Quick answers
- How many Medicare Advantage plans are in North Carolina for 2027?
- CMS lists 106 plans open to everyone from 16 companies, plus 57 special needs plans. You can join only plans sold in your county.
- Which counties have the most and fewest plans?
- Guilford and Davidson counties have the most for 2027 (57 plans open to everyone each) and Carteret County the fewest (11). Every county has some.
- How many North Carolinians have Medicare Advantage?
- 1,346,766 of North Carolina's 2,328,318 people with Medicare were in Medicare Advantage or another Medicare health plan in July 2026, per CMS.
- Do I still pay my Part B premium with Medicare Advantage?
- Yes. You keep paying Part B, and the plan may charge its own premium too.
- Can I go back to Medigap later in North Carolina?
- You can return to Original Medicare at set times, but North Carolina has no Medigap birthday rule or yearly switching right, so a Medigap company can ask health questions unless you have a guaranteed-issue right.
How does Medicare Advantage work?
Medicare Advantage, also called Part C, is a way to get your Medicare benefits through a private insurance company that contracts with Medicare. The plan covers what Part A and Part B cover, such as hospital stays, doctor visits, outpatient care and tests, and most plans also include Part D prescription drug coverage.
When you join, you are still in Medicare. You keep paying your Part B premium, and the plan may charge its own premium as well. The plan pays your doctors instead of Original Medicare, and its rules decide which providers you can see, whether you need a referral or approval first, and what you pay for each service.
To join, you need Part A and Part B and you must live in the plan's service area (42 CFR 422.50). In North Carolina, service areas are set county by county, so the plans open to someone in Greensboro aren't the same as those open to someone in Morehead City or Boone.
What types of plans are there?
| Plan type | Network | Referrals | Out-of-network care |
|---|---|---|---|
| HMO | You use the plan's doctors, hospitals and other providers. | Usually needed for specialists. | Generally not covered, except emergencies, urgent care and out-of-area dialysis. |
| HMO-POS | An HMO with a point-of-service option. | Usually needed. | Some services covered, usually at a higher cost. |
| PPO | The plan has a network, and you pay less when you use it. | Usually not needed. | Covered, usually at a higher cost. |
| PFFS | Private Fee-for-Service: the plan sets what it pays providers. Some have networks. | Not needed. | Depends on whether the provider accepts the plan's terms. |
| Special needs plan (SNP) | Limited to people with NC Medicaid or a Medicare Savings Program, certain chronic conditions, or nursing-home-level needs. | Depends on the plan. | Depends on the plan. |
For regional PPOs, CMS groups North Carolina with Virginia as Medicare Advantage Region 07. Every plan has a yearly limit on what you pay for covered Part A and Part B services: for 2027, up to $9,850 in network, and up to $14,800 combined in and out of network for a PPO. Plans may set lower limits. Part D drug costs have their own cap of $2,400 in 2027.
Many plans require prior authorization for some services. Since 2026, CMS requires plans to decide urgent requests within 72 hours and standard requests within 7 calendar days, and to explain any denial. You can appeal; see Medicare appeals in North Carolina.
How many plans does your county have?
| County | Plans open to everyone | Special needs plans | Companies |
|---|---|---|---|
| Guilford | 57 | 40 | 13 |
| Davidson | 57 | 39 | 12 |
| Forsyth | 56 | 41 | 13 |
| Mecklenburg | 50 | 39 | 12 |
| Buncombe | 44 | 35 | 11 |
| Durham | 41 | 28 | 11 |
| Cumberland | 40 | 24 | 8 |
| New Hanover | 37 | 29 | 9 |
| Wake | 35 | 28 | 9 |
| Robeson | 32 | 22 | 8 |
| Watauga | 30 | 20 | 6 |
| Pitt | 21 | 20 | 7 |
| Dare | 20 | 10 | 4 |
| Onslow | 14 | 7 | 3 |
| Craven | 13 | 9 | 4 |
| Carteret | 11 | 9 | 4 |
Source: CMS CY2027 Medicare Advantage Landscape file. Choice follows local networks of doctors and hospitals: the Piedmont Triad counties around Greensboro and Winston-Salem have the most plans for 2027, and the central coast (Carteret, Craven and Onslow) the fewest. Wake County has fewer plans than its size suggests. These counts cover plans sold to individuals; employer and retiree group plans, such as the State Health Plan's, aren't included. Every county is on our North Carolina counties page.
Medicare Advantage is the majority choice in North Carolina: CMS's Medicare Monthly Enrollment data for July 2026 shows 1,346,766 of the state's 2,328,318 people with Medicare in Medicare Advantage or another Medicare health plan, and 981,552 in Original Medicare. More figures are on North Carolina Medicare by the numbers.
Tip: before you join, check that your own doctors, your hospital and your pharmacy are in the plan's 2027 network. If you live near a state line and use a hospital in Virginia, Tennessee, South Carolina or Georgia, check that too. See rural and mountain Medicare in North Carolina.
Special needs plans and NC Medicaid
Special needs plans (SNPs) are Medicare Advantage plans for specific groups, and they include Part D. There are three kinds:
D-SNP (dual eligible)
For people with both Medicare and NC Medicaid. For 2027, every D-SNP in North Carolina is "coordination-only": it covers Medicare and works with NC Medicaid, which still pays its share separately. See D-SNPs in North Carolina.
C-SNP (chronic condition)
For people with certain severe or disabling chronic conditions, such as diabetes, chronic heart failure or end-stage renal disease. The plan confirms the condition with your doctor.
I-SNP (institutional)
For people who live, or are expected to live, 90 days or more in a nursing home or similar facility, or who need that level of care at home.
Most people with Medicare and full NC Medicaid get their Medicaid through NC Medicaid Direct, not an NC Medicaid Managed Care plan, so choosing a D-SNP doesn't change who pays your Medicaid benefits. See NC Medicaid and Medicare and What are special needs plans in North Carolina?
What does a plan cost?
What you pay depends on the plan: its premium (if any), deductibles, and the copayments or coinsurance it charges for each service, up to the yearly limit. Each plan's Summary of Benefits shows these costs. See Medicare costs in 2027 for the amounts Medicare sets.
Medicare Advantage plans may offer extra benefits such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.
State Health Plan retirees
If you retired from North Carolina state government, a public school or a university and have retiree coverage from the State Health Plan, you already have Medicare Advantage options of your own. Medicare-primary retirees choose the Plan's group Medicare Advantage PPOs, the "Base Plan" or the "Enhanced Plan", or the "70/30 Plan", which pays after Original Medicare.
Check before joining another plan. The State Health Plan says that if you're in its group Medicare Advantage plan and enroll in another Medicare Advantage or Part D plan, you'll be disenrolled from the group plan and moved to the 70/30 Plan. The Plan's own Open Enrollment for 2027 ran October 12 to 30, 2026, and is closed. See State Health Plan retirees and Medicare.
Retirees of local governments (LGERS) get retiree coverage, if any, from their former employer, so ask that employer how it works with Medicare. Federal retirees and military retirees should check how a plan works with FEHB or TRICARE For Life; TRICARE For Life requires Part A and Part B. See military, veterans and TRICARE in North Carolina.
Moving, travel and hurricanes
- Moving to North Carolina: a Medicare Advantage plan from another state usually ends when you move out of its service area. You get a special enrollment period to choose coverage here, generally through 2 full months after the move. See moving to North Carolina with Medicare.
- Time away: emergencies and urgent care are covered anywhere in the U.S. Routine care away from home usually isn't covered by an HMO. If you're outside your plan's service area for more than 6 months in a row, the plan must disenroll you, unless it offers a visitor or traveler program (42 CFR 422.74).
- Declared disasters: when a disaster or emergency is declared and access to care is disrupted, Medicare Advantage plans must cover care at non-network facilities at in-network cost sharing and waive referral rules until the disruption ends (42 CFR 422.100(m)). See hurricanes, floods and Medicare in North Carolina.
When can you join or switch?
- Initial Enrollment Period: the 7 months around your 65th birthday month.
- Open Enrollment: October 15 to December 7, 2026, for coverage starting January 1, 2027. It's under way now.
- Medicare Advantage Open Enrollment Period: January 1 to March 31, 2027, one change if you're already in a plan.
- Special enrollment periods for moving, losing other coverage, getting NC Medicaid or Extra Help, declared disasters and other events. See Medicare enrollment periods.
Think about Medigap before you switch. North Carolina has no Medigap birthday rule or yearly switching right. If you leave Original Medicare and Medigap for Medicare Advantage and later want Medigap back, a company can ask health questions and turn you down unless you have a guaranteed-issue right, such as the 12-month trial right. See Medigap vs. Medicare Advantage in North Carolina.
Is your plan ending in 2027?
Check your mail. For 2027, two companies stop selling regular Medicare Advantage plans in some North Carolina counties, mostly in the western mountains, and other companies end some plans where they stay. At least 30,654 North Carolinians must choose new coverage. Every county still has Medicare Advantage plans. If your plan is ending, choose by December 31, 2026 to avoid a gap; your special enrollment period runs through February 28, 2027, and you can buy certain Medigap policies without health questions until 63 days after your plan ends. See North Carolina plans ending in 2027.
Where can you get help choosing?
To see the plans sold where you live, see plans for your ZIP code. To compare plans from the companies they work with and check your doctors and drugs, you can request a call from a licensed insurance agent, or meet licensed insurance agents in North Carolina. Our step-by-step guide is How do I choose a Medicare plan in North Carolina?
For information on all your options, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) or use Medicare's Plan Finder at Medicare.gov. Complaints about an insurance agent or company in North Carolina go to the NC Department of Insurance complaint page.
Sources
- Medicare.gov — Your health plan options
- Medicare.gov — Understanding Medicare Advantage Plans
- Medicare.gov — Special Needs Plans (SNP)
- CMS — Interoperability and Prior Authorization Final Rule (CMS-0057-F) fact sheet
- CMS — Medicare Advantage and Part D Landscape files, contract year 2027 (plan counts, D-SNP integration status, regions)
- CMS — Medicare Monthly Enrollment (North Carolina)
- CMS — CY 2027 Rate Announcement (Part D out-of-pocket threshold)
- eCFR — 42 CFR 422.50, eligibility to elect an MA plan
- eCFR — 42 CFR 422.74, disenrollment (6-month absence rule)
- eCFR — 42 CFR 422.100(m), access to care during disasters
- NC Medicaid — Medicaid Health Plans and Programs (NC Medicaid Direct)
- State Health Plan — 2027 Medicare Primary Plan Comparison
- State Health Plan — Pre-65 retiree presentation (Medicare and the group Medicare Advantage plans)
- TRICARE — TRICARE For Life
- NC Department of Insurance — Assistance or file a complaint
Every question in this guide
- Can I be turned down for a Medicare Advantage plan in North Carolina?
- How do I choose a Medicare plan in North Carolina?
- How many Medicare Advantage plans are in North Carolina for 2027?
- Is Medicare Advantage available in every North Carolina county?
- What are Medicare special needs plans in North Carolina?
Frequently asked questions
What is Medicare Advantage (Part C)?
Medicare Advantage is a way to get your Part A and Part B benefits through a private plan approved by Medicare instead of Original Medicare. Most plans also include Part D drug coverage. You're still in Medicare and keep your Medicare rights and protections.
Do I need Part B to join a Medicare Advantage plan?
Yes. You need Part A and Part B, and you must live in the plan's service area. You keep paying the Part B premium while you're in the plan.
What's the difference between an HMO and a PPO Medicare Advantage plan?
An HMO generally covers care only from its network, except emergencies, urgent care and out-of-area dialysis, and usually needs referrals for specialists. A PPO also covers out-of-network care, at a higher cost, and usually doesn't need referrals.
What is prior authorization in Medicare Advantage?
Prior authorization means the plan must approve a service, item or drug before it will cover it. Since 2026, CMS requires Medicare Advantage plans to decide within 72 hours for urgent requests and 7 calendar days for standard requests, and to give a specific reason for a denial. You can appeal a denial.
Does Medicare Advantage include drug coverage?
Most plans do, and those plans are called MA-PD plans. If you join a plan without drug coverage, you generally can't add a standalone Part D plan, except with some Private Fee-for-Service or Medical Savings Account plans.
Medicare in your North Carolina county
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