Key Takeaways
- North Carolina requires a 6-month open enrollment period for Medicare Supplement starting at age 65
- Guaranteed issue rights apply when losing other coverage or during open enrollment
- North Carolina prohibits pre-existing condition waiting periods during open enrollment
- Medicare Supplement plans must be standardized (Plans A through N)
- North Carolina does not have a Birthday Rule like some other states
North Carolina Medicare Supplement (Medigap) Regulations
North Carolina has adopted standard federal protections for Medicare beneficiaries purchasing Medicare Supplement (Medigap) insurance.
Open Enrollment Period
North Carolina provides a 6-month open enrollment period for Medicare Supplement:
When It Begins
The 6-month period starts:
- First day of the month you are 65 or older AND
- Enrolled in Medicare Part B
Protections During Open Enrollment
- Guaranteed issue - Must be accepted regardless of health
- No pre-existing condition exclusions
- Standard rates - Cannot be charged more for health conditions
- Any plan available - Can choose any Medigap plan A through N
Exam Tip: North Carolina follows the standard 6-month open enrollment for Medigap. Unlike some states, North Carolina does NOT have a Birthday Rule.
Guaranteed Issue Rights
Beyond open enrollment, North Carolina provides guaranteed issue rights in specific situations:
Triggering Events
| Event | Guaranteed Issue Right |
|---|---|
| Losing employer coverage | Can purchase Medigap within 63 days |
| Leaving Medicare Advantage | Can return to Medigap within 63 days |
| Medicare Advantage plan leaves area | Can purchase Medigap |
| Medigap insurer becomes insolvent | Can switch to comparable plan |
| Losing Medicaid | Can purchase Medigap |
Trial Right
If you leave Medigap for Medicare Advantage:
- Have 12 months to decide
- Can return to previous Medigap plan
- Or any plan from same insurer
- Guaranteed issue, no health questions
Standardized Plans
North Carolina requires Medigap plans to be standardized:
Available Plans
| Plan | Benefits |
|---|---|
| Plan A | Basic benefits only |
| Plan B | Basic + Part A deductible |
| Plan C | Comprehensive (pre-2020 only) |
| Plan D | Similar to C, no Part B excess |
| Plan F | Most comprehensive (pre-2020 only) |
| Plan G | Like F without Part B deductible |
| Plan K | 50% cost sharing, out-of-pocket max |
| Plan L | 75% cost sharing, out-of-pocket max |
| Plan M | 50% Part A deductible |
| Plan N | Cost sharing, copays for visits |
Note: Plans C and F are only available to those eligible for Medicare before January 1, 2020.
Plan Comparison
All plans with the same letter must have the same benefits:
- Plan G from Company A = Plan G from Company B
- Only price and service differ between companies
- Makes comparison shopping easier
Rate Regulation
North Carolina allows different rating methods:
| Rating Method | How It Works |
|---|---|
| Attained Age | Premiums increase with age |
| Issue Age | Premium based on age when purchased |
| Community Rated | Same premium regardless of age |
Rate Increases
- Rate increases must be filed with NCDOI
- Justification required for increases
- NCDOI reviews for reasonableness
Pre-Existing Conditions
During open enrollment:
- No pre-existing condition exclusions
- Must accept applicant regardless of health
Outside open enrollment:
- May apply pre-existing condition waiting period up to 6 months
- Credit for prior creditable coverage
- Federal rules on creditable coverage apply
How long is the open enrollment period for Medicare Supplement in North Carolina?
Does North Carolina have a Birthday Rule for Medicare Supplement insurance?