Medicare in Rural and Mountain North Carolina

Quick answers

How many Critical Access Hospitals are in North Carolina?

20, in 19 counties, according to CMS's Hospital General Information file released November 12, 2026. They have no more than 25 inpatient beds and keep an emergency department open 24 hours a day.

Does North Carolina have a Rural Emergency Hospital?

Not yet. CMS's November 2026 hospital file lists none in North Carolina. State law (G.S. 131E-78.3) sets out what a hospital must do before converting to one.

Can I use Medicare telehealth from home in rural North Carolina?

Yes. Medicare.gov says that through December 31, 2027, Medicare covers telehealth you get from anywhere in the U.S., including your home. For most services you pay the same as in person.

How many Medicare Advantage plans are in the mountain counties?

For 2027, CMS data shows 35 in Graham, 35 in Swain, 28 in Cherokee and 44 in Buncombe, compared with 57 in Guilford.

Does Medicare pay for air ambulance?

Part B may pay for a helicopter or airplane ambulance when you need immediate, rapid transport that ground transport can't provide, to the nearest appropriate facility. After the Part B deductible, you pay 20%.

What makes rural North Carolina different

North Carolina stretches from the Great Smoky Mountains to the Outer Banks, and a lot of it is a long drive from a large hospital. A few verified facts frame the picture:

• 31 Appalachian counties. The Appalachian Regional Commission (ARC) counts 31 North Carolina counties in the Appalachian Region: Alexander, Alleghany, Ashe, Avery, Buncombe, Burke, Caldwell, Catawba, Cherokee, Clay, Cleveland, Davie, Forsyth, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Stokes, Surry, Swain, Transylvania, Watauga, Wilkes, Yadkin and Yancey. ARC lists Alleghany, Cherokee, Jackson and Rutherford as "at-risk" for fiscal year 2026.
• 12 hospital closures or conversions. The UNC Sheps Center's national list of rural hospital closures since 2005 includes 12 North Carolina hospitals that closed or stopped inpatient care, most recently a hospital in Williamston (Martin County) in 2023.
• 20 Critical Access Hospitals, 0 Rural Emergency Hospitals. That is CMS's Hospital General Information file, released November 12, 2026.

None of this changes what Medicare covers. It changes how you plan: which hospital you would go to, how you'd get there, and whether your coverage works with the doctors who are actually near you.

Critical Access Hospitals in North Carolina

A Critical Access Hospital is a small rural hospital certified under federal rules (42 CFR Part 485, Subpart F). It keeps no more than 25 inpatient beds, keeps acute inpatient stays to an annual average of 96 hours, runs an emergency department 24 hours a day, and is generally more than a 35-mile drive from another hospital, or 15 miles in mountainous terrain or where there are only secondary roads. Its beds can also be used as "swing beds" for skilled nursing care after a hospital stay. Medicare covers your care there like care at any other hospital. More in what is a Critical Access Hospital?

CMS lists North Carolina's 20 Critical Access Hospitals in these towns:

Source: CMS Hospital General Information, released November 12, 2026. Listing is not an endorsement.

Rural Emergency Hospitals: none yet

Since January 1, 2023, Medicare has recognized Rural Emergency Hospitals (REHs): small rural hospitals that keep a 24-hour emergency department and outpatient services but stop admitting inpatients. CMS's November 2026 file lists 49 nationwide and none in North Carolina. North Carolina law is ready for them: G.S. 131E-78.3 (added in 2023) requires a hospital that seeks REH status to notify NCDHHS and its county commissioners, submit a plan on the county's health care needs, and hold a public hearing with at least 15 days' newspaper notice. The conversion isn't subject to certificate-of-need review. See what is a Rural Emergency Hospital?

Telehealth from home through 2027

Medicare.gov says that through December 31, 2027, Medicare covers telehealth services you get from anywhere in the U.S., including your home. That includes office visits, outpatient psychotherapy, cognitive assessments, diabetes self-management training and more, by video and in some cases by phone. After the Part B deductible ($283 in 2026), you pay 20% of the Medicare-approved amount, and for most services that's the same as an in-person visit. If you don't have reliable broadband at home, ask whether your provider offers audio-only visits for your service. More in telehealth in rural North Carolina.

Ground and air ambulance

Part B covers ground ambulance when traveling any other way could endanger your health, to the nearest appropriate hospital, Critical Access Hospital, Rural Emergency Hospital or skilled nursing facility that can treat you. Medicare may pay for a helicopter or airplane ambulance when you need immediate, rapid transport that ground transport can't provide. After the Part B deductible you pay 20% of the Medicare-approved amount, and ambulance companies must accept Medicare's amount as payment in full for Original Medicare claims (42 CFR 414.610(b)). See air ambulance in North Carolina.

Plan choice in the mountains and rural counties

Original Medicare, Part D and Medigap work the same in every county. Medicare Advantage choice varies. CMS's 2027 plan data shows:

Every county has 11 standalone Part D plans for 2027. Two companies are leaving some North Carolina counties for 2027, mostly in the western mountains; if your plan is ending, see plans ending in 2027. A plan count is only a starting point: what matters in a rural county is whether the doctors and hospital you use are in a plan's network. More in Medicare options in the North Carolina mountains.

Original Medicare or Medicare Advantage in a rural county?

• Original Medicare with a Medigap policy works with any doctor or hospital in the U.S. that accepts Medicare, including specialists across the line in Tennessee, Virginia, Georgia or South Carolina. You add a Part D plan for drugs. North Carolina has no Medigap birthday rule, so choose carefully during your Medigap open enrollment at 65.
• Medicare Advantage plans combine coverage in one plan and many use networks. Check that your local hospital, the larger hospital you would be transferred to and your specialists are in network. 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.

Compare the two in Medigap vs. Medicare Advantage in North Carolina.

A rural North Carolina Medicare checklist

1. Know your nearest emergency department. Find out whether it's a Critical Access Hospital and which larger hospital it transfers patients to.
2. Check networks against real places. If you're looking at Medicare Advantage, confirm the local hospital, the transfer hospital and your specialists, and how the plan handles care across state lines.
3. Set up telehealth now. Ask your doctors which visits they offer by video or phone, so you're ready in bad weather.
4. Review Part D pharmacies. Make sure your plan has a network pharmacy near you, or mail order that reaches your address.
5. Compare before December 7. Open Enrollment for 2027 runs October 15 to December 7, 2026. You can see plans for your ZIP code, or request a call from a licensed insurance agent to review plans from the companies they work with.

Storm season adds its own planning; see hurricanes, floods and Medicare in North Carolina.

Sources

• CMS — Hospital General Information (released November 12, 2026)
• eCFR — 42 CFR Part 485, Subpart F, Critical Access Hospitals
• eCFR — 42 CFR Part 485, Subpart E, Rural Emergency Hospitals
• CMS — Rural Emergency Hospitals
• North Carolina General Statutes — G.S. 131E-78.3, Rural emergency hospital
• Medicare.gov — Telehealth
• Medicare.gov — Ambulance services
• eCFR — 42 CFR 414.610, ambulance payment and mandatory assignment
• Appalachian Regional Commission — FY 2027 Congressional Justification, Appendix B (county designations)
• UNC Sheps Center — Rural Hospital Closures
• CMS — 2027 Medicare Advantage and Part D Landscape files

Every question in this guide

• Does Medicare cover telehealth in rural North Carolina?
• Does Medicare pay for air ambulance in North Carolina?
• What is a Critical Access Hospital in North Carolina?
• What is a Rural Emergency Hospital in North Carolina?
• What Medicare options are there in the North Carolina mountains?

Frequently asked questions

Medicare in your North Carolina county

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