Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Both Medicare and Medicare Advantage provide health insurance coverage for seniors and other eligible individuals. Original Medicare falls under federal administration, whereas Medicare Advantage is delivered by private insurance companies and varies by state. Medicare Advantage Plans must offer the same basic coverage as Original Medicare Parts A and B, namely inpatient and outpatient medical services (except hospice care). Most private policies feature some level of prescription drug coverage, removing the need for seniors to sign up for Medicare Part D. Private plans, sometimes referred to as Part C, commonly include extra services that regular Medicare does not cover, such as nonmedical transportation, dental care and senior wellness education.
Original Medicare may require separate payments for the different parts, but seniors pay a single monthly premium for Medicare Advantage Plans. Essentially, Medicare Advantage combines traditional Medicare benefits into one easy-to-manage plan. In addition, Medicare Advantage providers cap an individual’s annual out-of-pocket expenses, unlike regular Medicare. Private plans have differing co-pays and deductibles, and Medicare Advantage companies can set their own referral criteria, service areas and health care provider networks. Seniors should compare options carefully to ensure they meet their requirements and budgets. In some cases, seniors can join group Medicare Part C plans through their employer or union.
North Carolina has around 10.7 million residents, with seniors 65 and over composing roughly 17.4% of the state’s population. In 2022, the state was home to over 2 million Medicare-eligible individuals. Of these, almost half (48%) had signed up for Medicare Advantage Plans from various providers. By July 2023, the number of people qualified for Medicare in North Carolina had increased by 2.95% to almost 2.2 million. Also, the number of Medicare Advantage enrollees increased by 12.07% to more than 1.1 million, resulting in 53% of all eligible individuals opting for Medicare Advantage in 2023. Compared with national figures, Part C participation is slightly higher in North Carolina than the U.S. norm of 51%.
This guide provides valuable insights into the Medicare Advantage Plans accessible in North Carolina, presenting coverage details, eligibility criteria, enrollment procedures, and a wealth of statewide resources.
The Top 10 Medicare Advantage Plans in North Carolina
North Carolina has a variety of Medicare Advantage plans available, each offering varying levels of coverage, copays, deductibles and premiums.
The table below lists the state’s 10 most popular Medicare Advantage plans based on enrollment numbers. In some cases, providers may offer multiple Medicare Advantage plans. When this occurs, cost information may be listed as a range instead of an average price, and a sum of enrollment numbers for each of those plans is listed, providing information about the provider’s total enrollment numbers throughout the state.
This table is accurate as of April 2022. For more accurate and up-to-date information, visit Medicare.gov to view the plans that are available across North Carolina.
Name
Enrollment
Medicare Star Rating
Monthly Cost Range
Plan Types
Humana
407865
3.5
$0 – $135
PPO, HMO
Highmark Inc.
251893
4.5
$0 – $36
HMO
Aetna Medicare
148509
3.5
$0 – $21
PPO, HMO
Blue Cross Blue Shield of Michigan
80601
4.5
$0 – $49
HMO
UnitedHealthcare
32053
3
$0 – $197
PPO, HMO, PFFS
Blue Cross and Blue Shield of North Carolina
26395
4.5
$0 – $49
PPO
Cigna
16535
4
$0 – $27
HMO
Wellcare
15069
2.5
$0 – $55
PPO, HMO
CARE N” CARE INSURANCE COMPANY OF NORTH CAROLINA
14680
5
$0 – $75
PPO
Highmark Blue Cross Blue Shield of Western New Yo
12689
4
$0 – $36
PPO
How Medicare Advantage Plans Work in North Carolina
There are several types of Medicare Advantage plans in North Carolina, and before you select one, it’s important to ensure that you know how each one works.
Plan types include health maintenance organizations (HMOs), preferred provider organizations (PPOs) medical savings accounts (MSAs) and special needs plans (SNPs), each of which are subject to different rules and regulations when it comes to referrals, out-of-network care and primary care providers. Further descriptions of these options are outlined below.
What Medicare Advantage Plans Cover in North Carolina
While every plan varies, all Medicare Advantage plans in North Carolina are required to provide coverage for all services covered by Original Medicare, except for hospice care. That means seniors who are enrolled in Medicare Advantage have coverage for services such as X-rays, primary care, laboratory testing and hospital care. Medicare Advantage also typically includes additional coverage for services such as eye care and hearing tests.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Preventive Screenings
Yes
Yes
Hospital Care
Yes
Yes
Durable Medical Equipment
Yes
Yes
Prescription Drugs
No
Yes**
Vision Care
No
Yes*
Dental Care
No
Yes*
Hearing Aids
No
Yes*
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in North Carolina
Those wanting to enroll in a Medicare Advantage plan must meet the Medicare eligibility requirements. That means they must be aged 65 or older and a United States citizen or legal permanent resident.
They also must already be enrolled in Medicare Part A and Medicare Part B, and they must reside within their provider’s and plan’s service area.
Medicare plans have limited enrollment periods, meaning that seniors may only initiate coverage at specific times throughout the year. The list below further explains how enrollment periods work, when they are and what to do when you miss your initial enrollment period.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Start Date
End Date
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
October 15th
December 7th
Medicare Advantage Open Enrollment Period
January 1st
March 31st
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in North Carolina
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
Medicare and Seniors’ Health Insurance Information Program (SHIIP)
SHIIP provides free, unbiased guidance to help Medicare beneficiaries and caregivers understand Medicare health care products. Counselors in every county meet with seniors by appointment only. Through the NC Senior Medicare Patrol Program, counselors help seniors recognize and avoid Medicare billing errors, fraud and abuse. SHIIP also offers information on its website, including this fact sheet, which discusses Medicare Advantage terms, enrollment periods and questions to ask when comparing plans. This program is available for current Medicare clients, people looking to enroll soon and their caregivers.
SHIIP can be contacted by phone at 1-855-408-1212 or by email at [email protected]. Seniors can consult this list of contacts for local counseling by county. They can also reach counselors through local Area Agencies of Aging.
Options Counseling helps seniors make informed decisions regarding long-term services and supports. This free service guides seniors through assessing the benefits and drawbacks of different options in light of their situation, values, preferences and resources. The program can benefit those who do not know how to take advantage of long-term services and supports, such as Medicare Advantage, or are unaware of existing local supports and resources. Options Counselors can also assist seniors with planning for future needs and help them formulate an individualized Action Plan.
Contact Info
Options Counseling is expanding throughout the state, so it may not be available in all areas yet. To see if there is an Options Counselor in their county, seniors can contact the program manager by email at [email protected].
The Long-Term Care Ombudsman Program (Advocacy for Residents in Long- Term Care Facilities) is made up of the State Long-Term Care Ombudsman and 16 Regional Long-Term Care Ombudsmen. These officials help long-term care facility residents secure their rights and work through grievances between residents, families and facilities. They explain long-term care options and investigate financial concerns, including Medicaid, Medicare and Social Security. Guidance is offered for Medicaid and Medicare, particularly on coverage conditions, the application process and the services covered. The ombudsmen also educate long-term care providers and community groups on residents’ rights, care planning and new legislation.
Established through the Older Americans Act, North Carolina’s Area Agencies on Aging (AAAs) are local programs that connect seniors and their caregivers with a wide range of local services and resources. These agencies develop, enhance and support systems designed to preserve dignity and promote independence for seniors. North Carolina has 16 AAAs located within regional Councils of Government. These agencies are direct providers of information and referral or assistance, educating seniors about available services in their community and helping them gain access to those benefits. AAAs advocate for seniors on local and state concerns beyond the services and programs they render or fund. Available services include case management, meals, in-home services, transportation and counseling on health insurance and benefits.
Contact Info
AAAs are dispersed throughout the state of North Carolina. A list of locations and contact information can be found on their website.
Community and Senior Services of Johnston County (CSS) is a private senior support organization in Smithfield. It provides home-delivered meals, in-home aides, housing assistance and transportation accommodations throughout the county. The nonprofit also has centers in Benson, Clayton, Harrison, Kenly and Princeton. CSS is a certified official counseling site for SHIIP and has an Options Counselor available to discuss long-term options, based on needs and preferences. The counselor acts as a liaison between seniors and services, following up with each person with status check-ins. Seniors who need help paying for Medicare coverage can ask the Options Counselor about the Extra Help Program. CSS holds SHIIP workshops at some of its senior centers, by appointment only, for seniors and caregivers looking for information about Medicare. Seniors can consult the bi-monthly newsletter on the CCS home page to find events near their location.
CSS is located at 1363 West Market Street in Smithfield. To make an appointment with an Options Counselor, seniors can call 1-919-934-6066.
Resources for Seniors, Inc.
Resources for Seniors provides information and support for seniors and adults with disabilities in Wake County. This private organization coordinates direct services, including adult day care, home care and senior centers to foster independence, security and comfort. It publishes a free annual directory of resources for the Triangle area, available in print or by PDF download.
Information Services at Resources for Seniors is available weekdays by phone, email and fax. Seniors can call 1-919-872-7933 to reach an Information and Referral Specialist who can assess their situation, help them identify the services they need and point them to the appropriate programs and resources.
