---
title: Medicare FAQ — Frequently Asked Questions | Triangle Life and Health
description: Get answers to the most common Medicare questions. Parts A, B, C, D, Medigap, enrollment periods, costs, and more. Free consultation with a licensed agent.
---

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# Medicare FAQ

Answers to the most common questions about Medicare in North Carolina. Can't find what you're looking for? [Schedule a free consultation](https://trianglelifeandhealth.com/calendar?hsLang=en) or call [(919) 689-6565](tel:+19196896565).

![Happy senior couple enjoying retirement — Medicare insurance in North Carolina](https://trianglelifeandhealth.com/hs-fs/hubfs/viktor-perf/medicare-agent-couple-1000.webp?width=1000&height=667&name=medicare-agent-couple-1000.webp)

## Medicare Basics

### What is Medicare?

Medicare is the federal health insurance program for people aged 65 and older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD). It's administered by the Centers for Medicare & Medicaid Services (CMS). Medicare has four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). [Learn more about Medicare →](https://trianglelifeandhealth.com/medicare-overview?hsLang=en)

### When am I eligible for Medicare?

Most people become eligible for Medicare at age 65. Your Initial Enrollment Period (IEP) begins 3 months before your 65th birthday month, includes your birthday month, and ends 3 months after. If you're already receiving Social Security benefits, you'll be automatically enrolled in Parts A and B. If not, you'll need to actively enroll. Some people under 65 qualify due to disability (after 24 months of SSDI) or ESRD.

### What's the difference between Original Medicare and Medicare Advantage?

**Original Medicare** (Parts A & B) is the traditional fee-for-service program run by the federal government. You can see any doctor or hospital that accepts Medicare. You pay deductibles and 20% coinsurance with no out-of-pocket maximum. Many people add a [Medigap plan](https://trianglelifeandhealth.com/medicare-supplement-insurance-medigap?hsLang=en) and/or [Part D drug plan](https://trianglelifeandhealth.com/prescription-drug-plan-part-d?hsLang=en). **Medicare Advantage** (Part C) is offered by private insurance companies approved by Medicare. Plans typically include Parts A, B, and D in one plan, often with extra benefits (dental, vision, hearing, gym memberships). They use provider networks (HMO or PPO) and have annual out-of-pocket maximums. [Compare Medicare Advantage plans in NC →](https://trianglelifeandhealth.com/medicare-advantage-part-c?hsLang=en)

### What does Medicare Part A cover?

Medicare Part A covers inpatient hospital stays, skilled nursing facility care (up to 100 days following a qualifying hospital stay), hospice care, and some home health care. Most people don't pay a premium for Part A if they or their spouse paid Medicare taxes for at least 40 quarters (10 years). The 2026 Part A deductible is $1,736 per benefit period. [Learn more about Parts A & B →](https://trianglelifeandhealth.com/medicare-overview?hsLang=en)

### What does Medicare Part B cover?

Medicare Part B covers doctor visits, outpatient care, preventive services (annual wellness visit, flu shots, screenings), durable medical equipment, ambulance services, mental health services, and some home health care. The standard 2026 Part B premium is $202.90/month (higher-income earners pay more via IRMAA). After the annual deductible ($283 in 2026), you typically pay 20% of the Medicare-approved amount.

## Medicare Supplement (Medigap)

### What is a Medigap plan?

Medigap (Medicare Supplement Insurance) is a private insurance policy that helps pay for costs that Original Medicare doesn't cover — the "gaps." This includes Part A and B deductibles, coinsurance, and copayments. Medigap plans are standardized by letter (A, B, C, D, F, G, K, L, M, N) — benefits are the same regardless of which company sells the plan. **Plan G** is the most popular choice in NC because it covers nearly everything except the Part B deductible. [Compare Medigap plans →](https://trianglelifeandhealth.com/medicare-supplement-insurance-medigap?hsLang=en)

### Does North Carolina have a Medigap birthday rule?

No. Some states let you switch Medigap plans each year around your birthday without medical underwriting, but North Carolina is not one of them. Your best window is the 6-month Medigap Open Enrollment Period, which starts when you're 65 and enrolled in Part B. After that, switching usually means answering health questions unless you have a guaranteed-issue right. [Schedule a Medigap review →](https://trianglelifeandhealth.com/calendar?hsLang=en)

## Enrollment Periods

### What is the Annual Enrollment Period (AEP)?

The Medicare Annual Enrollment Period runs from **October 15 to December 7** each year. During AEP, you can: switch from Original Medicare to Medicare Advantage (or vice versa), change your Medicare Advantage plan, join/switch/drop a Part D prescription drug plan. Changes made during AEP take effect January 1 of the following year.

### What is the Open Enrollment Period (OEP)?

The Medicare Advantage Open Enrollment Period runs from **January 1 to March 31** each year. During OEP, if you're already in a Medicare Advantage plan, you can: switch to a different Medicare Advantage plan, or switch back to Original Medicare (and optionally add a Part D plan). You can only make one change during OEP. Changes take effect the first of the month after the plan receives your enrollment request.

### What if I missed my enrollment period?

If you missed AEP or your Initial Enrollment Period, you may still qualify for a Special Enrollment Period (SEP). Common qualifying events include: moving to a new service area, losing employer coverage, qualifying for Extra Help/LIS, being released from incarceration, losing Medicaid, or having a change in institutional status. Some SEPs last 2 months, others 63 days. [Schedule a consultation to check your eligibility →](https://trianglelifeandhealth.com/calendar?hsLang=en)

## Costs & Coverage

### How much does Medicare cost in North Carolina?

Medicare costs in NC vary by plan type. **Part A:** $0 premium for most people. **Part B:** $202.90/month standard premium (2026). **Medicare Advantage:** Many $0-premium plans available in NC from UnitedHealthcare, Humana, Aetna, Blue Cross NC, and others — some include prescription drug coverage and extra benefits. **Medigap:** $90–$300/month depending on plan letter, age, and carrier. **Part D:** $7–$100/month depending on the plan. We compare all available options for free. [Call (919) 689-6565](tel:+19196896565)

### Does Medicare cover dental, vision, and hearing?

Original Medicare (Parts A & B) provides very limited dental, vision, and hearing coverage. However, many **Medicare Advantage** plans in NC include dental, vision, and hearing benefits at no extra cost. If you have Original Medicare, you can add a standalone [dental plan](https://trianglelifeandhealth.com/dental-insurance?hsLang=en) or vision plan separately. We can help you compare options that include the benefits that matter most to you.

### What is the Medicare Part D donut hole?

The Part D coverage gap (or "donut hole") was a phase of prescription drug coverage where you paid a higher share of drug costs. Thanks to the Inflation Reduction Act, the donut hole was eliminated in 2025. Part D now has an annual out-of-pocket cap on covered drugs: $2,100 in 2026 and $2,400 in 2027. Once you reach it, you pay $0 for covered Part D drugs for the rest of the year. This is a major improvement for seniors on expensive medications. [Learn more about Part D →](https://trianglelifeandhealth.com/prescription-drug-plan-part-d?hsLang=en)

![Healthcare consultation with a caring professional](https://images.unsplash.com/photo-1576091160550-2173dba999ef?w=800&q=80&auto=format)

## Still Have Questions?

Michael Cubell is a licensed, independent Medicare agent serving all of North Carolina. Free consultation — no obligation.

[📅 Book a Free Call](https://trianglelifeandhealth.com/calendar?hsLang=en) [📞 (919) 689-6565](tel:+19196896565)

Also visit [Senior Benefits Hub](https://seniorbenefitshub.com) for nationwide Medicare guidance.

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###### Disclaimer:

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800 MEDICARE (24 hours a day/7 days a week) to get information on all of your options. Not affiliated with the U.S. government or federal Medicare program. This is a solicitation for Insurance. Plans are insured or covered by a Medicare Advantage organization with a Medicare contract and/or a Medicare approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare.

Triangle Life and Health is an independent authorized agency licensed to sell and promote products from Blue Cross and Blue Shield of North Carolina (Blue Cross NC). The content contained in this site is maintained by Triangle Life and Health. Blue Cross NC is an independent licensee of the Blue Cross and Blue Shield Association®, SM Registered marks of the Blue Cross and Blue Shield Association.

###### Triangle Life and Health is licensed in the following states:

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