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Medicare Advantage Plans in North Carolina


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Information about Medicare Advantage plans in North Carolina

If you’re a North Carolina beneficiary enrolled in Original Medicare (Part A and Part B), you may be wondering about your Medicare coverage options. One alternative to the federally administered health-care program is getting your Medicare Part A and Part B benefits through a Medicare Advantage plan instead.

Also known as Medicare Part C, Medicare Advantage plans must cover at least the same level of benefits found in Original Medicare, but may also provide additional benefits such as routine dental or vision, hearing, and prescription drugs. These plans are available through private insurance companies that are approved by Medicare to offer Medicare Part C coverage.

Depending on where you live, you may have several options available to you. There are a variety of Medicare Advantage plans, and some of the options in your zip code may include:

  • Health Maintenance Organization (HMO) plans: These plans follow a managed-care model, providing health-care services through a provider network that you must use to be covered (with the exception of emergency care). You’ll have a primary care doctor and need referrals for specialist care.
  • Preferred Provider Organization (PPO) plans: Another managed-care plan option, PPOs offer more provider flexibility. You can use doctors in the plan’s preferred provider network for the lowest cost sharing, or you can go out of network and pay higher copayments. PPOs don’t require a primary care doctor or referrals for specialist care.
  • Special Needs Plans (SNPs): These plans target beneficiaries who live in institutions (such as nursing homes), have certain chronic illnesses, or have Medicare and Medicaid. Special Needs Plans tailor their plan benefits to meet the unique health needs of its members, which may include specialized provider networks or coordination services.
  • Medicare Savings Account (MSA) plans: This type of Medicare Advantage plan combines a high-deductible health plan with a medical savings account. Every year, your plan deposits a certain amount of money into a saving account, which you can use to pay for Medicare-covered medical expenses before you reach the deductible.
  • Private Fee-for-Service (PFFS) plans: Instead of having a provider network, PFFS plans allow you to use any provider that will accept the plan’s terms and conditions and agree to treat you. You’ll need to find doctors and hospitals that agree to contract with the plan on a case-by-case basis.

Medicare Advantage Prescription Drug plans in North Carolina

Medicare beneficiaries in North Carolina who want prescription drug coverage (Medicare Part D) can get this coverage by enrolling in a Medicare Advantage Prescription Drug plan. These plans give you the convenience of having your Medicare Part A, Part B, and Part D benefits under a single plan.

Not every Medicare Advantage plan in North Carolina covers prescription drugs, so be sure to double-check that the Medicare Advantage plan option you’re considering includes Medicare Part D benefits.

Comparing Medicare Advantage plans in North Carolina

It is important to take a look at all Medicare Advantage plan options available in your area before making a decision. You will find that availability and plan costs will differ depending on your county of residence. For instance, a Medicare Advantage plan option in one county may have a higher or lower monthly premium than a similar plan option in a different county. Some Medicare Advantage plans in North Carolina may have premiums as low as $0. If there is a Medicare Advantage plan with a $0 premium in your service area, remember that you may still have other plan costs, such as copayments, coinsurance, or deductibles. In addition, you’ll need to keep paying your Medicare part B premium.

If you like, you can start comparing Medicare plan options in North Carolina right now from the convenience of your home. Just enter your zip code in the plan finder tool to view a customized list of Medicare Advantage plan options available to you. You can include information on your current prescription drugs to help narrow your search to Medicare plan options that cover your medications.

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