With Original Medicare
Original Medicare has no network. You can see any doctor, hospital or other provider in the United States that's enrolled in Medicare and taking new Medicare patients. Providers who accept assignment take the Medicare-approved amount as full payment, so you pay only your deductible and coinsurance. Medicare.gov says most doctors accept assignment, but check that yours do. A Medigap policy works with the same doctors anywhere in the country, which helps North Carolinians who split the year with Florida or have family out of state.
Non-participating and opt-out doctors. A non-participating provider can charge up to 15% above the Medicare-approved amount for many services, the limiting charge; federal limits apply in North Carolina. A doctor who opts out of Medicare bills you directly under a private contract, and Medicare and Medigap won't pay.
With Medicare Advantage
Medicare Advantage plans use provider networks. In an HMO you usually must use network doctors, except in emergencies; in a PPO you can go out of network but generally pay more. CMS data show the number of Medicare Advantage plans open to everyone ranges from 11 in Carteret County to 57 in Guilford County for 2027, and networks differ from plan to plan, even in the same county.
- List your doctors and hospitals. Include specialists you see only once or twice a year.
- Check each plan's provider directory. Then call each office to confirm it's in network for 2027.
- Find doctors who take Medicare. Use Medicare's Care Compare.
If your plan is ending, at least 30,654 North Carolinians are in the same spot for 2027; see North Carolina plans ending in 2027.
State Health Plan retirees
If you're a retired North Carolina teacher or state employee, the State Health Plan's group Medicare Advantage options, the Base Plan and the Enhanced Plan, are PPOs. The Plan says members can see any provider, in or out of network, who accepts Medicare assignment and agrees to bill the plan. The 70/30 Plan pays after Original Medicare. Joining an outside Medicare Advantage or Part D plan disenrolls you from the Plan's group Medicare Advantage plan and moves you to the 70/30 Plan, so check before you switch. See State Health Plan retirees and Medicare.
Get help
A licensed insurance agent who works with Benefits Life can check your doctors against plans from the companies they work with, at no cost to you. You can request a call from a licensed insurance agent, or see plans for your ZIP code. See also Medigap vs. Medicare Advantage in North Carolina.
Related questions
Does Medicare cover mental health care?
Therapists, telehealth and costs.
Does Medicare cover eye exams and glasses?
What Part B covers for your eyes.
Does Medicare cover dental in North Carolina?
When it pays, and NC Medicaid dental.
Sources
- Medicare.gov — Does your provider accept Medicare as full payment?
- Medicare.gov — Care Compare
- Medicare.gov — Compare Original Medicare and Medicare Advantage
- CMS — CY2027 Medicare Advantage and Part D Landscape files
- State Health Plan — 2027 Plan Comparison, Medicare Primary Subscribers
- State Health Plan — 70/30 Plan for Medicare Retirees
More questions in this guide
- 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?
Part of the guide: Medicare basics for North Carolinians · All questions
Frequently asked questions
Can a North Carolina doctor charge me more than Medicare's rate?
A doctor who accepts assignment can't. A non-participating doctor can charge up to 15% above the Medicare-approved amount for many services, called the limiting charge. Federal limits apply in North Carolina, so ask whether your doctor accepts assignment.
What if my doctor leaves my Medicare Advantage plan's network?
Networks can change during the year and from year to year. Check the plan's provider directory and call your doctors each fall before Medicare Open Enrollment ends on December 7. If your plan is ending in 2027, you have a special enrollment period through February 28, 2027.
What is an opt-out doctor?
Some doctors opt out of Medicare for at least two years and see Medicare patients only under a private contract. Medicare won't pay for their services except in emergencies, even for covered services, so ask what you'll be charged before your visit.
Medicare in your North Carolina county
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