North Carolina residents have many choices when selecting a Medicare Advantage Plan in 2023. Which plans would be right for you? In this article, we rank the top-rated MA Plans in North Carolina, offering insights regarding the plans’ coverage areas, average costs, and quality ratings. MA Plans are an alternative method for Medicare beneficiaries to receive their Medicare Parts A and B services. Most MA Plans also offer Part D prescription coverage and other benefits not included in Original Medicare, such as vision, dental, hearing exams, and fitness memberships.
Best Medicare Advantage Plans in North Carolina in 2023: shortlist
- UnitedHealthcare — best overall member value
- Humana — highest customer service rankings
- Aetna — great affordable plan options
Best Medicare Advantage Plan in North Carolina: our top picks
Our search for the best Medicare Advantage plans in North Carolina led us to these top picks: United Healthcare, Humana, and Aetna. The plans offered by these companies, rated above average on their CMS Star Ratings in 2023, include broad service areas and provide great overall value for members. Read more about these top picks while learning about additional search tools to help you identify an MA Plan best suited for your needs. Your search may include alternate criteria to fit your unique circumstances.
1. UnitedHealthcare — best overall member value
UnitedHealthcare (UHC) ranks among the top Medicare Advantage providers in North Carolina because of its high-quality and cost-effective plans available in almost all NC counties. UHC offers plans with $0 options for monthly premiums and $0 annual drug deductibles. In addition to optional benefits such as fitness, dental, and hearing exams, they also have eyewear allowance and 24/7 telephonic access to a nurse.
2. Humana — highest customer service rankings
Humana stands out for its excellent customer service ratings and unique benefit offerings. They also provide the broadest service area covering all 100 North Carolina counties with 788 contract options. Some unique benefits include Part B Premium giveback for qualified individuals, SilverSneakers fitness memberships, and an over-the-counter spending allowance.
3. Aetna — great affordable plan options
Aetna is known for its affordable plan options, including $0 monthly premiums and $0 deductible for Tier 1 prescription drugs. Aetna is accredited by the National Committee for Quality Assurance and scored 4 out of 5 for overall MA Plan quality. Some additional benefits Aetna offers are Resources for Living, a 24-hour nurse line, prescription delivery, SilverSneakers fitness membership, OTC benefits, and meals-at-home post-hospitalization. Aetna offers 385 contracts throughout 85 counties in North Carolina.
Comparing the top 3 Medicare Advantage plans in North Carolina
To compare the top 3 MA plans in North Carolina, we reviewed average costs, availability, quality, and customer satisfaction ratings. This chart presents our findings.
You can compare plans specific to your zip code on Medicare’s plan finding tool since MA Plan availability is based on zip code and county.
|Avg. monthly premium (excluding $0)||$31.52||$67.08||$10.21|
|Avg. in-network max-out-of-pocket costs||$4,998.07||$6,660.19||$6,126.75|
|Avg. annual drug deductible||$0.00||$247.01||$109.47|
|Extra benefits||Fitness, dental, hearing, Part B premium reductions, eyewear allowance, prescription drug home delivery, house calls, Fitbit, Virtual Visits||Part B premium giveback, SilverSneakers, spending allowance; user-friendly website, Free rides to doctor’s appointments||Fitness, dental, hearing, meal delivery, OTC allowance, Prescription home delivery|
|Number of contracts available||415||788||385|
|Number of counties serviced||99||100||85|
|Avg. CMS star ratings||3.9||4.0||3.9|
|NCQA (based on quality and member experience)||Accredited 3.5/5||Not Accredited 3/5||Accredited 4/5|
|J.D. Powers (Overall customer satisfaction index ranking 2022)||4th||2nd||6th|
How we ranked the best North Carolina Medicare Advantage plans?
The criteria we used to rank the best North Carolina Medicare Advantage Plans included cost, availability, quality, and customer satisfaction ratings. We evaluated data from publicly available sources such as CMS.gov, the NCQA Health Plan Report Card, and J.D. Power rankings.
- Cost. We utilized the Centers for Medicare and Medicaid Services (CMS) 2023 data to evaluate plan costs such as monthly premiums, annual prescription drug coverage, and in-network max-out-of-pocket limits.
- Availability. Service areas for MA Plans are based on North Carolina county and zip code. We used CMS 2023 data to tally the number of providers and contracts provided per county.
- Quality ratings. CMS provides a public transparency tool to rate every MA plan called the 5-Star Rating system based on five categories and 38 quality measures. We used CMS Star Ratings from CMS.gov and the National Committee for Quality Assurance (NCQA) Report Card data. The NCQA is a nonprofit organization and the leader in healthcare accreditation.
- Customer satisfaction. We considered J.D. Powers' overall customer satisfaction index ranking from 2022 for each MA Plan. This J.D. Power analysis considered six factors: coverage and benefits, provider choice, cost, customer service, information and communication, and billing and payment.
Medicare Advantage in North Carolina: things to know
When selecting a Medicare Advantage Plan in North Carolina, knowing your rights and options is essential. MA plans must provide all services covered by your Medicare Parts A and B. Many plans also offer Part D prescription drug coverage and additional benefits not provided via Original Medicare. You cannot be denied an MA plan because of preexisting health conditions. Healthcare providers can join or leave an MA plan at any time during the year, so you may need to choose a new health provider if that occurs. The availability of MA plans is based on zip code and county. To optimize cost savings, use your in-network health services.
- Average consolidated monthly premium of North Carolina MA plans (excluding $0 premiums): $43.77
- Average annual drug deductible of North Carolina MA plans: $139.77
- Average in-network max out-of-pocket amount: $5,718.78
- Medicare mandates that the max OOP amount for MA plans is $8,300 although most plans have lower amounts
- Average overall star rating: 3.8
What providers offer Medicare Advantage plans in North Carolina
Medicare Advantage Plans in North Carolina comprise various insurance models such as HMO, PPO, PFFS, and MSA that operate differently. For example, the Health Maintenance Organization (HMO) plans revolve around managed care by the primary care provider, who would refer to specialists as needed. Preferred Provider Organization (PPO) plans offer a vast network of healthcare providers that members may visit without a referral. To learn more about each model of MA Plan, read this Best Medicare Advantage Plans article.
These are the 14 providers that offer MA plans in North Carolina in 2023 listed alphabetically, along with the number of contracts each provider offers:
- Aetna Medicare - 385
- Alignment Health Plan - 32
- ApexHealth - 39
- Blue Cross and Blue Shield of North Carolina -558
- Care N' Care Insurance Company of North Carolina - 22
- Cigna - 151
- Devoted Health -18
- Experience Health, Inc. - 8
- FirstMedicare Direct - 66
- Humana - 788
- Lasso Healthcare - 200
- Troy Medicare - 40
- UnitedHealthcare - 415
- Wellcare - 489
5-star Medicare Advantage plans in North Carolina
5 stars is the highest possible rating awarded by the Centers for Medicare and Medicaid Services (CMS), which oversees all Medicare Advantage plans. MA plans that achieve 5 stars are considered excellent. CMS rates every MA Plan annually based on five main categories comprising 38 quality measures. These ratings are updated on CMS.gov. Each category is rated on a scale of 1–5 stars, with 1 being the worst and 5 being the best.
The CMS Star rating categories include:
- Staying healthy (screenings, tests and vaccines)
- Managing chronic (long–term) conditions
- Member experience with health plan
- Member complaints and changes in the health plan’s performance
- Health plan customer service
UnitedHealthcare, Care N' Care Insurance Company of North Carolina, and Alignment Health Plan achieved 5-star CMS Ratings in 2023. These three providers offer the following plans:
Alignment Health Plan
- Alignment Health Platinum (HMO-POS)
Care N' Care Insurance Company of North Carolina
- HealthTeam Advantage Plan I (PPO)
- HealthTeam Advantage Plan II (PPO)
- Erickson Advantage Freedom (HMO-POS)
- Erickson Advantage Liberty with Drugs (HMO-POS)
- Erickson Advantage Liberty without Drugs (HMO-POS)
- Erickson Advantage Signature with Drugs (HMO-POS)
Medicare Advantage plans in North Carolina: comparing different counties
MA Plan service areas are based on North Carolina county and zip code. There are 100 counties in NC with more than 10.6 million residents. This chart compares costs and availability of four counties with the highest percentage of the population aged 65 or older.
|Brunswick county||Clay county||Polk county||Transylvania county|
|Pop aged 65+||34%||33.5%||32.3%||32.1%|
|Avg. monthly premium (excluding $0 premiums)||$57.00||$39.88||$39.36||$39.45|
|No. of MA plan providers||5||5||7||7|
|No. of contracts available||7||8||11||11|
|MA plan providers||Aetna, BCBS of NC, FirstMedicare Direct, Humana, UnitedHealthcare||Aetna, BCBS of NC, Humana, UnitedHealthcare, Wellcare||Aetna, ApexHealth, BCBS of NC, Cigna, Humana, UnitedHealthcare, Wellcare||Aetna, BCBS of NC, Cigna, FirstMedicare Direct, Humana, UnitedHealthcare, Wellcare|
|Avg. max in-network-out-of-pocket||$5,678.57||$5,893.75||$5,563.63||$5,454.55|
|Avg. annual drug deductible||$117.14||$167.50||$121.82||$121.82|
What are the eligibility requirements for a Medicare Advantage plan in North Carolina?
North Carolinians can enroll in a Medicare Advantage Plan if they are Medicare beneficiaries with Part A and Part B coverage, not concurrently enrolled in Medigap, and live within the service area of the chosen MA plan. Having a preexisting health condition does not preclude you from enrollment, and you are not required to answer any health questions prior to enrollment unless you have end-stage renal disease.
Eligibility requirements to be a Medicare beneficiary include:
- Qualify to receive Social Security (or Railroad Retirement) benefits by working for at least 10 years while paying Medicare and Social Security taxes.
- Be at least 65 years old or have a qualifying disease or disability for earlier enrollment.
There are three main periods during which you may sign up for, switch, or drop an MA plan. These include:
- Initial Enrollment Period when you turn 65
- Medicare Advantage Open Enrollment Period
- Special Enrollment Period
Choosing the best Medicare Advantage plan in North Carolina
Choosing the best Medicare Advantage plan in North Carolina involves asking the right questions to identify plans best suited to meet your needs. Considering questions like the ones below can help you identify an MA Plan with coverage that’s right for you.
- Plan network. Are your doctors and specialists in-network?
- Cost. What will the plan cost? Consider the monthly premium, drug cost, deductibles, co-pays/coinsurance, and max out-of-pocket costs.
- Benefits. What are the additional perks and benefits?
- Medications. Are my prescription medications covered?
- Utilization. How often do you plan to use your benefits?
- Coverage area. Will you be traveling often?
Medicare.gov offers a plan comparison tool that many people find useful: Medicare’s plan finding tool to analyze multiple insurance plans simultaneously.
These free North Carolina State programs provide assistance in choosing the right health coverage:
- The North Carolina State Health Insurance Assistance Program (SHIIP) is a state program that offers free local health insurance counseling to people with Medicare coverage. These programs are paid for with federal government money and are independent of any insurance company. Visit NC Department of Insurance or call 1-855-408-1212.
- The North Carolina Senior Medicare Patrol Program housed in the North Carolina Department of Insurance provides free counseling services regarding Medicare Statements. Visit Senior Medicare Patrol Program for more information.
Medicare Advantage Plans in other states
What is the best Medicare Advantage plan in North Carolina?
The best MA plan in North Carolina is UnitedHealthcare, considering its CMS star ratings, JD Power customer satisfaction ratings, and service area coverage. United Healthcare offers a robust array of benefits such as fitness, dental, hearing, Part B premium reductions, eyewear allowance, prescription drug home delivery, Housecalls, Fitbit, and virtual visits.
Does NC have Medicare Advantage plans?
Yes, North Carolina does have Medicare Advantage plans available in 2023. Fourteen insurance companies contracted with Medicare to provide 3,212 MA Plan contracts across North Carolina’s 100 counties.
Does NC have Medicare Part C?
Yes, North Carolina has Medicare Part C, synonymous with Medicare Advantage Plans or “MA Plans.” These terms are used interchangeably. If you enroll in an MA Plan, you choose an insurance company contracted with Medicare to provide your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).