%
Surry 8971 48% 10 5 50.0%
Orange 8798 35% 17 9 10.2%
Burke 8723 40% 11 4 8.8%
Caldwell 8673 43% 3 2 66.7%
Wilkes 8662 47% 15 8 8.5%
Moore 8382 31% 4 3 75.0%
Cleveland 8113 33% 3 2 66.7%
Robeson 8105 32% 18 10 73.8%
Chatham 7755 39% 18 10 79.6%
Pitt 7035 22% 8 4 12.4%
Stokes 6797 59% 16 9 19.4%
Wayne 6545 26% 7 3 5.1%
Haywood 6424 34% 20 11 62.4%
Harnett 6165 28% 12 4 5.8%
Lincoln 5957 33% 19 10 13.6%
Nash 5664 25% 10 4 7.5%
Davie 5403 50% 10 5 50.0%
Yadkin 5171 56% 8 4 7.6%
Rutherford 5108 29% 7 4 5.2%
Stanly 4976 34% 22 14 71.0%
Wilson 4830 24% 8 4 5.2%
Sampson 4441 33% 11 4 8.9%
Franklin 4429 34% 14 8 47.1%
McDowell 4334 36% 18 10 46.3%
Granville 4099 33% 8 4 6.1%
Onslow 4084 15% 12 5 7.7%
Halifax 4006 27% 7 4 13.8%
Vance 3940 35% 17 10 19.6%
Columbus 3821 27% 13 8 61.5%
Person 3803 39% 13 6 9.3%
Lee 3716 28% 8 4 8.9%
Craven 3569 14% 15 5 6.9%
Pender 3432 25% 3 2 66.7%
Alexander 3392 39% 18 10 15.2%
Carteret 3384 17% 13 8 88.6%
Transylvania 3281 30% 18 9 57.5%
Lenoir 3149 21% 7 3 6.1%
Edgecombe 3129 24% 18 11 75.1%
Caswell 3057 48% 20 9 14.0%
Richmond 2998 27% 14 8 55.2%
Beaufort 2998 21% 11 5 11.3%
Watauga 2921 29% 8 4 50.0%
Cherokee 2806 27% 10 3 4.2%
Macon 2768 23% 9 4 4.6%
Duplin 2703 24% 8 4 6.6%
Bladen 2662 32% 3 2 66.7%
Scotland 2603 29% 16 10 31.6%
Jackson 2545 27% 6 3 11.1%
Ashe 2312 28% 4 3 75.0%
Hoke 2201 29% 9 4 6.8%
Madison 2026 33% 4 3 75.0%
Yancey 2012 34% 15 9 53.5%
Montgomery 1947 32% 6 3 8.1%
Anson 1785 31% 18 10 27.7%
Pasquotank 1727 19% 18 11 88.0%
Warren 1669 33% 15 7 9.6%
Polk 1631 24% 11 4 7.3%
Mitchell 1517 33% 18 11 65.4%
Northampton 1389 24% 19 10 15.6%
Martin 1315 21% 13 8 82.8%
Avery 1305 27% 11 4 7.7%
Hertford 1299 23% 17 6 2.6%
Alleghany 1207 34% 12 6 17.0%
Dare 1173 12% 17 10 59.7%
Bertie 1099 20% 11 5 5.7%
Clay 1005 24% 11 6 78.3%
Greene 839 21% 18 10 73.8%
Swain 820 20% 7 4 57.1%
Washington 783 22% 19 11 18.3%
Currituck 745 14% 11 4 8.0%
Perquimans 709 17% 18 9 62.2%
Chowan 692 16% 10 4 7.6%
Graham 657 29% 8 4 4.1%
Pamlico 655 15% 9 3 7.7%
Gates 513 20% 9 3 7.0%
Jones 501 19% 12 6 8.9%
Camden 319 15% 10 4 6.9%
Hyde 311 26% 16 9 74.5%
Tyrrell 182 21% 17 9 32.1%

NC Medicare Advantage enrollees by plan type

This chart shows the percentage of 2019 North Carolina Medicare Advantage beneficiaries that are enrolled in each primary type of Medicare Advantage plan.1

Plan type Percentage of North Carolina enrollees (2019)
HMO 75.68%
Local PPO 24.1%
Regional PPO <1%
PPFS <1%
Other Plans <1%

The major types of Medicare Advantage plans include:

  • HMO
    Health Maintenance Organization (HMO) typically requires you to visit health care providers and pharmacies that are part of your plan’s network (except in the case of emergencies), while also typically requiring a referral from a primary care doctor (PCP) in order to see a specialist.

  • PPO
    Medicare Advantage beneficiaries enrolled in a Preferred Provider Organization (PPO) typically can see providers outside of their plan network, though it is often at a higher cost.

    Beneficiaries in a Medicare PPO typically pay less out of pocket if they choose to receive medical services from providers within their plan’s network.

    PPO plans typically do not require beneficiaries to acquire a referral before visiting with a specialist.

  • PFFS
    A Private Fee-For-Service (PFFS) plan determines how much it will pay to doctors and other providers at the point when care is received.

    With a PFFS plan, you can typically receive care from any doctor, hospital or health care provider that accepts your plan’s terms. Not all providers will accept these terms, however.

  • SNP
    A Special Needs Plan (SNP) is a type of Medicare Advantage plan that is limited to people who have certain chronic conditions and other specific characteristics.

    Typically, you must receive care from health care providers and hospitals within your SNP network, except for in cases of emergency or urgent care and when someone who has End-Stage Renal Disease (ESRD) needs out-of-area kidney dialysis.

Not all of these types of plans may be available in your area. A licensed insurance agent can help you compare the types of 2019 NC Medicare Advantage plans that are available where you live.

Local health insurance resources in North Carolina

  • The Seniors Health Insurance Information Program in North Carolina provides assistance to Medicare beneficiaries and caregivers who have questions about Medicare coverage. SHIP volunteers can also help identify instances of errors and Medicare fraud.

    The program may be reached at 855-408-1212.

  • You can also explore more information about the insurance industry in North Carolina by visiting the state’s Department of Insurance website.

  • North Carolina Prescription Drug Assistance Programs
    The state of North Carolina has a number of programs designed to help with the cost of prescription drugs. There are programs for both Medicare beneficiaries and non-Medicare beneficiaries alike that can cover the cost of premiums and cost-sharing or even lower the cost of the drugs themselves.