Who qualifies for Medicare in North Carolina?
Medicare in North Carolina is available to U.S. citizens and permanent legal residents who have lived in the United States for at least five years and meet these conditions:
- Age 65 years or older
- Under 65 with End-Stage Renal Disease (ESRD)
- Under 65 with ALS (Lou Gehrig disease)
- On Social Security Disability Insurance for at least 2 years
- Eligible for Social Security or Railroad Retirement benefits for at least 2 years but have not yet applied
Medicare in North Carolina is available to Government employees and retirees (and their spouses) who have not paid into Social Security but did pay into Medicare Payroll taxes.
Is Medicare in North Carolina free?
How Much is Medicare Part A?
Medicare Part A is premium-free for most beneficiaries. If you paid Medicare payroll taxes for fewer than 30 quarters, you will pay the $471 maximum premium.
The Standard Part A premium of $259 dollars is due if you paid Medicare for 30 to 39 quarters.
You will receive Medicare Part A benefits free if you have 40 or more work credits. A maximum of four work credits can be earned per year. It takes ten years to earn 40 credits.
How Much is Medicare Part B?
All Medicare beneficiaries must pay a monthly premium for Part B.
The Part B deductible is $203 in 2021 and must be paid by all Medicare beneficiaries before Original Medicare pays the prescribed 80% of the approved amounts for medical expenses for outpatient health care.
After Original Medicare pays the 80%, the remaining 20% coinsurance and deductibles must be paid by the patient. Original Medicare sets no limit on the amount of out of pocket costs. Many people purchase a Medicare Supplement plan at the time of Medicare enrollment to help cover these expenses.
How Much is a Medicare Part D Prescription Drug Plan?
Original Medicare (Medicare Part A and Part B) does not include prescription drug coverage. You can enroll in a Medicare Advantage Plan or purchase a stand-alone prescription drug plan, Part D plan.
Many Medicare Advantage health insurance plans include prescription drug coverage. In considering coverage options, check with a Medicare agent to be sure your Prescription drug (or drugs) will be covered by your plan.
The costs of a Medicare Part D prescription drug plan include deductibles, copays, and coinsurance. These vary with your region and service area, choice of insurance companies and health plan, and your medical and financial needs.
For those in low-income brackets, there are $0 Part D premiums available as long as you pay the Part B premium.
Individuals and couples in higher income brackets may have plan premiums ranging from $12.30 to $71.10 per month.
The deductible is the amount you pay before your medical insurance plan begins to pay. The copayments will depend on income, plan specifics, and the drug tier of your prescription drug.
What if I choose a “Free” $0 Premium Medicare Advantage Plan?
There is no premium for a Medicare Advantage Plan (Medicare Part C), but eligibility for the plan requires paying the Part B premium. A prescription drug plan is often included as one of the ‘advantages’ of Medicare Part C, along with dental, vision, hearing, fitness, and wellness benefits.
Three types of Medicare Advantage Plans include HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), and PFFS (Private Fee for Service) plans. They are offered by private insurance companies funded by the Federal Government through the Centers for Medicare & Medicaid Services.
How Much is a Medicare Supplement Plan?
Medicare Supplement plan costs vary with location and which of the 10 standardized plans you choose. These medical insurance plans do not provide prescription drug coverage, but a stand-alone drug plan can be purchased.
Many people choose supplement plans for the freedom to see any doctor in the country with no network or service area restrictions. Medicare Supplement Plans (Medigap) offer generous emergency foreign travel benefits and comprehensive coverage that make health care costs quite predictable.
What Medicare plans are available in North Carolina?
Best for network freedom: Medicare Supplement
With a Medicare Supplement Plan, you may have higher costs, but your coverage is nationwide. If you travel extensively and may need to seek specialty care in another state, a supplement plan may be best for you.
No referrals are necessary. There is no need for yearly plan changes. Premiums may change within a $125 to $250 price range.
Best for lowest premiums: Medicare Advantage
PPO plans have wider networks with no referrals. HMO plans have smaller networks and require referrals.
PPO premiums vary from $0 to $100 monthly. HMO premiums are ordinarily $0 monthly.
Best for low-income recipients or those with health conditions: Medicare Advantage D-SNIP
Coverage options include having an insurance plan with Medicare and Medicaid to decrease out of pocket costs like copayments and premiums.
North Carolina Medicare FAQs:
What is the income limit for Medicare in North Carolina?
In 2021, most people pay the standard amount Part B premium of $148.50. Those whose modified adjusted income exceeds certain amounts will pay the standard amount plus an Income Related Monthly Adjustment Amount (IRMAA). A calculated extra amount will be added to the Part B premium.
Individuals reporting $88,000 or less on federal tax returns and couples reporting $176,000 or less will pay the standard amount.
Increases in income up to $111,000 (individuals) or $222,000 (couples) will require a premium amount of $207.90. Premium amounts will be increased with higher income brackets up to $504.90 for individuals earning over $500,000 or couples earning over $750,000 annually.
How do I apply for Medicare in North Carolina?
The Medicare Program is administered by the Centers for Medicare & Medicaid Services (CMS). Social Security partners with CMS by automatically enrolling people in the Medicare Program.
Automatic enrollments apply to people in these categories:
- Railroad Retirement Board benefit recipients for at least 4 months before 65th birthday
- Social Security Disability Benefits (SSI) for 24 months
- Have amyotrophic lateral sclerosis (ALS) also called Lou Gehrig’s disease
- Have End-Stage renal disease (ESRD)
End-Stage renal disease patients can choose to enroll in Medicare Part A and Part B. Those already on Medicare who have been paying a late Part B penalty will have the penalty removed when changing to End-Stage Renal Disease enrollment.
Lacking any qualifying situation, you can apply for Medicare coverage online or by consulting a Medicare insurance agent by phone or in person. Consulting an agent assures you have all the needed facts about coverage options to choose your optimal coverage.
When can I apply for Medicare in North Carolina?
Your Initial Enrollment Period (IEP) begins three months before you turn 65 and ends three months after your 65th birthday month. After you enroll in the Part A and/or Part B Medicare Program, you can choose to enroll in a Medicare Advantage Plan as a substitute for Original Medicare or purchase a Medicare Supplement Plan to help pay the medical expenses not covered by Original Medicare.
If you have eligibility for premium-free Medicare Part A, you can enroll in it any time after you become eligible for Medicare. Your Part A health coverage will be retroactive for six months from your enrollment date, but not earlier than the first month you are eligible to enroll in Medicare.
If you must buy Medicare Part A and/or Part B, it must be done within a valid enrollment period. Annual Medicare enrollment periods include:
- General Enrollment Period (GEP) from January 1 to March 31 yearly – Part A and/or Part B premiums must be paid and health coverage begins July 1
- Special Enrollment Periods
If you are employed and have an employment-based group health insurance plan, you can enroll in Medicare Part A and/or Part B any time in these situations:
- You or your spouse is still working (or a family member if you’re disabled)
- You have group health plan coverage through your employer or a union
An 8-month enrollment period exists for Part A (hospital) and/or Part B (outpatient/wellness) beginning the month employment ends or the month after employer-based group health plan insurance ends.
Where do I apply for Medicare?
Three ways to apply for Medicare benefits:
- Online application: The Social Security Administration (SSA) website has an online application that may be completed in about 10 minutes
- Monday through Friday (7 a.m. to 7 p.m.) call 1-800-772-1213 to apply by phone. Those with hearing difficulties, call 1-800-325-0778
- To apply in person, go to your local Social Security Office
What should I bring when applying for Medicare?
If you choose to apply for Medicare in person, it would be wise to bring the following:
- Birth certificate
- Proof of United States citizenship or legal residency
- Social Security Card – Those receiving SSA benefits
- Health insurance information to determine which insurance will be primary coverage
- Tax information
- Military documents
- Part B Enrollment application – If you opted out of Part B but now wish to apply
Is enrollment in Medicare mandatory at age 65?
If you are on Social Security (SSA) benefits, you must sign up for Part A, as they are intertwined. You can delay enrollment in Medicare Part B, C and D without facing a late penalty if you have creditable coverage (comparable coverage with Medicare benefits).
Delaying without a qualifying condition may lead to an ongoing late penalty for the Part B and/or Part D premiums.
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- In North Carolina, Medicare Advantage & Medicare Supplement plans are the most popular choices.
- Your initial Medicare enrollment period begins three months before your 65th birthday and includes the entire month.
- Apply for Medicare online, by phone or at a Social Security office in your service area.