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Medicare Advantage Plans in NC

Now that you are on the country's largest health insurance program, Medicare, you're interested in finding out all your options for supplemental coverage. Medicare Advantage plans in NC offer you and excellent alternative to supplement your Parts A, B and D coverage

Most Medicare Advantage (MA) plans offer prescription drug coverage (Part D) in the plan so you do not have to purchase a seperate PDP plan.  This not only saves you money but can also reduce confusion because all your benefits are together in the same plan.

The two most common types of Medicare Advantage plans in NC are an HMO and a PPO.

  • Health Maintenance Organization (HMO):  If your plan is an HMO then you are required to use only doctors and facilities that participate in that HMO. You will have a primary doctor assigned to you and to see a specialists within the HMO you will typically need a referal from your primary doctor.

HMO plans are very popular in North Carolina but are not available in every region or county.  Typically in the larger areas like Raleigh and Charlotte you network is pretty good. However, one thing of caution on HMO is that if you use an out of network doctor, anything other than an emergency, you are likely going to be responsible for the majority of the bill.  Therefore if you travel out of state often this particular plan may not be the right option for you.

  • Preferred Provider Organization (PPO):  Like HMO's, PPO plans have a provider network that doctors and hospitals contract with.  As long as you see a doctor in the PPO your copayments and out of pocket expenses will be less.  Typically you will be free to see any doctor in the PPO without a referral from your primary doctor. Also, if you wanted to see an out of network doctor you could and have the plan cover some of the costs up until your reach your out of pocket maximum (in which the plan would then cover 100%.

MA plans are typically going to cost you less than if you were to supplement your coverage with a NC Medicare supplement.  However, you will have annual out of pocket exposure higher with a Medicare Advantage plan than you would say Medicare Supplement Plan F that covers 100% of your medical bills (not including prescription drugs).  If you are generally healthy or are on very limited funds then a Medicare Advantage plans in NC might be the right option for you.  It is very important that you work with a qualified professional to assist you in deciding if these plans are right for you.