Best Medicare Advantage Plans in North Carolina for 2023
Find Plans in your area with your ZIP Code
If you are thinking about getting out of Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. and into a Medicare Advantage plan available in North Carolina, you're not alone. Nearly half of the estimated 64 million people with Medicare will join a Medicare Advantage plan in 2023. Some join to get more benefits. Some join to save money. And some like a plan's doctors and other healthcare providers.
Our online tools will help you find top-rated Medicare Advantage plans in your region of North Carolina. The overview of North Carolina's market below will give you a clear picture of your top options and who the best providers are. It also shows you how much you can expect to pay each month for a plan.
Table of Contents
- Medicare Advantage PlansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). are available to U.S. citizens and legal U.S. residents living in North Carolina who are enrolled in Original Medicare.
- Insurance plans are offered by private health insurance companies and provide an alternative way to receive Medicare benefits in your North Carolina County.
- Medicare Advantage Plans in North Carolina are required to provide at least the same benefits as Original Medicare, but they may also provide additional benefits such as vision, dental, and hearing coverage.
- Plans may also offer prescription drug coverage, which is not available with Original Medicare. A stand-alone Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plans available in North Carolina can be added if the health plan does not include Part D.
- Medicare Advantage Plans in North Carolina may have different cost-sharing requirements than Original Medicare, such as copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service., coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. , and deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share.. Be sure to compare plans, including prices, quality and affordable out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments., to determine the best Medicare insurance for your situation.
- Medicare Advantage Plans in North Carolina may also have different provider networks than Original Medicare, so it is important to make sure that your preferred doctors and hospitals are in-networkDoctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get....
- Medicare Advantage insurance has specific open enrollment periods. Unlike Medicare Supplement plans, you cannot join, switch, or drop a plan outside of an enrollment period.
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Who Has The Best Plans in North Carolina?
Every year, the Centers for Medicare & Medicaid ServicesThe Centers for Medicare & Medicaid Services (CMS) is the U.S. Federal agency that runs the Medicare, Medicaid, and Children’s Health Insurance Programs. (CMS) reviews and rates all Medicare Advantage plans in North Carolina based on a 5-star scale. Input for the ratings comes from information that each plan self-reports, as well as individual member complaints. (Read more about Medicare star ratings.)
North Carolina has 5-star Medicare Advantage plans available in 2023. Not all states and locations do. This year, the highest rated Medicare plans available in North Carolina come from:
- HealthTeam Advantage
- Alignment Health Plan
We recommend evaluating the health plans from these North Carolina health insurance companies ahead of all others. Here's why. Simply put, more stars generally mean members will get better results. Members might get better service, phone support, and care from a 5-star than they would from a four-star plan.
CRUCIAL: Benefits are not the same throughout North Carolina. That's why it is so important to fully understand the advantages and disadvantages of Medicare Advantage plans specifically for you and your personal situation. Understanding Medigap vs Medicare Advantage is crucial. Evaluate benefits and costs carefully to find the plan best suited to your healthcare needs.
Complete List of North Carolina's Providers for 2023
Approximately 13 health insurance providers offer Medicare Advantage plans in North Carolina, including:
- Aetna Medicare
- Alignment Health Plan
- Blue Cross and Blue Shield of North Carolina
- Experience Health
- FirstMedicare Direct
- HealthTeam Advantage
- Lasso Healthcare
- Troy Medicare
Top Ranked 2023 Plans in North Carolina
According to the Centers for Medicare & MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. Services, here are the top 2023 Medicare Advantage Plans available in North Carolina:
Top Medicare Advantage Plans in North Carolina
|Provider||Plan ID||Plan Name||Premium||Limit||Stars|
|Alignment Health Plan||H5296-003||Alignment Health Platinum (HMO-POS)||$0.00||$2,499||5.0|
|HealthTeam Advantage||H9808-004||HealthTeam Advantage Plan I (PPO)||$0.00||$3,200||5.0|
|HealthTeam Advantage||H9808-005||HealthTeam Advantage Plan II (PPO)||$75.00||$3,000||5.0|
|UnitedHealthcare||H5652-006||Erickson Advantage Freedom (HMO-POS)||$68.00||$4,300||5.0|
|UnitedHealthcare||H5652-008||Erickson Advantage Liberty with Drugs (HMO-POS)||$0.00||$7,550||5.0|
|UnitedHealthcare||H5652-001||Erickson Advantage Signature with Drugs (HMO-POS)||$197.00||$2,600||5.0|
|Blue Cross and Blue Shield of North Carolina||H3449-026||Blue Medicare Choice (HMO)||$0.00||$3,200||4.5|
|Blue Cross and Blue Shield of North Carolina||H3449-024||Blue Medicare Enhanced (HMO-POS)||$19.00||$3,700||4.5|
|Blue Cross and Blue Shield of North Carolina||H3449-027||Blue Medicare Essential (HMO)||$0.00||$7,500||4.5|
|Blue Cross and Blue Shield of North Carolina||H3449-023||Blue Medicare Essential Plus (HMO-POS)||$0.00||$3,950||4.5|
|Blue Cross and Blue Shield of North Carolina||H3404-003||Blue Medicare PPO Enhanced (PPO)||$29.00||$5,650||4.5|
|Experience Health||H3777-001||Experience Health Medicare Advantage (HMO)||$0.00||$3,900||4.5|
|Humana||H1036-291||Humana Gold Plus H1036-291 (HMO-POS)||$0.00||$3,400||4.5|
|Humana||H5216-017||HumanaChoice H5216-017 (PPO)||$0.00||$8,300||4.5|
|Humana||H5216-211||HumanaChoice H5216-211 (PPO)||$47.00||$6,700||4.5|
|Humana||H1036-137||Humana Gold Plus H1036-137 (HMO-POS)||$0.00||$4,400||4.5|
|Humana||H6622-057||Humana Gold Plus H6622-057 (HMO-POS)||$0.00||$4,400||4.5|
|Humana||H6622-025||Humana Gold Plus H6622-025 (HMO-POS)||$0.00||$4,900||4.5|
|Humana||H6622-026||Humana Gold Plus H6622-026 (HMO-POS)||$30.00||$4,200||4.5|
|Humana||H6622-061||Humana Gold Plus H6622-061 (HMO-POS)||$0.00||$3,650||4.5|
|Humana||H5216-336||HumanaChoice H5216-336 (PPO)||$135.00||$6,700||4.5|
|Humana||H6622-060||Humana Gold Plus H6622-060 (HMO-POS)||$0.00||$4,200||4.5|
|Humana||H1036-233||Humana Gold Plus H1036-233 (HMO-POS)||$0.00||$4,200||4.5|
|UnitedHealthcare||H5253-037||AARP Medicare Advantage Plan 1 (HMO-POS)||$27.00||$3,600||4.5|
|UnitedHealthcare||H5253-038||AARP Medicare Advantage Plan 2 (HMO-POS)||$0.00||$4,500||4.5|
|UnitedHealthcare||H5253-117||AARP Medicare Advantage Plan 3 (HMO-POS)||$0.00||$3,600||4.5|
|UnitedHealthcare||H5253-110||AARP Medicare Advantage Rebate (HMO-POS)||$0.00||$6,700||4.5|
Whether or not you can join a plan from one of the top-rated providers depends on where you live. If your North Carolina County has the plan you want, and you qualify, you can enroll. Medicare Advantage plans are regional. Generally speaking, larger urban areas have more plan options than rural areas.
Best Plans in North Carolina by County
Choose your North Carolina County below to see the best (and the worst) 2023 plans.
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How to Find the Best Plan Available in North Carolina
You may be looking at plans for several different reasons, including turning 65 or the Annual Enrollment PeriodThe Annual Enrollment Period is when Medicare beneficiaries can join, drop or change Medicare Advantage and Medicare Part D prescription drug plans. AEP begins on 15 October and ends on 7 December.. Or, perhaps you are navigating a special enrollment event, such as moving to a new area. In all of these cases, there are a few important details you need to consider.
1. Consider Your Expected Utilization
Do you think you’ll take maximum advantage of your benefits (doctors, hospital inpatient careInpatient care refers to care provided in a hospital or other inpatient facility. Inpatients are admitted and stay at least one night depending on their condition., tests, etc.)? If so, prioritize plans with lower out-of-pocket maximums and lower copayments, even if they have higher monthly premiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. . Otherwise, look for plans with low monthly premiums. Just be aware that plans with low or no monthly premiums tend to have higher out-of-pocket maximums and/or higher deductibles.
2. Evaluate Your Prescription Costs
Prescription drugs are often the main reason that seniors pay more for healthcare. Because most Medicare Advantage plans include Part D coverage for prescriptions, it is important to ensure you get the right plan that covers your drugs at a cost you can afford.
3. Understand Your Additional Coverage Needs
Original Medicare only covers your major medical services, leaving you to pay for dental, vision, hearing, and other healthcare services, or get additional coverage. Fortunately, a growing number of Medicare Advantage plans cover many of the essential services not covered by your Part A and Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. benefits.
4. Consider Your Healthcare Providers
Medicare Advantage plans have healthcare provider networks. Unfortunately, not all specialists and primary care doctors accept all plans. Many people on Medicare in North Carolina tell us it's difficult to find a plan their doctors take. We can help!
Should I Choose an HMO or PPO plan?
There are many plan options available when shopping for Medicare Advantage plans in North Carolina, including HMO and PPO options. These are some of the differences you should consider before making a plan selection.
- With an HMO you may pay less out-of-pocket, but you will need to choose a primary physician to coordinate your care. Referrals for specialists are often required. Except in an emergency, you must remain within the provider network.
- With a PPO you are not required to get referrals for specialty care. You have the option to get health care outside of the plan's provider network. However, typically you will pay more and the out-of-pocket maximum for out-of-network care will be higher.
Need help choosing? Call 1-855-728-0510 (TTY 711) for plan assistance. There's no obligation.
Find Plans in your area with your ZIP Code
Medicare Advantage plans are available to people ages 65 and older. They are also available to individuals with certain disabilities. When eligible, you can generally join one of these Medicare Advantage Plans:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Medical Savings Account (MSA) Plan
You must live in the service area (i.e., County) of the plan you want to join. If you reside outside the plan's service area for part of the year, ask if the plan will cover you there. You must also have both Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Part B and be a U.S. citizen or a legal resident.
Medicare Advantage Plans are an alternative to Original Medicare coverage. However, there is another option. You can keep your Original Medicare benefits and add one of the best Medicare Supplement plans in North Carolina for additional coverage. And, there are North Carolina Medicare Part D plans for coverage of prescription drugs.
Many experts feel Medicare Supplement insuranceMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. plans offer superior financial coverage and the most flexibility. Plus, benefits rarely change and you can get a policy outside of a Medicare enrollment period. However, plans may not be affordable for all North Carolina seniors.
Due to the fact that Medicare Supplement plans cover more costs than Medicare Advantage Plans, their monthly premiums are generally higher. If you cannot afford Medicare's out-of-pocket costs, another alternative is a dual-eligibleDual-eligible beneficiaries are those who receive both Medicare and Medicaid benefits. It includes beneficiaries enrolled in Medicare Part A and/or Part B while receiving full Medicaid and/or financial assistance through a Medicare Savings Program.... Medicare Special Needs Plan in North Carolina. D-SNP plans help North Carolina seniors who qualify for both Medicare and Medicaid. D-SNP plans offer quality care at very affordable prices.
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Frequently Asked Questions
Still have questions? These common questions and answers might help.
What are the disadvantages of a Medicare Advantage plan?
Medicare Advantage plans have several potential disadvantages. For instance, most plans require their members to use their network of providers. Also, costs are also largely based on your use of healthcare services, making it more difficult to budget for healthcare costs. And, most plans make members get referrals to see a specialist or prior authorizationPrior authorization is a process used by health plans to control healthcare costs. Most HMO plans and some PPO plans require authorization before receiving certain treatments, medical services, or prescription drugs. to receive a service. Read about all five disadvantages of Medicare Advantage plans.
How much do Medicare Advantage plans cost in North Carolina?
A Medicare Advantage plan in North Carolina costs an average of $20.38. This is just the monthly premium. You should also consider the out-of-pocket expenses of a plan if you have any chronic conditions, which include a plan's copays and deductibles. Prescription drug benefits are also included in most Medicare Advantage plans, but they have their own out-of-pocket costs.
What is every Medicare Advantage plan required to include?
Approved Medicare Advantage plans sold in North Carolina must, at a minimum, cover everything that's in Original Medicare. But plans do not have to cover healthcare services at the same cost as Original Medicare. For example, Medicare Part A covers about 80% of hospital stays, skilled nursing care, home health careHealth care services and supplies a doctor decides you may receive in your home under a plan of care established by your doctor. Medicare only covers home health care on a limited basis as ordered..., and hospiceHospice is a special way of caring for people who are terminally ill. Hospice care involves a team-oriented approach that addresses the medical, physical, social, emotional, and spiritual needs of the patient. care. Whereas Part B provides coverage for about 80% of outpatient services, including lab tests and doctor visits. Medicare Advantage plans set their own copays and deductibles, and often charge more than 20%. However, plans have an annual limit and Original Medicare doesn't.
Methodology and Sources
Our analysis of the top-rated Medicare Advantage plans in North Carolina excludes employer group plans, Medicare-Medicaid Plans (MMPs), Medicare Savings Account Plans (MSAs), Special Needs Plans (SNPs), and plans that do not include Part D benefits.
CMS rates and reviews health plans in several categories, including delivery of health care, member experience and customer service. When comparing plan ratings, we use state-specific data, not CMS' nationwide figures.
Medicare Advantage plan data is sourced from CMS public use files (see: Citations & References). When needed, we combined affiliated companies to calculate insurer averages.
Our research does not include North Carolina's Medicare Advantage SNP Plans. We evaluate these plans separately. We also did not include plans without Part D benefits for prescription drugs, employer plans, or Medicare-Medicaid Plans (MMPs). If you're not looking for a Medicare Advantage plan but want to cover out-of-pocket costs that Original Medicare plan doesn't cover, MedicareWireMedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. also ranked the best Medigap Plans in North Carolina.
Citations & References
- CMS.gov, 2023 Medicare Part C Landscape Source Files, Last Accessed January 13, 2023
- CMS.gov, "CMS Releases 2023 Medicare Advantage and Part D Star Ratings", Last Accessed October 6, 2022
- Medicare.gov, "Medicare Advantage Plans", Last Accessed October 1, 2022
- KFF.org, "Medicare Advantage in 2022: Enrollment Update and Key Trends", Last Accessed November 5, 2022
- Medicare.gov, "Things to know about Medicare Advantage Plans", Last Accessed October 12, 2022
- CMS.gov, Part C and D Performance Data, Last Accessed January 13, 2023
- CMS.gov, Monthly MA Enrollment by State/County/Contract, Last Accessed January 13, 2023
- CMS.gov, Biden-Harris Administration Announces Lower Premiums for Medicare Advantage and Prescription Drug Plans in 2023, Last Accessed September 29, 2022
- CMS.gov, Medicare Marketing Guidelines, Last Accessed February 2, 2023
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The Medicare Advantage information on the page was researched and published by David Bynon, and was last updated on .
Our content follows the guidance provided by the Medicare Marketing Guidelines on CMS.gov. If you believe the information on this page is inaccurate, please contact us.