Medicare Eligibility in North Carolina

To be eligible for Medicare in North Carolina, you must fulfill at least one of the following requirements: 

• You are at least 65 and a U.S. citizen or legal permanent resident.

• You have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS, also called Lou Gehrig’s Disease).

• You have been receiving Social Security Disability Insurance (SSDI) for 24 months or Railroad Retirement benefits.

If you receive SSI or RR disability payments, you will automatically be enrolled in Medicare. If you are not receiving disability payments, you’ll have to sign up through the Social Security Administration. Medicare eligibility begins three months before your 65th birthday, includes the month of your birthday, and continues until three months after (Initial Enrollment Period). Medicare’s General Enrollment Period also runs from Jan. 1 to Mar. 31 each year. During this time, seniors can enroll in Part B, but the premiums might include a late-enrollment penalty.

How Do I Apply for Medicare in North Carolina?

Here are a few ways you can sign up:

1. Sign up online for Medicare benefits at medicare.gov.

2. By phone, Call 1-800-772-1213. TTY users can call 1-800-325-0778.

3. In person with the Social Security Administration.

How Do I Pick A Medicare Plan?

Once you are eligible for Medicare in North Carolina, you’ll have choices in how you’d like to purchase your Medicare coverage through private insurance companies. However, understanding plan options can be confusing, so here is a quick walkthrough.

The Different Medicare Plans:

  • Medicare Part A: Hospital Insurance – Free for most recipients.
  • Medicare Part B: Medical Insurance – Monthly premium required.
  • Original Medicare (Parts A and B together) – Original Medicare has cost-shares such as deductibles, coinsurance, and copayments with no out-out-pocket limit.
  • Medicare Part C: Medicare Advantage Plans (Combine Parts A, B, and additional coverage)
  • Medicare Part D: Prescription Drug Coverage
  • Medigap: Medicare Supplement Plans – helps cover Original Medicare’s out-of-pocket expenses.

(Eligibility requirements are the same for Original Medicare and Medicare Part C.)

Reducing Medicare Costs

For help covering other out-of-pocket costs, however, North Carolina seniors can buy a Medicare Supplement insurance plan. However, you must purchase a stand-alone Medicare prescription drug plan (Part D) if you want drug coverage. Low-income Medicare beneficiaries can get supplement insurance through the North Carolina Medicaid program if they meet eligibility requirements. The Department of Health and Human Services oversee North Carolina Medicaid services.

Ready to learn more?

Choosing an insurance plan is not an easy decision. However, educating yourself about the differences between the types of insurance coverage, comparing different plans and policies, and talking to a licensed insurance agent will help you make the right choice.

Resource Links:

Joining a Medicare Plan

North Carolina Area Agencies on Aging

Seniors Health Insurance Information Program (SHIIP)

North Carolina Department of Health and Human Services