Medicare FAQ

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 →

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.

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 and/or Part D drug plan. 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 →

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 $1,676 per benefit period. Learn more about Parts A & B →

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 $185/month (higher-income earners pay more via IRMAA). After the annual deductible ($257 in 2026), you typically pay 20% of the Medicare-approved amount.

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 →

North Carolina's Birthday Rule gives you a 30-day open enrollment window around your birthday each year to switch Medigap plans without medical underwriting. This window runs from 30 days before to 30 days after your birthday. You can switch to any Medigap plan with equal or lesser benefits from any insurance company — no health questions asked. This is a powerful protection that many NC residents don't know about. Schedule a Medigap review →

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.

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.

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 →

Medicare costs in NC vary by plan type. Part A: $0 premium for most people. Part B: $185/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

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 or vision plan separately. We can help you compare options that include the benefits that matter most to you.

The Part D coverage gap (or "donut hole") is a phase of prescription drug coverage where you pay a higher share of drug costs. In 2026, thanks to the Inflation Reduction Act, the donut hole has been largely closed — once you and your plan have spent $5,850 on covered drugs, you enter the catastrophic phase where your out-of-pocket costs are capped at $2,000/year. This is a major improvement for seniors on expensive medications. Learn more about Part D →