Understanding Medicare Advantage in North Carolina

Seniors seeking Medicare coverage in North Carolina have options. You may enroll in Medicare Part A (inpatient/hospital insurance), Part B (outpatient/medical insurance), Part C (Medicare Advantage), or Part D (prescription drug coverage), as well as Medicare Supplement Insurance plans (Medigap). You might hear Parts A and B referred to as Original Medicare, a federal health insurance program.

With so many choices, it can be difficult for NC residents to find the right plan. Original Medicare doesn’t always cover the medical services seniors need. When you want more flexibility and convenience with your health care, you might prefer Medicare Advantage.

Finding the best Medicare coverage in North Carolina will take time and may seem overwhelming. Alignment Health Plan is here to help you navigate the complex world of Medicare and weigh your options. Below, we’ll explore these plans and their benefits.

 

Understanding Medicare Part C in North Carolina

Unlike Original Medicare, Medicare Part C comes from private insurance companies. These plans are Medicare-approved and follow the rules set by the program. To join a Medicare Advantage plan, you must already be enrolled in Part A and Part B. Medicare beneficiaries must also live in the service area of the plan you want.

Alignment Health NC proudly serves Avery, Buncombe, Chatham, Davidson, Davie, Forsyth, Guilford, Henderson, Johnston, Madison, McDowell, Mitchell, Orange, Transylvania, Wake, and Wilkes counties.

 

What Do Medicare Advantage Plans in North Carolina Cover?

The United States government requires Medicare Advantage plans to include both Medicare Part A and Part B benefits. However, they can also provide additional benefits, such as hearing, dental, and vision care. Most Part C plans include Medicare prescription drug coverage.

Some packages even include adult day care services, transportation to medical appointments, gym memberships, meal delivery, and other health-related services. The North Carolina Department of Insurance keeps a complete and up-to-date list of Medicare Advantage plans and benefit summaries by county and company. Click here to learn about available Alignment Health Plans and benefits in your area.

 

Types of Medicare Advantage Plans in NC

As a North Carolina resident, you have a few Advantage plans to choose from. Here is a closer look at your options — HMOs, PPOs, HMO-POS, and SNPs.

• HMO - Health Maintenance Organization (HMO) plans offer managed health care coverage through a network of carefully chosen doctors and specialists. You’ll need to select a primary care physician (PCP) within the plan’s network to coordinate care. If you need a specialist, your PCP must approve and make a referral. Out-of-network providers are not covered unless there is an emergency. HMO plans tend to offer the lowest out-of-pocket costs as long as you stay in-network.
• HMO-POS - Health Maintenance Organization Point-of-Service (HMO-POS) plans are similar to HMO plans. But with HMO-POS, you can go outside your network for certain medical services. Out-of-network care generally comes with higher copays and coinsurance. Some HMO-POS plans don’t require referrals to see a specialist.
• PPO - With a Preferred Provider Organization (PPO) plan, members do not need a PCP and can seek services outside the contracted network. PPO plans partially cover services outside their network, but your out-of-pocket costs will be higher than if you stay in-network. You do not need a referral to visit a specialist.
• SNP -
  • D-SNP - Dual Special Needs Plans (D-SNP) combine Medicare Parts A, B, and D with the North Carolina Medicaid program to provide comprehensive coverage. These plans often include vision, dental, and hearing care as well. You must be eligible for both Medicare and Medicaid to join.
  • C-SNP - Medicare Chronic Special Needs Plans (C-SNP) are for individuals diagnosed with severe or disabling chronic conditions. This includes dementia, diabetes, cardiovascular disorders, and more. These plans offer customized care and give members access to a network of specialists. See Medicare.gov’s complete list of qualifying conditions.

Want more details about Medicare Advantage Plans? Get in touch with Alignment Health Plan to learn more.

 

Why Choose a Medicare Advantage Plan From Alignment Health?

At Alignment Health, we treat our members like family and want what’s best for you. We are committed to putting seniors first, providing exceptional coordinated care, and improving health experiences. That means taking a personalized approach and maintaining a top-notch network of trusted local partners.

As a member, you’ll benefit from accessible service, first-class care, and a 24/7 concierge team. Our Advantage plans offer many benefits for members depending on your chosen plan, such as low or no premiums, an out-of-pocket cap, and non-medical supplemental benefits like meal delivery and assistance with cooking and bathing. Medicare can be complicated, but we’re here to guide you through your options and serve your needs.

Alignment Health Plan has been awarded a 5-star rating in North Carolina, the Senior Choice Gold Award, and the Excellence in Medicare Advantage Benefits Value for 2022.

Learn more about our North Carolina Medicare Advantage plans, or request a pre-enrollment kit to begin the process of enrollment.

 

FAQ

Am I eligible for Medicare in NC?

Medicare eligibility requires enrollees to be U.S. citizens or legal residents living in the U.S. for more than five years. Additionally, you must meet at least one of the following criteria:

• Be 65 years or older.
• Be on Social Security Disability Insurance (SSDI) for two years.
• Have end-stage renal disease (ESRD) or Lou Gehrig’s disease.

How does Medicare Advantage differ from Original Medicare?

Original Medicare, which includes Parts A and B, covers most medically necessary services. If you want drug benefits (Part D), you’ll need to join a separate Medicare drug plan. You can also add supplemental insurance, or Medigap, to help pay for out-of-pocket costs.

Medicare Advantage is a Medicare-approved plan offered by private insurance companies. This alternative option includes all Original Medicare benefits plus Part D coverage for prescription drugs (in most cases). Most plans have extra benefits that Part A and Part B don’t cover, such as vision and dental.

How do I enroll in a Medicare Advantage Plan?

When you decide to join a Medicare Part C plan, visit the Medicare.gov website to explore plans in your area. Some allow you to enroll online, but you’ll need to call directly for others. Every plan must allow Medicare enrollees to fill out a paper form.

Anyone with Original Medicare can join during the Open Enrollment period between October 15 and December 7. Your Part C coverage will begin the following January 1.

To enroll with Alignment Health, simply input your zip code here and start shopping for a plan that meets your needs.