Medicare Info - NC Medicare Plans

Medicare Info

Medicare Eligibility:

Medicare is a federal health insurance program for:

  • People age 65 and older
  • People under 65 with certain disabilities
  • People of any age with End-Stage Renal Disease (ERSD)

What are my Medicare coverage choices?

There are 2 main ways to have Medicare coverage—Original Medicare or a Medicare Advantage Plan. Use the steps below to help you decide which way to get your coverage.

Parts of Medicare:

Medicare is divided into separate parts, each part serving its own purpose and covering specific areas of health care.

Medicare Part A:

Medicare Part A is premium-free to those who qualify through Social Security, railroad retirement or government employment and it is financed by the payroll tax (FICA). People under age 65 who have been disabled for 24 months and receive Social Security disability benefits qualify for Medicare Part A as well. Individuals over age 65 who do not qualify through Social Security, railroad retirement or government employment may still receive Part A by paying a monthly premium.

Part A Covers:

  • Hospitalization
  • Post-hospital Skilled Nursing Facility Care
  • Home Health Care
  • Hospice Care
  • Psychiatric Care

Medicare Part B:

Medicare Part B is optional and offered to all applicants when they become eligible for Part A either by qualification or premium. All Part B participants pay a monthly premium and annual deductible for services.

Part B Covers:

  • Medical Expenses
  • Clinical Laboratory Services
  • Home Health Care
  • Outpatient Hospital Treatment
  • Blood (except the first 3 pints per benefit period)

Medicare Part C or Medicare Advantage:

Medicare Part C, also known as Medicare Advantage plans, are provided by private insurance companies contracted with Medicare. These plans package the benefits and services of Part A and Part B into one plan and usually include prescription drug (Part D) coverage. Although Part C is an alternative to Part A and Part B, you must be enrolled in Part A and Part B to be eligible.

Part C Covers:

  • All benefits of Part A and Part B
  • Insurance Carriers offer MAPD (Medicare Advantage Prescription Drug) Plans – Typically, either PPO or HMO Plans.
  • Physicians and Hospital may or may not be “in-network.”
  • Generally, requires Physician and Hospital copays.
  • No deductibles; pay copays up to “Out of Pocket Maximums”.
  • Usually these plans include Medicare Part D Prescription coverage with one low monthly premium.
  • Available for individuals on Social Security disability under 65 years of age.

Medicare Part D:

Medicare Part D is prescription drug coverage. These plans are provided by private insurance companies contracted with Medicare.

Medicare Supplement Insurance or Medigap:

Medicare Supplement Plans are designed to fill gaps in coverage that exist within Medicare Part A and Part B. These plans are offered by private insurance companies and are not a government benefit. Standard Medicare Supplement Benefits Medicare Supplement plans are not a required option; however, they are usually recommended due to potential high out of pocket cost when only covered by Original Medicare (Part A and Part B).

Medicare Supplement Covers:

  • Depending on which “Plan” you purchase, it will cover the other 20% Medicare approved amount (coinsurance) that Medicare doesn’t cover, plus, deductibles and possibly even the 15% Excess Charges that physicians can charge.
  • You have freedom to choose any physicians and hospitals.
  • “Plans A – N” available (we recommend “Plan F” or “Plan G”).
  • Health questions are asked IF NOT enrolling when first eligible for Medicare.
  • Prescriptions Coverage Medicare Part D is not included with this policy; you must purchase a separate Medicare Part D policy.

To discuss your Medicare options, please contact us at 704-791-2978. To view the different Medigap prices, click the Get Quote button.

Medicare Enrollment Dates

Medicare Advantage

Between: October 15 - December 7

  • Change from Original Medicare to a Medicare Advantage Plan.
  • Change from a Medicare Advantage Plan back to Original Medicare.
  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
  • Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
  • Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
  • Join a Medicare Prescription Drug Plan.
  • Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan.
  • Drop your Medicare prescription drug coverage completely.

January 1—Coverage Begins

Your new coverage begins if you switched to a new plan. If you stay with the same plan, any changes to coverage, benefits, or costs for the new year will begin on January 1.

Between January 1–February 14

If you’re in a Medicare Advantage Plan (like an HMO or PPO), you can leave your plan and switch to Original Medicare. If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.

When to buy a Medicare Supplement policy?

The best time to buy a Medigap policy is during your Medigap Open Enrollment Period, which is the six-month period that begins on the first day of the month in which you turn 65 or older and have enrolled in Part B. After this enrollment period, you may not be able to buy a Medigap policy, due to health questions and increase in cost.

If you select to delay Medicare Part B, because you have group health coverage based on you (or your spouse's) current employment, your Medigap Open Enrollment Period will not begin until you enroll into Medicare Part B.

To discuss your Medicare options, please contact us at 704-791-2978. To view the different Medigap prices, click the Get Quote button.

By contacting the phone number on this website you will be directed to a licensed agent.