Medicare guide
Medicare Advantage Plans in North Carolina for 2027
Shopping for Medicare Advantage plans in North Carolina for 2027? Open Enrollment runs October 15 to December 7, and several insurers are changing where they sell plans. Here’s what CMS, KFF, and insurer announcements show for North Carolina, plus how to compare plans in your county.
Blake Insurance Group is an independent agency serving clients by phone, email, and online in states where we are licensed; coverage depends on the insurer, the policy, and underwriting.
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Medicare Advantage in North Carolina: 2027 snapshot
CMS publishes a 2027 landscape fact sheet for each state, including North Carolina, with plan counts and average premiums; we couldn’t extract North Carolina’s figures for this page, so check the CMS fact sheet or Medicare.gov’s plan compare tool for your county.
KFF reports that in 2024, 55.4% of North Carolina’s Medicare beneficiaries were in Medicare Advantage or other private health plans, compared with 50.2% nationally.
- Alignment Health adds Cabarrus, Gaston, Mecklenburg, and Rowan counties for 20 North Carolina counties.
- Live Insurance News, a secondary source, reports North Carolina’s plan count rising from 175 to 179, an average premium falling from $12.49 to $6.19, and a $0-premium plan in every county.
Free help in North Carolina
Free, unbiased Medicare counseling in North Carolina is available from SHIIP (Seniors’ Health Insurance Information Program, NCDOI) at 1-855-408-1212. SHIP counselors don’t sell insurance. You can also call 1-800-MEDICARE (1-800-633-4227) or the national SHIP line at 877-839-2675.
How to compare plans in your county
- Read your ANOC and Evidence of Coverage when they arrive.
- Use Medicare.gov’s plan compare tool to enter your drugs and pharmacies and estimate yearly costs.
- Confirm your doctors and hospitals are in network for next year.
- Compare premiums, deductibles, copays, and the out-of-pocket maximum, not just the premium.
- Check the plan’s 2027 Star Rating.
- Make changes between October 15 and December 7 so coverage starts January 1.
Medicare Advantage or Medigap?
Medicare Advantage plans replace Original Medicare with a private plan that has a network and an annual out-of-pocket limit, and usually include drug coverage. Medigap supplements Original Medicare, lets you see any provider that accepts Medicare, and is paired with a separate drug plan.
North Carolina doesn’t have a Medigap birthday rule, according to KFF’s October 2026 state review, so outside your Medigap Open Enrollment Period or a guaranteed issue right, insurers can generally use medical underwriting when you apply or switch.
North Carolina law makes Plans A, D, and G available to people under 65 during a six-month window after Part B enrollment, and gives a new six-month open enrollment for any plan at 65, according to NCDOI.
NCDOI points shoppers to Medicare.gov’s Medigap comparison tool.
Insurers changing their footprint for 2027
| Insurer | County exits | County entries |
|---|---|---|
| Health Care Service Corp. (HCSC) | 498 | 0 |
| Centene (Wellcare) | 359 | 15 |
| UnitedHealth Group | 228 | 9 |
| CVS Health (Aetna) | 186 | 63 |
| BCBS of Michigan | 177 | 1 |
| Elevance Health | 66 | 10 |
| Humana | 62 | 4 |
| Kaiser Permanente | 3 | 3 |
| Devoted Health | 0 | 342 |
| Molina Healthcare | All MA-PD | Still offers SNPs in many counties |
Source: KFF analysis of CMS data, October 9, 2026. Counts exclude Special Needs Plans and employer plans.
Becker’s Payer Issues, a trade publication, lists insurers fully leaving Medicare Advantage for 2027, including Blue Cross and Blue Shield of Montana, Braven Health in New Jersey, Wellmark Blue Cross Blue Shield in Iowa and South Dakota, Blue Cross and Blue Shield of North Dakota, Christus Health Plan in Texas and New Mexico, ConnectiCare, WellSense, and Memorial Hermann Health Plan in Texas. It also reports Blue Cross and Blue Shield of Texas and of Oklahoma ending their Blue-branded Medicare Advantage plans while HCSC keeps HealthSpring plans in some counties. If your plan is leaving, you have a Special Enrollment Period and may have Medigap guaranteed issue rights.
How to read 2027 Star Ratings
CMS rates each Medicare Advantage contract from 1 to 5 stars, and the rating covers every plan under that contract. The 2027 ratings, released October 8, 2026, used up to 43 measures for plans with drug coverage, covering areas such as preventive care, chronic condition management, member experience, complaints, and drug safety.
| Measure | 2027 | 2026 |
|---|---|---|
| MA-PD contracts rated | 508 | 516 |
| Contracts at 4 stars or higher | 188 (about 37%) | About 44% |
| Enrollees in 4+ star contracts | About 71% | About 67% |
| Five-star contracts | 15 | 22 |
| Enrollment-weighted average (MA-PD) | 3.99 | 4.01 |
| Average standalone drug plan rating | 3.22 | 3.01 |
Source: CMS 2027 Star Ratings fact sheet, October 8, 2026. A contract’s rating can differ from the company’s average, so check the specific plan on Medicare.gov.
Litigation also affects comparisons. A federal court ruled in May 2026 that CMS improperly used some measures, CMS recalculated 2026 ratings in June, and Alignment Health has sued over its 2027 rating, according to Healthcare Dive; SCAN and Alignment had sued over 2026 ratings. Ratings are one factor; a plan’s network, drug list, and costs usually matter more for your situation.
Types of Medicare Advantage plans
| Type | How it works |
|---|---|
| HMO | Generally in-network care only, except emergencies, urgent care, and out-of-area dialysis; referrals usually required |
| HMO-POS | Like an HMO, but some out-of-network services allowed at higher cost |
| PPO | Out-of-network care allowed at higher cost; no referrals needed |
| PFFS | See any Medicare-approved provider that accepts the plan’s terms |
| SNP | Limited to people with Medicaid, certain chronic conditions, or institutional care; includes drug coverage |
| MSA | High-deductible plan with a medical savings account; no network; separate drug plan needed |
Source: Medicare.gov. Medicare Advantage plans often require prior authorization for some services.
Out-of-pocket limits
Medicare Advantage plans must cap in-network out-of-pocket costs for Part A and B services. For 2026, KFF reports the federal limit is $9,250 in network and $13,900 combined for in- and out-of-network services in PPOs, and that the average plan’s in-network limit is about $5,421. Original Medicare has no out-of-pocket cap, which is one reason people pair it with Medigap.
When you can enroll or switch
| Period | When | What you can do |
|---|---|---|
| Initial Enrollment Period | 7 months around your 65th birthday month | Sign up for Parts A and B, and join a plan |
| Annual Open Enrollment | October 15 – December 7 | Join, switch, or drop Medicare Advantage or drug plans; coverage starts January 1 |
| Medicare Advantage Open Enrollment | January 1 – March 31 | One change: switch MA plans or return to Original Medicare (and add a drug plan) |
| General Enrollment Period | January 1 – March 31 | Sign up for Parts A and B if you missed your IEP; penalties may apply |
| Special Enrollment Periods | After qualifying events | For example, moving or losing employer coverage |
| Medigap Open Enrollment | 6 months from the first month you have Part B and are 65+ | Buy any Medigap policy sold in your state without health questions |
Source: Medicare.gov, October 2026.
Original Medicare costs
| Item | 2026 amount |
|---|---|
| Part A hospital deductible | $1,736 per benefit period |
| Part A coinsurance, days 61–90 | $434 per day |
| Skilled nursing facility, days 21–100 | $217 per day |
| Part B standard premium | $202.90 per month |
| Part B deductible | $283 per year |
| Part D deductible (maximum) | $615 |
| Part D out-of-pocket cap | $2,100 |
| Insulin | No more than $35 for a month’s supply |
Sources: CMS (Nov. 2025, Apr. 2025) and Medicare.gov. 2027 Part A and B amounts had not been announced as of Oct. 22, 2026; CMS usually publishes them in mid-November. Higher-income beneficiaries pay more for Parts B and D.
How agents help, and the rules they follow
An independent agent appointed with several insurers can compare Medicare Advantage, Medigap, and Part D options available in your area, check your doctors and prescriptions against plan networks and drug lists, and help again each fall during Open Enrollment. Agents are paid by the insurers, so you don’t pay a fee for their help. Medicare.gov, 1-800-MEDICARE, and your State Health Insurance Assistance Program (SHIP) also give free, unbiased help; the national SHIP line is 877-839-2675.
Federal rules shape how agents work. Third-party marketing organizations that represent more than one Medicare Advantage organization must give a disclaimer explaining that they don’t offer every plan in your area. Agents must agree with you on a Scope of Appointment, the products you want to discuss, before a sales appointment; a CMS rule effective June 1, 2026 removed the old 48-hour waiting period. And under a 2024 CMS rule, your personal information can be shared with another marketing organization only with your prior express written consent for each recipient.
Avoiding Medicare scams
Medicare.gov says Medicare will never call you to sell you anything or visit you at your home, and that it calls for personal information only in limited cases, such as returning your call. Don’t join a plan over the phone unless you called and asked for help, and don’t give your Medicare or Social Security number to anyone who contacts you unexpectedly. The FTC adds that Medicare sends new cards automatically and for free.
Report suspected fraud to 1-800-MEDICARE (1-800-633-4227) or the HHS Office of Inspector General at 1-800-HHS-TIPS (1-800-447-8477). Medicare Advantage and Part D members can also call the I-MEDIC at 1-877-772-3379.
The 2027 Medicare Advantage landscape
CMS projects the average monthly Medicare Advantage premium will fall from $14.37 in 2026 to $12.00 in 2027, with about 5,532 plans offered and about 34 million people enrolled, roughly 47.4% of people with Medicare. CMS also says more than 99% of beneficiaries have at least one Medicare Advantage plan available and about 8 in 10 enrollees can keep their current plan at the same or a lower premium. Standalone drug plan premiums are projected to average $36 a month, up from $35.09.
KFF’s analysis of CMS data finds the average beneficiary has 28 Medicare Advantage plans with drug coverage for 2027, down from 32 in 2026 and a peak of 36 in 2024. Counties with no general-enrollment Medicare Advantage plan with drug coverage rose from 123 to 193; standalone drug plans are still available there.
Checking a plan and insurer
- Networks. Confirm your doctors and hospitals are in the plan’s network.
- Drugs. Check each prescription on the plan’s formulary and its tier.
- Costs. Compare premiums, deductibles, copays, and the out-of-pocket maximum.
- Agent license. Confirm the agent is licensed in your state through your state insurance department.
- Star Ratings. Review the plan’s rating in Medicare.gov’s plan compare tool.
What an independent agency does
An independent insurance agency is licensed to sell policies from several insurance companies. Instead of quoting one company's products, an independent agent can compare options from the insurers the agency represents, explain the differences in coverage, and help you re-shop at renewal. The insurance company, not the agent, makes underwriting and claim decisions.
Blake Insurance Group is an independent agency. We work with clients by phone, email, and online in states where we are licensed, and we will tell you which insurers we can quote for your situation.
How we work
Blake Insurance Group serves clients by phone, email, and online in states where we are licensed. The insurers and plans we can offer depend on our appointments and your location; a company named on this page may not be available through us.
How to verify an insurer or agency
Before buying through any website or app, confirm who is selling you the policy and who will issue it:
- Find the licensed agency or insurer named in the site's footer, terms, or license page.
- Look up the agency or producer on your state insurance department's license search, or through the National Insurance Producer Registry (NIPR).
- Look up the insurer on your state insurance department's company search to confirm it is authorized in your state.
- Save the insurer's name and policy number once issued, since that is who handles claims.
A legitimate service will make this information easy to find. Be cautious if you cannot identify the licensed entity.
Sources
We checked the facts on this page against the sources below in October 2026. Plans, prices, and rules change, so confirm current terms before you buy.
- CMS: Medicare Advantage and Part D expected to remain stable in 2027 (Sep. 28, 2026)
- KFF: The average Medicare beneficiary has 28 MA-PD plan options for 2027 (Oct. 2026)
- KFF: Medicare Advantage plan availability for 2027 (Oct. 2026)
- CMS: 2027 Medicare Advantage and Part D Star Ratings (Oct. 2026)
- Medicare.gov: Compare Medicare Advantage plan types
- KFF: Medicare Advantage out-of-pocket limits
- Medicare.gov: Joining a health or drug plan
- Medicare.gov: Special Enrollment Periods
- CMS: 2026 Medicare Parts A & B premiums and deductibles (Nov. 2025)
- Medicare.gov: What Original Medicare doesn't cover
- 42 CFR 422.2267: Required materials and content (TPMO disclaimer)
- 42 CFR 423.2264: Beneficiary contact and Scope of Appointment
- ACL: State Health Insurance Assistance Program (Mar. 2026)
- Medicare.gov: Medicare fraud
- CMS: Contract Year 2027 Medicare Advantage and Part D final rule (Apr. 2026)
- Medicare.gov: Your Medicare in 2027: What's new and changing (Sep. 2026)
- CMS: 2027 MA and Part D landscape state-by-state fact sheets (Sep. 28, 2026)
- KFF State Health Facts: Total Medicare beneficiaries and MA enrollment share (2024 data)
- Alignment Health: 2027 expansion (Oct. 1, 2026)
- Live Insurance News: North Carolina Medicare enrollees and 2027 plans (Oct. 2026)
- SHIP Technical Assistance Center: SHIP contact list
- Becker's Payer Issues: Payers exiting Medicare Advantage in 2027 (Oct. 20, 2026)
What to have ready for a Medicare review
These details help an agent quote accurately.
- Medicare card. Your Medicare number and Part A and B start dates.
- Doctors. Names of doctors and hospitals you want to keep.
- Prescriptions. Drug names, doses, and pharmacies.
- Current coverage. Any plan, employer, or Medicaid coverage you have.
- ZIP code. Plans differ by county.
Medicare Advantage in North Carolina FAQs
How many Medicare Advantage plans are in North Carolina for 2027?
Check CMS’s 2027 state fact sheet or Medicare.gov’s plan compare tool; availability varies by county.
Which companies are leaving North Carolina?
We didn’t find a verified statewide 2027 exit for this state; check your Annual Notice of Change to see whether your plan is continuing.
When can I enroll?
October 15 to December 7 for coverage starting January 1, 2027; new enrollees use their Initial Enrollment Period.
What if my plan is leaving?
You get a Special Enrollment Period to choose a new plan, and you may have a guaranteed right to buy certain Medigap policies.
Where can I get free help in North Carolina?
SHIIP (Seniors’ Health Insurance Information Program, NCDOI) at 1-855-408-1212.
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Important information
Compensation. Links in the partner section of this page are sponsored, and Blake Insurance Group may be paid if you make a purchase. Sponsored placement does not affect the other information on this page.
Independent agency. Blake Insurance Group LLC is an independent insurance agency. Licensed insurance producer NPN 16117464. Licensed states: AZ, AL, TX, CA, NY, OH, FL, NC, VA, GA, OK, NM, IA, KS, MI, NE, SC, SD, WV, IL, NJ, PA, TN, and WA. Which insurance companies we can quote depends on our current appointments, the product, and your state. Mentioning a company on this page does not mean we represent it.
Medicare disclaimer. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE (TTY users 1-877-486-2048), or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.
Medicare figures. Costs, limits, and rules on this page were checked against CMS, Medicare.gov, and the other listed sources in October 2026. 2027 Part A and B amounts had not been announced. Confirm current figures at Medicare.gov.
Company names. Company names are trademarks of their owners. Blake Insurance Group isn’t affiliated with the companies described unless a partner link says so, and a company named here may not be available through us. Plan availability, ratings, and benefits vary by county and can change; facts were checked in October 2026.
Coverage terms. Descriptions are general. The policy contract controls what is covered.
Availability. Coverage, prices, and eligibility vary by company, state, and applicant, and are subject to underwriting. The issued policy controls.
Your next step
Request a review, and a licensed agent will compare Medicare plans available to us in your area. You can also use Medicare.gov or 1-800-MEDICARE to see all options.
