The NC 411 on Medicare

There is ample information available to assure you get the perfect insurance fit. And North Carolina professionals can help assure you get the program that’s right for you—and avoid scammers.

The North Carolina Department of Insurance provides a bounty of information to guide successful participation in one of the U.S. government’s most popular programs. While some insurance agents say Medicare is confusing because there are so many companies offering so many options, basic Medicare is relatively easy. It’s when people begin looking at coverage beyond that that the challenge sets in. 

Go to ncdoi.gov for more detail as you set out. Basically, several months before turning 65, you should begin to learn more about Medicare and how it relates to your circumstances.

For example:

• If you or your spouse have paid into the Social Security System for 10 or more years, you are eligible for premium-free Medicare Part A (Hospital Insurance) at age 65. If you have paid fewer than 10 years, you can buy Medicare Part A coverage. Everyone pays a premium for Medicare Part B (Medical Insurance).   

• If you have been on Medicare due to disability, you have a brand new six-month Open Enrollment Period for purchasing Medicare supplemental insurance when you turn 65. 

• Talk to your employer’s benefit officer and ask for any information about company health insurance after age 65. You will need to decide if you should keep your employer group health plan (EGHP) as secondary to Medicare or if you need to drop your EGHP and purchase a Medicare supplement or join a Medicare Advantage Plan. If your EGHP has drug benefits, make sure they are as good as or better than Medicare Part D.

• If you aren’t covered by an EGHP plan, investigate other health insurance options like an individual Medicare Supplement Policy or a Medicare Advantage Plan. Senior Health Insurance Information can provide information about the Medicare Supplement Plans, Medicare Advantage Plans (Part C), and Medicare Prescription Drug Plan (Medicare Part D) options available in North Carolina.  

According to experts, Medicare coverage is issued by large insurance companies like UnitedHealthcare, Anthem, Aetna, and Humana. They offer a variety of packages that can include gym memberships, vision, dental, hearing, over-the-counter drug payment, groceries, and transportation, among them. 

If you’re looking for help in making a decision about a plan, you shouldn’t be charged for the advice. Find a professional locally who will help you, avoiding the telephone solicitations and TV commercials that are handled from far away. Organizations like the N.C. Department of Insurance, League of Older Americans, and the Social Security Administration also offer a good bit of free help. 

Medicare Overview

Medicare is a federal health insurance program primarily for people aged 65 and older, but also for certain younger people with disabilities or specific conditions.

Medicare is divided into several parts, each covering different services and having its own list of covered drugs (formulary) and costs.

Part A (Hospital Insurance) covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. It is usually premium-free if you or your spouse paid Medicare taxes for at least 10 years. Otherwise, there is a premium.

Part B (Medical Insurance) covers outpatient care, doctor services, preventive services, durable medical equipment, preventive services (e.g., screenings, vaccinations), and some home health care. It requires a monthly premium, which can vary based on income. There’s also an annual deductible and typically 20% coinsurance for services after meeting the deductible. 

Part C (Medicare Advantage) is an alternative to Original Medicare (Parts A and B) offered by private insurance companies. These plans often include Part D (prescription drug coverage) and additional benefits like vision, hearing, and dental. 

Part D (Prescription Drug Coverage) helps cover the cost of prescription drugs. 

Part F was the long-standing champion of Medicare plans because it was simple to explain, understand, and use. It has been the most comprehensive—and most popular—Medicare Supplement but is no longer available for new clients. 

Medigap is Medicare Supplement Insurance, which helps pay for some costs not covered by original Medicare. It is offered by private companies and standardized into different plans A to N.

Choosing Plans

Use the Medicare Plan Finder tool at medicare.gov to compare Medicare Advantage and Part D plans. Medicare Savings Programs (MSPs) help pay Part A and/or Part B premiums, and sometimes deductibles, copayments, and coinsurance. There is also extra help for low-income people. State Health Insurance Assistance Programs (SHIP) provide free, personalized Medicare counseling. MyMedicare.gov is an online portal to access your personal Medicare information and to manage your benefits. Local insurance professionals most often provide free advice. 

Long-Term Care coverage

Long-term care insurance (LTCI) helps cover the costs of long-term care services, which can include in-home care, assisted living, nursing homes, adult day care, and hospice care. These services are not typically covered by Medicare or standard health insurance. 

Financial Considerations

If you have significant assets and income, you might be able to self-insure, meaning you can pay out-of-pocket for long-term care costs. If you have limited assets, you may qualify for Medicaid, which covers long-term care after your assets are depleted. Be certain you can afford the premiums now and in the future. 

It is often a good idea to consult a professional. A financial advisor can help you assess your financial situation, understand your options, and decide which option is best for you.