Medicare Advantage Plans, Orange County, NC, 2024
We reviewed the top 52 Medicare Advantage Plans available in Orange County, North Carolina for 2024. Here's what we learned:
Key Facts
- The average premium is $9.26 per month.[3]
- The average out-of-pocket limit is $5,451 per year.[3]
- The average drug plan deductible (for plans that include Part D) is $121.79 per year.[3]
- The Centers for Medicare & Medicaid Services (CMS) rated 77% of all plans available in Orange County 4 stars or higher.[3]
- There are 2 5-star plans available that qualify for the 5-star special enrollment period.
- There are 3 plan types to choose from, including PPO, HMO-POS, HMO, and possibly SNP plans (see: Orange County, NC Medicare Special Needs Plans.
Orange County, North Carolina Medicare Advantage Plans
Orange County, NC
Medicare Advantage Plan Information
Medicare Advantage (MA) plans are the private health insurance alternative to Original Medicare. There are 52 MA plans currently available in Orange County. The coverage is provided under strict Medicare regulations and oversight. Also known as Medicare Part C, most MA plans have additional benefits unavailable through Original Medicare.
Prescription medication coverage is one of the most popular additional benefits. These plans are also known as Medicare Advantage Prescription Drug Plans (MAPDs). These Orange County plans offer people on Medicare comprehensive coverage that can help them reduce their out-of-pocket costs.
Medicare Advantage plans in North Carolina with a star rating of 4.0 or higher are often the plans people consider first. See: medicarewire.com/medicare-advantage/north-carolina/
Types of MA Plans in Orange County
Medicare allows 7 distinct types of private health plans, although the availability of these plans may vary by location. In Orange County, people on Medicare (beneficiaries) can select from 3 out of the 7 plan types, which are as follows:
Plan Type | Description |
---|---|
HMO | Health Maintenance Organization (HMO) members usually receive services through the plan's local network of providers. Referrals are typically required to see a specialist and other providers. However, plans allow out-of-network care for emergencies and out-of-area dialysis. Prescription drug coverage is often included in HMO plans, and many plans include some coverage for dental, vison, and hearing. |
PPO | Preferred Provider Organization (PPO) members can usually use in-network and out-of-network providers for care, including hospitalization. However, visits to non-network providers could cost significantly more. PPO plans often include prescription drug coverage and other benefits, and referrals are typically not required for specialist visits. |
HMO-POS | An HMO-POS (point-of-sale) plan offers the same features as an HMO plan. There is however one major difference. HMO-POS plans allow members to access healthcare providers outside of the plan's network to receive some or all of their services. In most cases, to go out of the plan's network a member will need to get a referral from their physician. Plus, there are separate deductibles for in-network and out-of-network services. |
SNP |
See below. |
Getting Enrolled in a Medicare Advantage Plan
Most people with Medicare in North Carolina qualify to join a Medicare Advantage plan. The availability of plans in your area that meet your needs may be the determining factor.
You can join or switch Medicare Advantage plans during a Medicare Election Period. For most people, the Annual Enrollment Period, which starts on October 15 and ends on December 7, is the time they update their plan choices.
There's also an Individual Election Period (IEP) that you can use once. Your IEP is a 7-month period of time around your 65th birthday. It begins three months before you turn 65 and ends three months later. If you have Social Security Disability Insurance (SSDI), your IEP begins on the 25th month.
How to Get Prescription Drug Coverage If It's Not Included
Some people may qualify to join a standalone prescription drug plan. A Medicare Part D plan, or PDP, adds coverage for prescription Original Medicare or Medicare Advantage plans that don't include prescription coverage.
It is important to note that plans that provide prescription drug coverage can disenroll members who join a standalone PDP. Medicare does not allow you to be enrolled in plans that provide overlapping benefits.
An Option to Medicare Advantage
If you are worried that your Medicare Advantage plan options in Orange County may not meet your needs, or that Medicare Advantage plans are bad, inconvenient, or will limit your services, there is another way to get more coverage. There are Medicare Supplements available in North Carolina, as well as Medicare prescription drug plans. These work hand-in-hand with your Original Medicare to give you more coverage and more flexibility.
If you're not familiar with Medigap policies, and how they protect you from out-of-pocket costs in Original Medicare, please review our Medicare Supplement directory, where you can learn about and compare Medigap plans. All Medigap plans are standardized. That means you can choose the plan you need based on the best price without worrying about the benefits.
NOTE: If you choose a Medicare Advantage plan you cannot buy a Medicare Supplement for additional coverage. Medicare Supplements only work with Original Medicare.
Special Needs Plans (SNP) in Orange County
Many people on Medicare have unique health plan needs. This includes institutional care, care for chronic diseases, and access to both Medicare and Medicaid. Consider a Medicare Advantage Special Care Plan (SNP) if you or your loved one has one or more of these special needs.
We organize Medicare Special Needs Plans for Orange County, North Carolina in a separate directory. Although SNP plans are Medicare Advantage plans, they are only available to qualifying individuals, including:
- Individuals in a nursing home or receiving skilled nursing care at home;
- Individuals with both Medicare and Medicaid benefits; and
- Individuals with certain chronic health conditions.
Plan Availability
The MA and MAPD plans on this page are available to people on Medicare enrolled in both Medicare Part A and Part B living in Carrboro, Cedar Grove, Chapel Hill, Efland, Hillsborough, and all other areas of Orange County, North Carolina.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
Citations & References
- CMS.gov, "2024 Medicare Part C Landscape Source Files", Last Accessed October 14, 2023
- CMS.gov, "2024 Part C and D Performance Data", Last Accessed October 14, 2023
- MedicareWire.com, "What is Medicare Advantage?", Last Accessed 11 April, 2022
- Medicare.gov, "Special Needs Plans (SNP)", Last Accessed 11 June, 2023
- Medicare.gov, "How to compare Medigap policies", Last Accessed 1 June, 2023
[3]Data & Statistics
The data presented on this page is derived from the 2024 Landscape Source Files and the Part C and D Performance Data published by CMS.
The average premium, average out-of-pocket limit, and average drug plan deductible statistics for Orange County, North Carolina are derived from the most recent Landscape Source Files, excluding employer, MMP and SNP plans. MedicareWire publishes Special Needs Plans here.
Star rating statistics are derived from the most recent Part C and D Performance Data, excluding employer, MMP, SNP, and plans that have not yet been rated by CMS.
[4]Highest-Rated Medicare Advantage Plans
CMS publishes the Medicare Advantage and Medicare Part D Star Ratings each year to measure the quality of health and drug services received by people on Medicare in Orange County. MedicareWire highlights plans rated 4.0 or better as "highest-rated" or "top-rated" because they received the overall highest summary rating from CMS. According to CMS, "The Star Ratings system helps Medicare consumers compare the quality of Medicare health and drug plans being offered so they are empowered to make the best health care decisions for them."