What is a North Carolina Medicare Advantage Plan?
The advantages of Medicare Advantage (MA) health plans are found in what they can cover that Original Medicare cannot. Specifically, the MA plans (aka, Part C of Medicare) available in North Carolina can include minor healthcare benefits such as prescription drug coverage, vision, hearing, dental, fitness, telehealth, and more. In contrast, Original Medicare only covers major medical healthcare services. To join an MA plan you must first be enrolled in both Medicare Part A and Part B.
Many people love the extra benefits they get with their MA plan, particularly a prescription drug plan. However, before you jump in with both feet, take the time to fully understand the trade-offs. The extra benefits and perks are nice, but they come at a cost. Specifically, when you become a Medicare Advantage plan member in North Carolina you are agreeing to accept the plan's managed care health system. As an MA plan member, you agree to let the insurance plan be a gatekeeper and fully control your access to doctors and other healthcare providers.
Medicare vs. North Carolina Medicare Advantage Plans: How Do They Compare?
The big differences between traditional Medicare coverage and what you get with a Medicare Advantage plan in North Carolina are easy to see by pointing out the pros and cons. Neither type of insurance is perfect. They each suit different needs.
Pros and Cons: Medicare vs. North Carolina Medicare Advantage Plans
- When you have Original Medicare you are free to use any Medicare-approved doctor you choose. When you join a Medicare Advantage plan, your choices are limited to the plan's network of North Carolina providers.
- If you travel frequently or you are a snowbird and winter or summer in another state, your Original Medicare coverage remains the same. It goes where you go. This is not true with North Carolina Medicare Advantage plans, which are only required to cover you if you have a medical emergency.
- With OriginalMedicare there are no limits on your out-of-pocket costs. However, all North Carolina Medicare Advantage plans have an annual maximum out-of-pocket (MOOP) limit. If you reach the MOOP spending limit on your copays and coinsurance, the plan picks up the tab for the remainder of the year.
- If you want prescription coverage and have Original Medicare you must purchase a Medicare Part D plan. However, most Medicare Advantage plans include a North Carolina Medicare Part D plan. Just be aware that a stand-alone Part D plan gives you the best opportunity to get your most expensive prescriptions at the lowest cost.
- In the Medicare Advantage program, the government allows plans to set their own copays and coinsurance for each healthcare service offered. This makes comparing plans difficult, at best. However, in the Original Medicare system deductibles and coinsurance are fixed, making them predictable. Plus, you can get a Medigap plan to help pay these costs.
- There are eligibility requirements with Medicare Advantage plans. For example, you must have both Medicare Part A and Medicare Part B to join, and you cannot have end-stage renal disease (ESRD) or one of a handful of other diseases.
North Carolina Medicare Advantage Plans vs. Medigap
Most North Carolina seniors just getting their Medicare benefits want to know which type of plan is better. We commonly see these three questions:
- Why are Medicare Advantage plans bad?
- What are the disadvantages of Medicare Advantage plans?
- Is it better to have Medicare Advantage or Medigap?
Let's take a minute or two to compare and contrast, shall we?
Why North Carolina Medicare Advantage Plans are Bad
First things first. Medicare Advantage plans are not bad. More than 20% of all Medicare beneficiaries choose enrollment in a Medicare Advantage plan. But, it's not for everyone. Before you enroll, learn the disadvantages of these plans if you are a senior in North Carolina.
In particular, if you have one or more chronic conditions, Original Medicare could be a better option because you have the ability to choose your doctors. MedicareWire believes that Medicare Advantage is the best option for healthy people, people with Medicare Advantage retiree benefits, and for people who qualify for both Medicare and Medicaid.
Conversely, Original Medicare and a Medicare supplement work best for people with chronic health conditions (based on overall cost), as well as those who can afford a higher monthly premium, even when they are well.
You can check out supplemental Medicare insurance in North Carolina on our North Carolina Medicare supplements page.
Are There Disadvantages to Joining a Medicare Advantage Plan in North Carolina?
As you have already read, both Medicare Advantage and traditional Medicare have their benefits. But the two types of coverage are apples and oranges. However, if you remove the issue of doctor choice from the equation, the primary difference is when and how you pay. This fact remains the same no matter what type of Medicare Advantage plan you are considering (e.g., HMO, PPO, PFFS, Cost, or HSA).
With Medicare Advantage you pay a little each month (with some plans you pay nothing). This is the monthly premium. But you also pay copayments when you use most medical services, and they add up fast. It does not matter if you have a Health Maintenance Organization (HMO) plan or a Preferred Provider Plan (PPO). The majority of your costs are due when you use health services.
However, with Original Medicare and a Medigap plan for supplemental coverage, you pay for most of your costs in advance with a higher premium. You control your costs by choosing a plan that pays the deductible(s) you want to be covered. This makes your health care costs predictable, and for most people on a fixed budget, that's very comforting.
When Should I Consider Medigap Instead of Medicare Advantage?
- If you can afford Medigap Plan F or G, then keep your Original Medicare and add one of these supplements. These plans help you manage your out-of-pocket costs the best, giving you complete peace-of-mind.
- If you are a healthy senior and have good health in your family heritage, Medigap Plan N will let you save money by sharing some costs when you see your doctor. The plan benefits are excellent and pay just a little to see your doctor (up to $25 per visit).
- If you are a healthy senior but you cannot afford a Medigap Plan F, G, or N, Medicare Advantage is a good choice. Both Original Medicare and Medicare Advantage cover preventive care at no additional cost to keep you healthy
- If you are turning age 65, have one or more chronic health conditions that require frequent doctor visits, and you do not qualify for both Medicare and Medicaid (dual eligible), the most Medigap coverage you can afford is the best option.
- If you qualify for both Medicare and Medicaid, regardless of your health condition, Medicare Advantage is your best option.
- If you have special needs (i.e., a full-time nursing home resident, diabetes, etc.) and an appropriate Medicare Advantage Special Needs Plan (SNP) is available, this is your best option.
- With both Medigap and Medicare Advantage, you must continue to pay your Medicare Part B premium (it typically comes straight out of your Social Security income, unless you're not yet taking it).
- With Medicare supplement insurance there are no service area restrictions. With Medicare Advantage, you must receive care within the plan's provider network unless you need emergency care.
- Medicare Advantage plans have an enrollment period. You get an individual enrollment period when you're first eligible. After that, there's an annual enrollment period to switch plans or go back to Original Medicare. Medigap plans do not have the same restrictions, but you can be turned down if you leave a Medigap plan and later want to come back. Medicare Advantage plans cannot generally turn you down as a Medicare supplement insurance company can.
Frequently Asked Questions About North Carolina Medicare Advantage Plans
North Carolina Medicare Advantage plans are not statewide, they are local. So, the only way to answer this question is to enter your zipcode here.
Most Medicare Advantage plans available in North Carolina include a Part D plan, but not all. Before joining a plan, be sure to check that all of your most important medications are covered. You can do that with this tool.
While not for everyone, Medicare Advantage plans have their benefits. The best way to understand these plans is to evaluate your health and financial situation. Here is an article that will help you make the right choice.
Compare the Best Medicare Advantage Plans in North Carolina by County
Citations & Referencesmedicare.gov
- Medicare.gov: the official U.S. government site for Medicare | Medicare http://www.medicare.gov/
- Medicare.gov: the official U.S. government site for Medicare | Medicare https://www.medicare.gov/
- Find a Medicare plan https://www.medicare.gov/plan-compare/
- Medicare Benefits | SSA https://www.ssa.gov/medicare/
- Extra Help with Medicare Prescription Drug Plan Costs | SSA https://www.ssa.gov/medicare/prescriptionhelp/
- Medicare Benefits | SSA https://www.ssa.gov/benefits/medicare/
- Five-Star Quality Rating System | CMS https://www.cms.gov/medicare/provider-enrollment-and-certification/certificat...
- Medicare Open Enrollment | CMS https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-h...
The Medicare Advantage plan information on this page is maintained by David Bynon and was last updated on .