Quick answers
- When can I first sign up for Medicare?
- During your 7-month Initial Enrollment Period: the 3 months before your 65th birthday month, that month and the 3 months after.
- When is open enrollment for 2027?
- October 15 to December 7, 2026. Changes take effect January 1, 2027. The State Health Plan's own 2027 enrollment for retirees was earlier, October 12 to 30, 2026.
- Can I change my Medicare Advantage plan after January 1?
- Yes, once, from January 1 to March 31, 2027, during the Medicare Advantage Open Enrollment Period.
- I missed my Initial Enrollment Period. What now?
- Sign up for Part B from January 1 to March 31 during the General Enrollment Period, unless you qualify for a special enrollment period. You may owe a late penalty.
- Does North Carolina have a Medigap birthday rule?
- No. North Carolina gives you a 6-month Medigap open enrollment period starting when you're both 65 and in Part B, and no yearly switching right after that.
How do Medicare enrollment periods work?
Medicare has fixed windows for signing up for Part A and Part B and for joining, switching or dropping Medicare Advantage and Part D plans. Outside them you usually have to wait, and signing up late can mean a gap in coverage and a penalty that lasts as long as you have Medicare. The windows are federal, so they're the same in North Carolina as anywhere. What's different here: North Carolina has no Medigap birthday rule but does require companies to offer some Medigap plans to people under 65 with a disability, State Health Plan retirees follow the Plan's own calendar, people with Medicare and full NC Medicaid are in NC Medicaid Direct, and some North Carolina Medicare Advantage plans end in 2027.
Timeline at a glance
| Period | Dates | What you can do | When coverage starts |
|---|---|---|---|
| Initial Enrollment Period | 7 months: 3 months before your 65th birthday month, that month and 3 months after | Sign up for Part A and Part B; join a Medicare Advantage or Part D plan | First of your birthday month if you sign up before it; otherwise the first of the month after you sign up |
| Medigap open enrollment | 6 months, starting the first month you're 65 and in Part B | Buy any Medigap policy a company sells in North Carolina with no health questions | When the policy says |
| General Enrollment Period | January 1 to March 31 | Sign up for Part B (or premium Part A) if you missed other chances | First of the month after you sign up |
| Open Enrollment | October 15 to December 7 | Join, switch or drop Medicare Advantage or Part D plans | January 1 |
| Medicare Advantage Open Enrollment Period | January 1 to March 31 | One change if you're in a Medicare Advantage plan | First of the month after the change |
| Part B special enrollment period | 8 months after job-based coverage or the job ends, whichever is first | Sign up for Part B (and Part A) without a penalty | See losing employer coverage |
| Plan not renewing (2027 endings) | December 8, 2026 to February 28, 2027 | Choose a new Medicare Advantage or Part D plan | First of the month after you join |
This year's key dates are also on What are the Medicare deadlines in North Carolina for 2027?
When is my Initial Enrollment Period?
Your Initial Enrollment Period is 7 months long: the 3 months before the month you turn 65, your birthday month, and the 3 months after. Sign up in the 3 months before your birthday month and coverage starts on the first day of your birthday month. Sign up during or after your birthday month and coverage starts the first day of the next month. (If your birthday is on the first of the month, everything moves a month earlier.)
If you already get Social Security or Railroad Retirement benefits, you're enrolled in Part A and Part B automatically. If not, sign up with Social Security online, by phone at 1-800-772-1213 (TTY 1-800-325-0778), or at a Social Security office.
North Carolina public employees: about 93% of North Carolina's state and local government workers are covered by Social Security on their jobs (Congressional Research Service, 2023 data), so most teachers and state and local employees earn premium-free Part A the usual way. You're enrolled automatically only if you've started Social Security benefits; if you're waiting to claim, sign up yourself. State Health Plan retirees need Part A and Part B in effect to use the Plan's Medicare Advantage options. See State Health Plan retirees and Medicare.
People under 65 who get Social Security disability benefits are enrolled automatically after 24 months of benefits; people with ALS get Medicare the month disability benefits begin. See Medicare eligibility and the turning 65 in North Carolina guide.
What is the General Enrollment Period?
If you missed your Initial Enrollment Period and don't qualify for a special enrollment period, you can sign up for Part B (or Part A, if you'd pay a premium for it) from January 1 to March 31 each year. Coverage starts the first day of the month after you sign up. You may owe a late enrollment penalty (see below). If you have to buy Part A and sign up for Part B in this period, you get 2 months after Part B starts to join a Part D plan.
Open Enrollment: October 15 to December 7
Each fall, anyone with Medicare can join, switch or drop a Medicare Advantage plan or a Part D drug plan, or move between Original Medicare and Medicare Advantage. Your choice takes effect January 1. The window open now is for 2027 coverage. If you make more than one change, the last one you make by December 7 counts. See Medicare open enrollment in North Carolina.
Before it starts, your plan sends an Annual Notice of Change listing next year's changes. Read it even if you're happy with your plan: networks, drug lists and service areas can all change. CMS lists 106 Medicare Advantage plans open to everyone from 16 companies and 11 standalone Part D plans in North Carolina for 2027. Choice varies a lot by county, from 11 Medicare Advantage plans in Carteret County to 57 in Guilford County; the list for your county is on the county pages.
State Health Plan retirees: the Plan's 2027 Open Enrollment ran October 12 to 30, 2026 and is closed. If you're in the Plan's group Medicare Advantage Base Plan or Enhanced Plan and join an outside Medicare Advantage or Part D plan during Medicare's Open Enrollment, the Plan says you'll be removed from its Medicare Advantage plan and placed on the 70/30 Plan. See State Health Plan vs. individual Medicare plans.
Medicare Advantage Open Enrollment Period: January 1 to March 31
If you're in a Medicare Advantage plan on January 1, you can make one change by March 31: switch to a different Medicare Advantage plan, or drop your plan, return to Original Medicare and join a Part D plan. If you're new to Medicare and joined a Medicare Advantage plan, you get the same one change during your first 3 months with Medicare. This period can't be used to move from Original Medicare into Medicare Advantage or to switch between standalone drug plans. In North Carolina, moving to Original Medicare doesn't guarantee you can buy Medigap; companies can ask health questions unless you have a guaranteed-issue right.
Which special enrollment periods matter most in North Carolina?
Certain life events open a special enrollment period (SEP) outside the usual windows. These are the ones North Carolinians use most.
Your plan is ending or leaving your county
For 2027, two companies stop selling regular Medicare Advantage plans in some North Carolina counties, mostly in the western mountains plus Wake, Johnston and Chatham, and six more end some plans where they stay. Together, at least 30,654 North Carolinians must choose new coverage. Every county still has regular Medicare Advantage plans in 2027. If your plan isn't renewing, you'll get a non-renewal letter. You can choose a new plan during Open Enrollment and then through February 28, 2027. Choose by December 31, 2026 so the new plan starts January 1 with no gap. If you don't choose, you'll be in Original Medicare on January 1 without drug coverage. You may also have a guaranteed right to buy a Medigap policy until 63 days after your plan coverage ends. See North Carolina plans ending in 2027.
Moving to, from or within North Carolina
- Moving outside your plan's service area, whether into North Carolina from Florida or the Northeast, out of the state, or to a county your plan doesn't serve: you can switch plans or return to Original Medicare. If you tell your plan before you move, the window starts the month before the move; otherwise it starts the month you move. Either way it lasts 2 full months after the move.
- Moving to a place with new plan options: you get the same kind of window, even within your plan's area.
- Returning to the U.S. after living abroad, or moving into or out of a nursing home or other institution, also opens a window.
More on moving to North Carolina with Medicare and half-backs and Florida retirees.
Losing employer or union coverage
When job-based coverage from your own or your spouse's current work ends, you have 8 months to sign up for Part B without a penalty, starting the month after the job or the coverage ends, whichever comes first. If you sign up while you still have the job coverage or in the first full month after it ends, you can pick a Part B start date of the first of that month or any of the next 3 months; later in the 8 months, Part B starts the month after you sign up. To join a Medicare Advantage or Part D plan, you have 2 full months after the month the coverage ends. COBRA and retiree coverage don't count as coverage from current work; see working past 65.
NC Medicaid, MQB and Extra Help
- Once a month, if you have NC Medicaid and Medicare, or you get Extra Help (people in a Medicare Savings Program, called MQB in North Carolina, get it automatically), you can join or switch to a standalone Part D plan, or leave a Medicare Advantage plan with drug coverage for Original Medicare plus a standalone drug plan.
- Gaining, losing or changing NC Medicaid or Extra Help gives you 3 months from the change, or from when you're notified, whichever is later, to make one change.
Changes take effect the first day of the next month. People with Medicare and full NC Medicaid get their Medicaid through NC Medicaid Direct, not a Standard Plan, and every North Carolina dual eligible special needs plan (D-SNP) for 2027 is a coordination-only plan. NC Medicaid questions go to the NC Medicaid Contact Center at 1-888-245-0179. More on NC Medicaid and Medicare, D-SNPs in North Carolina and Medicare Savings Programs in North Carolina.
Hurricanes, floods and other disasters
If a federal, state or local government declares an emergency or major disaster where you live (or where the person who helps you with health decisions lives), and it kept you from making a change during another enrollment period you were eligible for, you get a special enrollment period for Medicare Advantage and Part D. It lasts until 2 full calendar months after the incident period ends. It isn't an open season for everyone in the area: it replaces a choice the disaster kept you from making. After Hurricane Helene (FEMA DR-4827-NC, incident period September 25 to December 18, 2024), that window ran through February 28, 2025. See hurricanes, floods and Medicare in North Carolina.
Other situations
Other special enrollment periods include losing creditable drug coverage through no fault of your own, joining or leaving PACE, and switching once a year into a plan with an overall 5-star rating where one is offered. If something unusual kept you from enrolling, such as wrong information from a government or employer representative, call 1-800-MEDICARE or Social Security to ask whether an exceptional-circumstance period applies.
When can I buy Medigap in North Carolina?
Your one-time Medigap open enrollment period lasts 6 months, starting the first month you're both 65 or older and enrolled in Part B. During it, companies selling Medigap in North Carolina must sell you any policy they offer, regardless of your health. After it, companies can generally use medical underwriting unless you have a guaranteed-issue right, such as your Medicare Advantage plan ending, your employer coverage ending, or the 12-month trial right after first joining Medicare Advantage.
North Carolina has no birthday rule or yearly switching right (N.C.G.S. Chapter 58, Article 54). If you're under 65 with Medicare because of a disability, North Carolina law (G.S. 58-54-45) requires Medigap companies to offer you at least Plan A, plus Plan D or G if they sell those plans to people 65 and older, during the 6 months after you first enroll in Part B. At 65 you get a new, full open enrollment period. Every new policy comes with a 30-day free look (G.S. 58-54-30). Details on Medigap in North Carolina.
What are the late enrollment penalties?
Part B: if you don't sign up when first eligible and don't have job-based coverage from current work, your Part B premium can go up 10% for each full 12-month period you could have had Part B but didn't. The penalty usually lasts as long as you have Part B. The standard premium is $202.90 a month in 2026.
Part D: if you go 63 days or more in a row without Part D or other creditable drug coverage after your Initial Enrollment Period, a penalty is added to your drug plan premium: 1% of the national base beneficiary premium ($38.99 in 2026) for each full month without coverage. It usually lasts as long as you have Part D. People who get Extra Help don't pay it, and care from the Indian Health Service, a tribe or an urban Indian program counts as creditable drug coverage.
Estimate a penalty with the late enrollment penalty calculator.
Where can I get help?
During an open window, you can see plans for your ZIP code. To check which enrollment period applies to you and go over plans from the companies they work with, you can request a call from a licensed insurance agent.
For Part A and Part B sign-up, contact Social Security at ssa.gov or 1-800-772-1213 (TTY 1-800-325-0778). For general Medicare questions, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048). See North Carolina Medicare contacts.
Sources
- Medicare.gov — When does Medicare coverage start?
- Medicare.gov — Special enrollment periods
- Medicare.gov — When can I join a health or drug plan?
- Medicare.gov — Avoid late enrollment penalties
- Social Security — Sign up for Medicare
- Social Security — Apply for Part B during a special enrollment period
- eCFR — 42 CFR 406.24, special enrollment period and coverage start dates
- eCFR — 42 CFR Part 407, Part B enrollment (including the General Enrollment Period)
- eCFR — 42 CFR 422.62, Medicare Advantage election periods (including the disaster SEP)
- eCFR — 42 CFR 423.38, Part D enrollment periods
- North Carolina General Assembly — G.S. Chapter 58, Article 54, Medicare Supplement Insurance Minimum Standards
- North Carolina General Assembly — G.S. 58-54-45, Medigap for people under 65 by reason of disability
- State Health Plan — 2027 Open Enrollment (October 12–30, 2026)
- State Health Plan — Retiree presentation (Medicare Parts A and B, outside Medicare plans)
- NC Medicaid — Medicaid health plans and programs (NC Medicaid Direct)
- FEMA — North Carolina Tropical Storm Helene (DR-4827-NC)
- Congressional Research Service — Social Security Coverage of State and Local Government Employees (R46961)
- CMS — CY2027 Medicare Advantage and Part D Landscape files
Every question in this guide
- Can I get Medicare before 65 in North Carolina?
- Do I need Medicare Part B if I'm still working at 65 in North Carolina?
- How do I sign up for Medicare in North Carolina?
- What are the Medicare deadlines in North Carolina for 2027?
- What happens if I miss my Medicare enrollment period in North Carolina?
- When should I sign up for Medicare if I'm turning 65 in North Carolina?
Frequently asked questions
Am I automatically enrolled in Medicare at 65?
Only if you already get Social Security or Railroad Retirement benefits at least 4 months before you turn 65; then you're enrolled in Part A and Part B and your card arrives about 3 months before your birthday month. If you haven't started those benefits, for example because you're waiting to claim Social Security, you must sign up through Social Security yourself.
What is the Medicare Part B late enrollment penalty?
If you don't sign up for Part B when first eligible and don't have job-based coverage from your or your spouse's current work, your premium goes up 10% for each full 12-month period you could have had Part B but didn't. You usually pay it as long as you have Part B. In 2026 it's figured on the standard premium of $202.90.
What is the Medicare General Enrollment Period?
It runs January 1 to March 31 each year, for people who missed their Initial Enrollment Period and don't qualify for a special enrollment period. You can sign up for Part B, or for premium Part A, and coverage starts the first day of the month after you sign up. A late penalty may apply.
I'm a State Health Plan retiree. Can I change plans during Medicare Open Enrollment?
Not your State Health Plan option. The Plan's 2027 Open Enrollment for retirees ran October 12 to 30, 2026. Joining an outside Medicare Advantage or Part D plan removes you from the Plan's group Medicare Advantage coverage and moves you to the 70/30 Plan, so check with the Plan first.
My Medicare Advantage plan is ending in 2027. How long do I have to choose?
You can use Open Enrollment through December 7 and then a special enrollment period through February 28, 2027. Choose by December 31, 2026 so new coverage starts January 1 with no gap. If you do nothing, you'll have Original Medicare without drug coverage. You may also have a guaranteed right to buy Medigap for 63 days after your plan coverage ends.
Medicare in your North Carolina county
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