Quick answers
- What is the difference between Part A and Part B?
- Part A is hospital insurance: inpatient stays, skilled nursing after a hospital stay, hospice and some home health care. Part B is medical insurance: doctors, outpatient care, preventive services, ambulance and medical equipment.
- Does Medicare cover dental, hearing aids or glasses?
- Original Medicare doesn't cover routine dental care, hearing aids or routine eye exams and glasses. Some Medicare Advantage plans add these; check a plan's Evidence of Coverage. NC Medicaid covers adult dental and eye care for people who qualify, but not hearing aids for adults.
- Does Medicare pay for a nursing home or assisted living?
- Only short-term skilled nursing care after a qualifying hospital stay, up to 100 days per benefit period. Long-term custodial care isn't covered. In North Carolina, NC Medicaid pays for most long-term nursing home care for people who qualify, and State-County Special Assistance helps pay for adult care homes.
- How many people have Medicare in North Carolina?
- 2,328,318 North Carolinians had Medicare in July 2026, according to CMS Medicare Monthly Enrollment data.
- Is Medicare the same in North Carolina as in other states?
- Parts A, B and D work the same everywhere. What differs is the plans sold in your county, North Carolina's Medigap rules (there is no birthday rule) and NC Medicaid programs such as CAP/DA and MQB.
What is Medicare?
Medicare is the federal health insurance program run by the Centers for Medicare & Medicaid Services (CMS). It covers people 65 and older, people under 65 who have received Social Security or Railroad Retirement disability benefits for 24 months, and people with end-stage renal disease (ESRD) or ALS. Social Security handles sign-up; Medicare and the plans you choose pay the claims.
CMS counts 2,328,318 people with Medicare in North Carolina as of July 2026: 981,552 in Original Medicare and 1,346,766 in Medicare Advantage or other health plans. The rules are federal, so the parts work the same in Charlotte, Raleigh, Boone and Manteo. What changes by place is which plans are sold in your county, North Carolina's Medigap rules and NC Medicaid's programs for people with low incomes. See North Carolina Medicare by the numbers.
What are the parts of Medicare?
| Part | What it covers | Who provides it |
|---|---|---|
| Part A (hospital insurance) | Inpatient hospital stays, skilled nursing facility care after a qualifying hospital stay, hospice, some home health care | Medicare |
| Part B (medical insurance) | Doctors, outpatient care, preventive services, lab tests, ambulance, durable medical equipment, some drugs given in a clinic | Medicare |
| Part C (Medicare Advantage) | Everything Parts A and B cover, usually with drug coverage, through a private plan with its own network and rules | Private companies approved by Medicare |
| Part D (drug coverage) | Prescriptions you fill at a pharmacy | Private companies approved by Medicare |
More detail: Medicare Part A, Medicare Part B, Medicare Advantage in North Carolina and Part D in North Carolina.
Original Medicare or Medicare Advantage?
Everyone with Medicare chooses between two ways to get coverage.
Original Medicare
Parts A and B, run by the federal government. You can see any doctor or hospital in the country that accepts Medicare, usually without referrals. It has no yearly limit on what you pay, so many people add a Medigap policy to cover deductibles and the 20% coinsurance, and a standalone Part D plan for drugs.
Medicare Advantage (Part C)
A private plan that provides your Part A and Part B coverage (you still have Medicare and still pay the Part B premium). Most include drug coverage. Plans use networks, may require referrals or prior approval, and have a yearly in-network out-of-pocket limit, which can't exceed $9,250 in 2026.
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.
CMS lists 106 Medicare Advantage plans open to everyone somewhere in North Carolina for 2027, from 16 companies, plus 57 special needs plans. Each county has its own list: from 11 in Carteret County to 57 in Guilford County. Look yours up on the county pages. The full comparison is in Medigap vs. Medicare Advantage in North Carolina.
What doesn't Medicare cover?
Original Medicare doesn't cover:
- Most dental care and dentures
- Routine eye exams for glasses, and most eyeglasses and contact lenses
- Hearing aids and exams for fitting them
- Long-term custodial care, the help with bathing, dressing and eating that most nursing home and adult care home residents need
- Routine physical exams (it covers a yearly Wellness visit instead)
- Rides to appointments, other than a medically necessary ambulance
In North Carolina, people with full NC Medicaid can get some of these: adult dental care, a routine eye exam and glasses every two years, rides to Medicaid-covered appointments arranged through the county Department of Social Services, and long-term care at home through CAP/DA or in a nursing home. NC Medicaid doesn't cover hearing aids for adults 21 and older. See NC Medicaid and Medicare.
What does Medicare cost?
| Cost (2026) | Amount |
|---|---|
| Part A premium | Most people pay none; others pay up to $565 a month |
| Part A deductible, per benefit period | $1,736 |
| Part B standard premium | $202.90 a month (more with higher income) |
| Part B deductible | $283 a year |
| Part D out-of-pocket cap | $2,100 a year |
CMS announces each year's Part A and Part B amounts in the fall. See Medicare costs in 2026 and Medicare costs in 2027. If your income is limited, North Carolina's Medicare Savings Programs, called MQB, can pay your Part B premium; see Medicare Savings Programs in North Carolina and Extra Help in North Carolina.
What is different about Medicare in North Carolina?
- No Medigap birthday rule. North Carolina law (G.S. Chapter 58, Article 54) has no birthday, anniversary or yearly switching right. Your best time to buy is the one-time six-month Medigap open enrollment period that starts when you're 65 and in Part B. People under 65 on Medicare because of a disability can buy at least Plan A (G.S. 58-54-45). See Medigap in North Carolina.
- Its own Part D region. North Carolina is Part D Region 08 by itself, with 11 standalone drug plans from 6 companies for 2027. For Medicare Advantage it shares Region 07 with Virginia.
- State Health Plan retirees. Retired teachers and state employees choose among the State Health Plan's own Medicare options, and joining an outside Medicare Advantage or Part D plan changes their Plan coverage. See State Health Plan retirees and Medicare.
- Dual eligibles stay in NC Medicaid Direct. People with Medicare and full NC Medicaid get their Medicaid through NC Medicaid Direct, not a Standard Plan.
- 2027 plan endings. Some Medicare Advantage plans are ending or leaving counties for 2027, affecting at least 30,654 North Carolinians. See North Carolina plans ending in 2027.
How do I get started?
- Check when you're eligible. See Medicare eligibility and enrollment periods.
- Sign up for Part A and Part B. Apply through Social Security at ssa.gov or 1-800-772-1213, unless you're enrolled automatically. If you're turning 65, use the turning 65 in North Carolina checklist.
- Choose your path. Original Medicare with Medigap and Part D, or a Medicare Advantage plan sold in your county.
- Compare plans. See plans for your ZIP code, or you can request a call from a licensed insurance agent to go over plans from the companies they work with.
For general Medicare questions, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048). Other North Carolina numbers are on North Carolina Medicare contacts, and terms are explained in the glossary.
Sources
- Medicare.gov — Parts of Medicare
- Medicare.gov — What's not covered by Part A and Part B
- Medicare.gov — Physical therapy services
- Medicare.gov — Hospice care
- Medicare.gov — Yearly wellness visits
- Medicare.gov — Ambulance services
- CMS — 2026 Medicare Parts A and B premiums and deductibles
- CMS — Medicare Monthly Enrollment (North Carolina, July 2026)
- CMS — CY2027 Medicare Advantage and Part D Landscape files
- North Carolina General Statutes — Chapter 58, Article 54, Medicare Supplement Insurance Minimum Standards
- NC Medicaid — Medicaid Health Plans and Programs
- NC Medicaid — Clinical Coverage Policy 7, Hearing Aid Services
Every question in this guide
- Can I keep my doctor when I go on Medicare in North Carolina?
- Does Medicare cover assisted living in North Carolina?
- Does Medicare cover dental in North Carolina?
- Does Medicare cover eye exams and glasses in North Carolina?
- Does Medicare cover hearing aids in North Carolina?
- Does Medicare cover home health care in North Carolina?
- Does Medicare cover mental health care in North Carolina?
- Does Medicare cover nursing home care in North Carolina?
- How do I get rides to the doctor with Medicare in North Carolina?
Frequently asked questions
What is the difference between Medicare Part A and Part B?
Part A is hospital insurance: inpatient hospital care, skilled nursing facility care after a qualifying hospital stay, hospice and some home health care. Part B is medical insurance: doctors' services, outpatient care, preventive services, ambulance rides and durable medical equipment. Most people pay no Part A premium; the standard Part B premium is $202.90 a month in 2026.
Does Medicare cover physical therapy?
Yes. Part B covers medically necessary outpatient physical therapy when your doctor or other provider certifies you need it. Medicare.gov says there is no limit on how much Medicare pays for medically necessary outpatient therapy in a calendar year. You usually pay 20% of the Medicare-approved amount after the Part B deductible.
Does Medicare cover hospice?
Yes. Part A covers hospice care if a hospice doctor and your regular doctor certify you're terminally ill and you choose comfort care instead of treatment to cure the illness. You pay nothing for covered hospice services, though small copayments can apply for some drugs and respite care.
Does Medicare cover a yearly physical?
Medicare doesn't cover a routine physical exam. Part B covers a one-time Welcome to Medicare preventive visit in your first 12 months of Part B and a yearly Wellness visit after that, with no cost to you if your provider accepts assignment. Tests or treatment during the visit may cost extra.
Does Medicare cover ambulance rides?
Part B covers ground ambulance transport to the nearest appropriate medical facility when traveling any other way could endanger your health. Non-emergency ambulance rides are covered only in limited cases with a written order from your doctor. You usually pay 20% after the Part B deductible.
Medicare in your North Carolina county
Plans, local agents and help, county by county: Wake · Mecklenburg · Guilford · Forsyth · Durham · Cumberland · Buncombe · Union · Johnston · Cabarrus · New Hanover · Gaston · Onslow · Iredell · Alamance · Pitt · Davidson · Brunswick · Catawba · Rowan · All 100 counties →
