Alyssa Lane
If you are a resident of North Carolina and are over the age of 65, you are eligible for Medicare, a major federally-funded medical plan that provides a basic foundation of benefits. However, Medicare does not cover 100% of medical bills, and beneficiaries are responsible for premiums, deductibles, and coinsurance. This means that most people need some kind of supplemental plan to fill in the gaps. If you are employed, you may be covered by your employer's health plan, but it is important to confirm with your employer the details of your coverage. If you are retired, you can use the Health Insurance Marketplace to buy an insurance plan.
| Characteristics | Values |
|---|---|
| Medicare eligibility | If you or your spouse have paid into the Social Security System for 10 or more years, you are eligible for premium-free Medicare Part A (Hospital Insurance) at age 65. |
| Medicare Part B | Everyone pays a premium for Medicare Part B (Medical Insurance). |
| Medicare Part B and employment status | If you or your spouse are actively working at age 65, are covered by an <co: 3,4>Employer’s Group Health Plan (EGHP) and the company has 20 or more employees, you may be able to delay Medicare Part B coverage without penalty. |
| Medicare Part A and employment status | If you are actively working for the state after 65, the Plan will continue to be your primary coverage and you can delay enrollment into Medicare Part B until you actually retire from state employment. |
| Medicare Advantage Plans | If you are already retired and about to turn 65, you will be auto-enrolled into the Humana Group Medicare Advantage (PPO) Base Plan. |
| Medicare Supplement Plans | SHIIP can provide information about the Medicare Supplement Plans available in North Carolina. |
| Medicare and retirement | If you retire before you’re 65 and lose your job-based health plan, you can use the Health Insurance Marketplace to buy a plan. |
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What You'll Learn
Medicare eligibility and enrolment
If you are actively working for the state after the age of 65, the State Health Plan will continue to be your primary coverage, and Medicare will be secondary. In this case, you can choose to enrol in Medicare Part A, but you can delay enrolment in Medicare Part B until you retire from state employment. However, it is crucial to remember to enrol in Medicare Part B to become effective as of your retirement date. It is recommended to consult with your Human Resources Department before retirement to discuss your options and submit your retirement paperwork at least 120 days in advance.
If you are covered by an Employer's Group Health Plan (EGHP) and plan to continue working after turning 65, you may be able to delay Medicare Part B coverage without penalty. To understand your specific situation, speak to your employer's benefit officer and ask about company health insurance options available to those working past the age of 65. They can advise you on whether you need to keep your EGHP as secondary to Medicare or if you should consider other options, such as purchasing a Medicare supplement or joining a Medicare Advantage Plan.
If you are retiring under the Teachers' and State Employees' Retirement System (TSERS) and are eligible for State Health Plan retiree group coverage, you will be auto-enrolled in a health plan after submitting your retirement application. If you are Medicare-eligible and complete your retirement application at least 60 days before your coverage effective date, you will be automatically enrolled in the Medicare Advantage Base Plan. However, you have the option to change plans up to 30 days before your coverage effective date. If no changes are made, you will remain in the assigned Medicare Advantage Base Plan until the next Open Enrollment period.
Additionally, if you are already retired and about to turn 65, your options under the State Health Plan will change. The State Health Plan will automatically enrol you in the Humana Group Medicare Advantage (PPO) Base Plan when you become Medicare-eligible. You will receive written notification of this auto-enrolment approximately 80 to 90 days beforehand and will have the opportunity to make changes if desired.
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Medicare supplement plans
In North Carolina, if you are over the age of 65, you will be eligible for Medicare and your options under the State Health Plan will change. The State Health Plan will automatically enrol you in the Humana Group Medicare Advantage (PPO) Base Plan when you become eligible for Medicare. You will receive written notification of this auto-enrolment from the State Health Plan around 80 to 90 days before your Medicare becomes effective and will be given an opportunity to make a change.
Medicare is a major federally-funded medical plan that provides a basic foundation of benefits. However, it does not pay 100% of all medical bills. Because of these costs, most beneficiaries need some kind of plan, policy or program to fill in the “gaps”. Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private health insurance company to help pay your share of out-of-pocket costs in Original Medicare. Medicare Supplement plans are one health insurance option for people in this situation.
Medigap plans may help pay some of the healthcare costs that Medicare Parts A and B do not, like coinsurance, copayments or deductibles. Depending on the state where you live, you could get 6% off your monthly premium if you enrol online. Plans A through G generally provide benefits at higher premiums with limited out-of-pocket costs compared to Plans K through N. Plans K through N are cost-sharing plans offering similar benefits at lower premiums with greater out-of-pocket costs. If you live in Massachusetts, Minnesota or Wisconsin, your Medicare Supplement policy may be called something different than "Medicare Supplement Plans A through N".
If you are actively working at age 65, are covered by an Employer’s Group Health Plan (EGHP) and the company has 20 or more employees, you may be able to delay Medicare Part B coverage without penalty. You will still be eligible for Part A without paying a premium as long as you or your spouse has 40 credits of work. If your retirement date is January 1, your retiree health plan benefit effective date is February 1. If you are already enrolled in Medicare Part A, you must give written notice to your company of your intention to continue working past age 65.
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Medicare prescription drug coverage
In North Carolina, if you are about to turn 65, you will become eligible for Medicare and your options under the State Health Plan will change. The State Health Plan will automatically enrol you in the Humana Group Medicare Advantage (PPO) Base Plan, which will become effective when you become eligible for Medicare/Medicare Primary. You will receive written notification of this auto-enrolment from the State Health Plan approximately 80 to 90 days before your Medicare coverage is set to begin.
If you are actively working for the state after turning 65, the Plan will continue to be your primary coverage, and Medicare will be secondary. This means you can choose to enrol in Medicare Part A, but you can delay enrolment in Medicare Part B until you actually retire from state employment. However, remember to enrol in Medicare Part B to become effective as of your retirement date.
If you or your spouse are actively working at age 65 and are covered by an Employer's Group Health Plan (EGHP), with the company having 20 or more employees, you may be able to delay Medicare Part B coverage without penalty. You will still be eligible for Part A without paying a premium as long as you or your spouse have 40 credits of work. Talk to your employer's benefits officer and ask for information about company health insurance options for people working past their 65th birthday.
If you have an EGHP that will continue to pay secondary to your Medicare, study the benefits booklet to find out the cost and benefits of the plan. You will then need to decide if you should keep your EGHP as secondary to Medicare or if you need to drop your EGHP and purchase a Medicare supplement or join a Medicare Advantage Plan. If your EGHP has drug benefits, make sure they are as good as or better than Medicare Part D. If you will not be covered by an EGHP plan that will pay secondary to Medicare, begin to investigate other health insurance options, such as an individual Medicare Supplement Policy or a Medicare Advantage Plan. SHIIP can provide information about the Medicare Supplement Plans, Medicare Advantage Plans (Part C), and Medicare Prescription Drug Plan (Medicare Part D) options available in North Carolina.
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Medicare and retirement
Medicare is a major federally-funded medical plan that provides a basic foundation of benefits. However, it does not pay 100% of all medical bills, and beneficiaries are responsible for premiums, deductibles, and coinsurance. These costs can be significant, so most beneficiaries need a plan, policy, or program to fill in the "gaps".
If you are under 65 and not Medicare-eligible, you will be automatically enrolled in the health plan you were enrolled in as an active employee, along with any covered dependents. If you did not have coverage in the State Health Plan as an active employee, you will be automatically enrolled in the Base PPO Plan (70/30) Plan retiree-only coverage. You can change your auto-enrollment plan or coverage (or opt out of coverage) up to 30 days after your coverage effective date.
If you are retiring under TSERS and are eligible for State Health Plan retiree group coverage, you will be auto-enrolled into a health plan after you have submitted, and the Retirement System has processed, your online retirement application or Form 6E, Choosing Your Retirement Payment Option. If you were "first hired" before October 1, 2006, and have five or more years of TSERS membership, the state will pay all the costs for your individual coverage under the Base PPO Plan (70/30) or the Medicare Advantage Base Plan as a TSERS retiree.
If you are Medicare-eligible and your retirement application is completed 60 days or more before your coverage effective date, you will be automatically enrolled into the Medicare Advantage Base Plan. You will have up to 30 days before your coverage effective date to change plans. If no action is taken, you will remain in your assigned Medicare Advantage Base Plan until the next Open Enrollment, and your non-Medicare-eligible dependents will be enrolled in the health plan they were enrolled in while you were an active employee.
If you are already retired and about to turn 65, you will become eligible for Medicare, and your options under the State Health Plan will change. The State Health Plan will automatically enrol you in the Humana Group Medicare Advantage (PPO) Base Plan when you become Medicare-eligible. You will receive written notification of this auto-enrolment from the State Health Plan approximately 80 to 90 days before your Medicare becomes effective and be given an opportunity to make a change.
If you are actively working for the state after 65, the Plan will continue to be your primary coverage, and Medicare will be secondary. This means you can choose to enrol in Medicare Part A but delay enrolment in Medicare Part B until you actually retire from state employment. However, it will be important to remember to enrol in Medicare Part B to become effective as of your retirement date.
If you or your spouse are actively working at age 65 and are covered by an Employer's Group Health Plan (EGHP), you may be able to delay Medicare Part B coverage without penalty. You will still be eligible for Part A without paying a premium as long as you or your spouse has 40 credits of work. If your EGHP has drug benefits, make sure they are as good as or better than Medicare Part D. If you will not be covered by an EGHP plan that will pay secondary to Medicare, begin to investigate other health insurance options—either an individual Medicare Supplement Policy or a Medicare Advantage Plan.
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Medicare and employer-based insurance
If you are a resident of North Carolina and are over the age of 65, you may be eligible for Medicare. This is a federally funded medical plan that provides a basic foundation of benefits. Medicare beneficiaries are responsible for premiums, deductibles, and coinsurance.
If you are approaching the age of 65, it is important to begin learning about Medicare and how it relates to your circumstances. You should also talk to your employer's benefit officer to ask about any company health insurance options for people working past their 65th birthday. You should ask how many hours you must work to keep your health insurance plan and whether the Employer Group Health Plan (EGHP) will be "primary" or "secondary" coverage to Medicare. If your EGHP is primary to Medicare, you do not have to enroll in Medicare Part B at this time, but you will need to enroll within eight months of the EGHP's termination of coverage or when it stops being primary. If your EGHP will be secondary to Medicare, you should study the benefits booklet to find out the cost and benefits of the plan and decide if you should keep your EGHP as secondary to Medicare or if you need to drop it and purchase a Medicare supplement or join a Medicare Advantage Plan.
If you or your spouse are actively working at age 65, are covered by an EGHP, and the company has 20 or more employees, you may be able to delay Medicare Part B coverage without penalty. You will still be eligible for Part A without paying a premium as long as you or your spouse have 40 credits of work. If you have been on Medicare due to disability, you have a brand new six-month Open Enrollment Period for purchasing Medicare supplemental insurance when you turn 65.
If you have Medicare and other health insurance, each type of coverage is called a "payer". The "primary payer" pays up to the limits of its coverage, then sends the rest of the balance to the "secondary payer". If the secondary payer doesn't cover the remaining balance, you may be responsible for the rest of the costs.
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Frequently asked questions
If you are over 65, you are eligible for Medicare, a federally-funded medical plan that provides a basic foundation of benefits. Medicare consists of Part A (Hospital Insurance) and Part B (Medical Insurance). If you or your spouse have paid into the Social Security System for 10 or more years, you are eligible for premium-free Medicare Part A at age 65. If you have paid in fewer than 10 years, you can buy Medicare Part A coverage. Everyone pays a premium for Medicare Part B.
If you have an EGHP when you become eligible for Medicare, you may be able to delay Medicare Part B coverage without penalty. You will still be eligible for Part A without paying a premium as long as you or your spouse has 40 credits of work. You should ask your employer's benefits officer for information about company health insurance options for people working past the age of 65.
If you do not have an EGHP, you should begin to investigate other health insurance options, such as an individual Medicare Supplement Policy or a Medicare Advantage Plan. SHIIP can provide information about the Medicare Supplement Plans, Medicare Advantage Plans (Part C), and Medicare Prescription Drug Plan (Medicare Part D) options available in North Carolina.
