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North Carolina Medicare Advantage: The 8 Best & Worst Plans
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Medicare Advantage plans can be hard to compare, especially since not all plan options are the same throughout the state and premiums and other costs can vary. Find out which plans are the best in North Carolina and how to compare your plan options.
Medicare Advantage plans, which are also referred to as MA plans or Medicare Part C, are a great way to get additional healthcare benefits that Original Medicare ( Medicare Part A and Medicare Part B ) won’t cover. These often include drug coverage ( Medicare Part D ), hearing and dental coverage, fitness programs, and more.
Keep in mind that plan options from private insurance companies are not the same throughout the state; instead, plan costs and availability vary locally, and your ZIP code will help you determine which plan options you have access to in North Carolina.
Are you wondering which Medicare Advantage plans are available to enrollees in your service area? Check the Insurify Medicare comparison tool to find out.
Top Medicare Advantage Health Insurance Plans in North Carolina
These top plans were chosen for factors such as plan costs (including coinsurance and co-payments ) and out-of-pocket maximums, overall benefits, and whether the plan received a 5-star rating from Medicare. For more information on our ranking procedure, see our methodology page.
Best Medicare Advantage Plans In North Carolina
1. Humana Gold Plus - Score: 76.76
2. FirstMedicare Direct smartHMO - Score: 75.05
3. Cigna Preferred Plus Medicare - Score: 74.68
4. Cigna Preferred Medicare - Score: 74.68
5. Erickson Advantage Signature with Drugs - Score: 74.31
6. AARP Medicare Advantage Plan 1 - Score: 73.43
7. Erickson Advantage Liberty with Drugs - Score: 72.22
8. Erickson Advantage Freedom - Score: 72.22
A complete description of benefits documents for each plan and for other medical insurance plans are available on the North Carolina Department of Insurance website. These documents also specify which plans offer Medicare prescription drug coverage for enrollees and include a formulary explaining drug coverage costs.
#1: Humana Gold Plus
Insurify Composite Score: 76.76
Monthly Premium: $0
Prescription Drug Plan Deductible: $0
Out-of-Pocket Maximum: $4,400
This low cost plan comes with a lot of advantages indeed. We want to be sure to poin out the low out-of-pocket maximum first. That’s set at just $4,400 annually.
Additionally, you’ll get low copays for Tier 1 and Tier 2 prescriptions. Plus $0 copays for preventive and primary care visits, preventive dental, and routine vision. For most other care, including hearing and mental health, copays are well below average.
The best news is that costs may be even lower depending on your county.
#2: FirstMedicare Direct smartHMO
Insurify Composite Score: 75.05
Monthly Premium: $0
Prescription Drug Plan Deductible: $0
Out-of-Pocket Maximum: $3,400
Though this plan is only available to residents of Wake county, those who can get it should certainly consider it. No monthly premium, a $0 drug deductible, and a very-advantageous $3,400 out-of-pocket maximum limit makes this plan an incredible contender.
And the cost of use is low too. Low copays for Tier 1 and Tier 2 prescriptions. Plus, $0 copays for urgent care, preventive, and primary care visits. You’ll also get low cost preventive dental, comprehensive dental, and routine vision care.
The only drawback is that you’ll need stand-alone hearing coverage. Exams are covered, but not hearings aids or fittings.
#3: Cigna Preferred Plus Medicare Plan
Insurify Composite Score: 74.68
Monthly Premium: $29
Prescription Drug Plan Deductible: $0
Out-of-Pocket Maximum: $3,900
Unlike the first Cigna plan, this HMO plan has a premium of $29. The plan includes Part D drug coverage and a $0 medical deductible, along with $0 co-pays for primary care, specialist visits, and many hearing, dental, and vision benefits.
Its out-of-pocket maximum is a bit higher at $4,050 for covered in-network services, but it offers lower costs for some provided benefits, such as diagnostic services, and higher allowances for benefits like over-the-counter items.
#4: Cigna Preferred Medicare Plan
Insurify Composite Score: 74.68
Monthly Premium: $0
Prescription Drug Plan Deductible: $0
Out-of-Pocket Maximum: $4,900
Here’s another health plan option that offers users both Part D drug coverage and a $0 monthly premium. This HMO plan has a $0 medical deductible, and it caps out at $3,650 on out-of-pocket costs for covered in-network services.
Like other top plans, there’s also a $0 co-pay for primary care services and preventive care, but it takes the savings a step further with a $0 co-pay for specialist visits as well. Lastly, many hearing, dental, and vision benefits also have $0 co-pays.
#5: Erickson Advantage Signature Plan with Drugs
Insurify Composite Score: 74.31
Monthly Premium: $199
Prescription Drug Plan Deductible: $0
Out-of-Pocket Maximum: $2,600
Erickson Living describes this HMO option as its “most complete plan,” with coverage including a prescription drug plan, $0 co-pays for preventive care, in-network primary care, and lab visits, and only a $20 co-pay for in-network specialist visits.
The plan also features $0 co-pays for some dental, vision, and transportation benefits, as well as fitness and respite care coverage, but those benefits and more come with a $199 monthly premium. It also offers a lower $2,600 out-of-pocket maximum for covered in-network services.
#6: AARP Medicare Advantage Plan 1
Insurify Composite Score: 73.43
Monthly Premium: $27
Prescription Drug Plan Deductible: $50
Out-of-Pocket Maximum: $3,600
While this is another plan where you’ll pay a monthly premium, you’ll be happy with the many low costs across the plan. And don’t forget that $27 a month for a premium is still quite low. You get a low prescription deductible at just $50, with no deductible for the health plan. Plus, a low out-of-pocket maximum set at $3,600..
Beyond that, you’ll see low or no copayment for low-tier prescriptions, preventive care visits, primary care visits, and diagnostic services. Plus no or no cost hearing, dental, and vision coverage. Add to that the ability to access out-of-network coverage and you can see why this plan made the list.
#7: Erickson Advantage Liberty with Drugs
Insurify Composite Score: 72.22
Monthly Premium: $0
Prescription Drug Plan Deductible: $400
Out-of-Pocket Maximum: $6,700
This 5-star HMO plan is great for those who want extra coverage regarding co-payments and other regular care-related costs. In addition to prescription drug plan coverage, it offers a $0 premium and a $6,700 out-of-pocket maximum for covered in-network care.
The plan also offers $0 co-pay costs for preventive care, primary care for providers in the Erickson Health Medical Group, and lab services, with just a $50 cost for specialist visits.
Like other Erickson Advantage plans, there’s a list of additional benefits for dental, transportation, hearing aids, fitness, and vision.
#8: Erickson Advantage Freedom Plan
Insurify Composite Score: 72.22
Monthly Premium: $70
Prescription Drug Plan Deductible: $200
Out-of-Pocket Maximum: $4,300
Also a 5-star HMO health plan, this plan is a mid-level option for those looking for extra coverage around any out-of-pocket expenses. The plan benefits include prescription drug coverage along with a $70 monthly premium (lower than the Champion plan), and it includes a $4,300 out-of-pocket maximum for covered in-network care.
The plan also offers $0 co-pays for preventive care, primary care doctor visits within Erickson Health Medical Group, and lab services, in addition to a $50 co-pay for in-network specialist visits.
Like the Champion plan, it also provides $0 co-pays for some preventive dental care, transportation to approved locations, and annual vision exams in addition to other benefits, such as those for hearing aids and fitness.
Now that you know what the top plans have to offer, discover which plans are available in your service area with the Insurify Medicare comparison tool.
How Much Does Medicare Advantage Cost in North Carolina?
Your costs will likely be different from someone in the next county or even next door. That’s because there are many factors that can influence how much you pay throughout the year. Those factors include:
Where you live
Health conditions under treatment
The size of your health plan network
The pricing structure of your health plan
That being said, you should expect to pay around $XX a month in premiums. You’ll also want to budget for your deductible (around $XX) and copayments. The typical copayment is $25 to $50 depending on what type of physician you see (generalist vs specialist).
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Types of Medicare Advantage Health Insurance Plans
To understand which alternative to Original Medicare is best for you, it’s important to know how the plan types differ. The most common are health maintenance organization ( HMO ) plans, preferred provider organization ( PPO ) plans, private fee-for-service ( PFFS ) plans, and special needs plans ( SNPs ). While private insurers do provide the plans, the federal Medicare program provides them with guidelines.
Medicare.gov provides additional details on each plan type mentioned below.
HMO Plans
HMO plans generally require you to use in-network healthcare providers unless it is for emergency care or for out-of-area urgent care or dialysis. These plans typically do provide prescription drug coverage, and you are usually required to select a primary care doctor. You also usually require a referral to see a specialist.
PPO Plans
With PPO plans, you’ll typically pay less if you see a physician in your healthcare provider network. They also usually cover prescription drug costs. Unlike HMO plans, you don’t have to choose a primary care doctor, and you usually don’t need a referral to see an in-network specialist.
PFFS Plans
Some PFFS plans allow you to see any provider, while plans with a network allow you to see any physician in your healthcare provider network who agrees to always treat your plan’s members. Some out-of-network providers also agree to treat plan members, but the cost to see them will usually be higher.
These plans may or may not provide prescription drug coverage, so be sure to check the plan details. Usually, they don’t require you to choose a primary care doctor or have a referral for specialist visits, either.
SNPs
SNPs only offer membership to those with certain diseases or characteristics. These plans have specific benefits that are meant to fit the needs of the groups they’re created for. For this reason, SNPs have in-network providers, and plan members must get their care from those providers, except during an emergency or for dialysis-related to end-stage renal disease (ESRD).
Unlike other MA plans, these plans must offer drug coverage. Usually, they do require you to have a primary care doctor or may require you to have a care coordinator, and they usually require referrals for specialist visits as well.
FAQ: North Carolina Medicare Advantage
Generally, you are eligible for enrollment in an MA plan if you live in the service area where the plan you want to join is offered and if you have Medicare Part A and Part B. If you live in another state for part of the year, you will need to check with the plan to see if it will cover you there as well.
Also, beginning January 2021, people with end-stage renal disease (ESRD) have the option for enrollment either in Original Medicare or an MA plan at the start of their coverage.
No, enrollees cannot use benefits from both MA plans and medicare supplement plans at the same time. If you already have a Medigap plan and join an MA plan, you should consider dropping the Medigap plan since the MA plan won’t pay any of your co-payments, deductibles, or premiums.
You may be eligible for dual enrollment in both Medicare and Medicaid. The North Carolina Medicaid program can help you determine your eligibility.
If you decide that you’d rather have a Medigap plan, you will have special rights to buy a Medigap policy if you return to Original Medicare (hospital insurance and medical insurance) coverage within 12 months of joining an MA plan.
After the 12-month period, generally, you must keep your MA plan through the end of the year, and you can disenroll or change plans during the Open Enrollment Period (or if you’re subject to a Special Enrollment Period).
North Carolina’s Medicare and Seniors' Health Insurance Information Program (SHIIP) can also provide you with more information on enrollment periods.
Conclusion: Choose a Medicare Advantage Plan That’s Right for You
When it comes to choosing a plan, ultimately, you’ll need to look at your budget and health to determine the coverage you need and the premiums and other costs that you can afford.
You also need to examine the options available in your area, especially since coverage from Durham to Charlotte and every city in between can vary.
Want a closer look at the Medicare coverage options available to you in North Carolina? Try out the Insurify Medicare comparison tool.
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Jasmine FlemingInsurance Writer
Jasmine Fleming is a freelance digital content marketer and strategist. She loves crafting helpful content that readers can use to make important decisions. You can learn more about Jasmine at her website, www.jasminefleming.com.
