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North Carolina Medicare: The Ultimate Guide

Are you one of more than 1.7 million NC Medicare beneficiaries? We have good news for you! Our organization has NC Medicare agents that can answer your questions and make sure you’re getting the best benefits possible. Let’s look at your options.

A Guide to Medicare North Carolina Includes:

North Carolina Medicare Eligibility

The North Carolina Medicare eligibility requirements are the same as in every other state. You can qualify if you are age 65 or older (or within three months of turning 65) or if you are diagnosed with either ALS or ESRD. You can also qualify for Medicare in North Carolina if you receive SSDI (Social Security Disability Insurance), in which case you will be automatically enrolled in Medicare your 25th month of receiving SSDI benefits.

What is the Cost of Medicare in North Carolina?

Your Medicare costs will depend on your employment history. If you worked and paid your Medicare employment taxes for a minimum of 39 quarters, you can get “premium-free Part A,” which means you will not pay a premium for your Medicare hospital coverage. Unfortunately, if you worked and paid Medicare employment taxes for only 30 to 39 quarters, you will face a Part A premium of $240 in 2019. However, if you did not work and pay Medicare taxes for a minimum of 30 quarters, your Part A premium will be $437 per month in 2019. The 2019 Part A deductible for hospital stays is $341 per day for the first 90 days, and then $682 per day.

Most people will pay a monthly premium for Part B, medical coverage. The standard Part B premium in 2019 is $135.50 per month, and the standard deductible is $185. Some people with high income may be asked to pay more.

Can I have Medicaid and Medicare in North Carolina?

We get this question a lot, and the answer is yes, it is possible to have both NC Medicare and Medicaid! If you qualify for North Carolina Medicaid and either have ALS or ESRD or are at least 65 years old, you can qualify for a “dual-eligible special needs plan,” a form of Medicare Advantage designed specifically for those who can get benefits from both Medicare and Medicaid.

What does North Carolina Medicare Cover?

Medicare Part A covers hospital, nursing home, hospice, and home health services. Part B covers physical wellness services, lab tests, medical equipment, mental health, emergency transportation, and other services related to your primary physician. You can add coverage for other items such as prescription drugs, dental, vision, and other services by selecting a Medicare Advantage or Medicare Supplement plan.

Have Questions? Ask a Benefits Advisor in Your Area

What Medicare Plans are Available in North Carolina?

Every North Carolina Medicare beneficiary will begin with Original Medicare. Original Medicare includes Part A (hospital coverage), and Part B (medical coverage). Then, you’ll need a prescription drug plan.

There are two ways to get prescription drug coverage. The first option is to keep your Original Medicare and enroll in a “Part D,” or stand-alone prescription drug plan. If you want more coverage than what your Original Medicare includes, you can instead opt for Medicare Advantage, or “Part C.” NC Medicare Advantage plans usually include Part A, Part B, Part D, and other benefits like dental, vision, hearing, and even fitness benefits.

Medicare Advantage is not for you but you still want additional coverage, you can add a Medicare Supplement plan to your Original Medicare. Some Medicare Supplement plans include prescription drug coverage, but they don’t usually include other benefits in the same way that Medicare Advantage does. Instead, NC Medicare Supplement plans can help you pay for your existing copayments, premiums, and deductibles.

Medicare Supplement plans are named by letter (A, B, C, D, F, G, K, L, M, and N). Each letter represents a different type of Medicare Supplement plan, which offers a different amount of coverage at a different price. Keep in mind that Medicare Supplement and Medicare Advantage plans are NOT the same things, and you CANNOT have both.

Medicare in North Carolina: Relevant Resources

The North Carolina Division on Aging and Adult Services offers several programs for North Carolina seniors. You can get access to most of these programs through your local North Carolina Area Agency on Aging or your local North Carolina Senior Center. Let’s look at some that you may find helpful:

Adult Placement Services - Seniors who are no longer able to support themselves at home can reach out to North Carolina’s Adult Placement Services for help finding a home.

Congregate Nutrition & Home Delivered Meals - North Carolina seniors in need can get home-delivered meals and nutrition guidance. Click here to find a home meal delivery provider in your area and click here for the Congregate Nutrition Program.

Community Alternatives Programs for Disabled Adults (CAP/DA) - The CAP/DA program helps seniors stay in their homes instead of having to move into facilities. The program helps with items like adult day care, home aides and nurses, meal prep and delivery, personal emergency response services, medical equipment, financial management, etc. Find the CAP/DA in your county here.

Elder Housing Locator - Click to access a list of North Carolina senior housing options.

In-Home Aides - North Carolina in-home aides can help seniors with eating, bathing, dressing, cooking, cleaning, shopping, etc. For more information, contact Glenda Artis (glenda.artis@dhhs.nc.gov), Mary Jo Littlewood (maryjo.littlewood@dhhs.nc.gov), or Lorrie Roth (lorrie.roth@dhhs.nc.gov).

Local Contact Agency (LCA) - LCAs are located within your local Area Agency on Aging. They can help those who live in or want to live in nursing homes and other skilled facilities make a move. For more information, contact mary.edwards@dhhs.nc.gov.

Long-Term Care Ombudsman - Similarly to LCAs, the long-term care ombudsman is for those living in long-term care facilities. You can find them at your local Area Agency on Aging and they can help you file grievances and handle any legal issues that you may face. For assistance, contact victor.orija@dhhs.nc.gov, laura.ward@ddhs.nc.gov, or lakendra.dixon@dhhs.nc.gov.

Have Questions? Ask a Benefits Advisor in Your Area

Operation Fan and Heat Relief - Seniors with chronic health conditions and those who have little income but are struggling with extreme heat can receive fans to help in the warmer months. Click here to find a fan provider near you.

Targeting Program - If you’re disabled and have very low income, the targeting program can help you find an affordable living situation. Just email Heather Dominique at hcdominique@nchfa.com or call 919-877-5661.

Project CARE - Otherwise known as Caregiver Alternatives to Running on Empty, Project CARE assists North Carolina caregivers (especially for those who work with seniors who have dementia and related diseases). Project CARE provides counseling, education, referrals, partnerships, and more to caregivers. You can contact the North Carolina Project CARE Director, Dawn Oakey Gartman, at (919) 855-3462.

Senior Community Service Employment Program - Low-income, disadvantaged seniors can find a part-time job through the North Carolina Senior Community Service Employment Program as a way to help transition into an unsubsidized job. The seniors involved have the chance to learn valuable skills that can help them in the workforce.

Special Assistance In Home Program (SA/IH) - Low-income seniors who are at risk for moving into a residential facility can get cash supplements from the SA/IH. Eligibility is based on your ability to live at home, financial situation, and availability of friends, family, and neighbors that can help.

State and County Special Assistance for Adult Care Home Residents - Some North Carolina special needs residents can access state or county funding for nursing home facilities. You can apply at your local DDS (Social Services) office.

North Carolina Senior Transportation Services - Eligible seniors can get help finding transportation to senior programs, grocery stores, and medical appointments. If you are eligible for Medicaid, Medicaid will provide these services. Otherwise, contact your local Social Services office or the Department of Transportation.

What is the North Carolina Medicare Savings Program?

The Medicare Savings Program is a national program that can help certain Medicare members afford premiums, deductibles, coinsurance, and copayments. To qualify for one of the programs, you’ll have to meet certain income and resource limits. Resources refer to other financial gains you may have that are not considered income, such as stocks, bonds, and any money you have in a savings account.

Where do I Apply for Medicare in North Carolina?

Most people can apply for Medicare online at the Social Security website or in person at your local Social Security office. If you’d prefer to apply over the phone, call 1-800-772-1213 (TTY: 1-900-325-0778). If you worked for a railroad, your enrollment will go through the Railroad Retirement Board. You can call the RRB for more information at 1-877-772-5722.

Have Questions? Ask a Benefits Advisor in Your Area

How do I Apply for NC Medicare?

The options listed above can help you apply for Medicare in North Carolina. Keep in mind that those options are for Original Medicare only. If you think you want to enroll in Medicare Advantage or a Medicare Supplement plan, you’ll want to speak to a Medicare Plan Finder agent.

What is the Best Medicare Plan in North Carolina?

At this point, you’re probably wondering which of the options we’ve discussed is best for you. There is not one “best Medicare plan in North Carolina,” because everyone’s needs are different, That’s why there are so many options. While a Medicare Advantage plan may be best for you, your spouse or friend may be better off with a Medicare Supplement plan. What’s more, once you select the type of plan you want, you’ll have to choose from the hundreds available in North Carolina state!

Our agents can come to meet with you at no cost and help you figure out if you’re eligible for cost savings and help you pick the best plan for you. Plus, our agents are contracted with every major NC Medicare carrier. That means they can sort through them all with you to help you figure out which one truly works best for your needs. To get started, complete this Medicare Plan Finder form or give us a call at 833-GET-ENROLLED (833-438-3676).

Have questions? Ask a Benefits Advisor!