Quick answers
- When is my Medigap open enrollment period?
- The 6 months that start the first month you are both 65 or older and enrolled in Part B. During it, a company can't turn you down or charge you more because of your health. It happens once.
- Does North Carolina have a Medigap birthday rule?
- No. North Carolina's Medigap law (G.S. Chapter 58, Article 54) and rule (11 NCAC 12 .0843) have no birthday, anniversary or yearly switching right.
- Can I buy Medigap in North Carolina if I'm under 65?
- Yes, if you have Medicare because of a disability. G.S. 58-54-45 requires every Medigap company to offer you at least Plan A, and Plan D or G if it sells them to people 65 and older, if you apply within 6 months of first enrolling in Part B.
- Can I switch Medigap policies later?
- You can apply any time, but outside open enrollment and guaranteed-issue situations the new company can ask health questions and turn you down.
- How long do I have to return a new Medigap policy?
- 30 days from delivery, for a full premium refund if you aren't satisfied for any reason (G.S. 58-54-30).
What is Medigap?
Medigap, also called Medicare Supplement Insurance, is a policy sold by private insurance companies to people who have Original Medicare (Part A and Part B). It pays some or all of the costs Original Medicare leaves to you, such as the Part A hospital deductible, the 20% Part B coinsurance and skilled nursing facility coinsurance. Current amounts are on Medicare costs in 2026 and Medicare costs in 2027.
- Medigap works only with Original Medicare. You can't use it with a Medicare Advantage plan.
- It doesn't include drug coverage, so most people also join a Part D drug plan. North Carolina is its own Part D region, with 11 standalone Part D plans for 2027.
- You pay a monthly premium to the Medigap company on top of your Part B premium.
- Each policy covers one person. Spouses buy separate policies.
- The benefits of each plan letter are set by federal law. The North Carolina Department of Insurance (NCDOI) licenses the companies and agents that sell them here.
What are North Carolina's Medigap rules?
North Carolina's law is N.C. General Statutes Chapter 58, Article 54, "Medicare Supplement Insurance Minimum Standards" (G.S. 58-54-1 to 58-54-50). The working rule, 11 NCAC 12 .0843, adopts the national NAIC Medicare supplement model regulation, with later amendments, for policies issued on or after January 1, 2006. What they mean for you:
Open enrollment at 65
Your 6-month window starts the first month you are both 65 or older and in Part B. Companies must sell you any policy they offer, with no health-based denial or surcharge.
Under-65 window
If you have Medicare because of a disability, companies must offer at least Plan A, plus Plan D or G if they sell them to people 65 and older, during the 6 months after you first enroll in Part B (G.S. 58-54-45).
No birthday rule
There is no yearly right to switch policies without health questions. After open enrollment, switching usually means medical underwriting.
Pre-existing conditions
A policy can't refuse to pay for a pre-existing condition after the first 6 months, and can only count conditions treated or advised on within the 6 months before coverage starts (G.S. 58-54-10(d)).
Age pricing disclosed
Companies choose how to price. If a policy is attained-age rated, the company must tell you in writing that the premium rises each year and show a 10-year illustration (G.S. 58-54-25(f)).
30 days to return it
Every policy must say on its first page that you can return it within 30 days of delivery for a premium refund, for any reason (G.S. 58-54-30).
Does North Carolina have a birthday rule?
No. Some states give Medigap policyholders a yearly window, often around their birthday or policy anniversary, to switch without health questions. Article 54 and 11 NCAC 12 .0843 contain no such right. In North Carolina, the times a company must accept you regardless of your health are open enrollment, the under-65 disability window and the guaranteed-issue situations below. See Does North Carolina have a Medigap birthday rule?
When should I buy? Your Medigap open enrollment period
Federal law gives you a 6-month Medigap open enrollment period that begins the first month you are both 65 or older and enrolled in Part B. It happens once. During it:
- A company must sell you any Medigap policy it offers in North Carolina.
- It can't use medical underwriting to deny you or charge you more because of your health.
- It can make you wait up to 6 months for coverage of a pre-existing condition, unless you had at least 6 months of continuous creditable coverage (such as employer coverage) with no break longer than 63 days.
Delaying Part B delays this window. If you're still working with employer coverage, your Medigap open enrollment doesn't start until you sign up for Part B. See working past 65 and turning 65 in North Carolina. State Health Plan retirees should read State Health Plan retirees and Medicare before buying anything, because the Plan's own options work differently.
Medigap under 65 in North Carolina
Federal law doesn't require companies to sell Medigap to people under 65, but North Carolina's does. G.S. 58-54-45 covers "persons eligible for Medicare by reason of disability before age 65":
- Which plans: every Medigap company must offer at least Plan A. If you became eligible for Medicare on or after January 1, 2020, it must also offer Plan D or Plan G if it sells either to people 65 and older. (For people eligible before 2020, the law names Plan C or F instead.)
- When: apply during the 6 months beginning with the first month you enroll in Part B. If Social Security grants Part B retroactively, the 6 months start the month you're notified.
- No health screening: the offer must be made "without regard to medical condition, claims experience, or health status."
- Price: companies may set separate rates for people under 65 with a disability, but can't price by health in this window. Rates must be filed with and approved by the Commissioner of Insurance.
- If a managed care plan ends: people under 65 with a disability whose Medicare Advantage or other managed care plan is canceled, not renewed or left have a guaranteed right to buy Plan A, D or G from any company within 63 days.
The statute speaks of Medicare "by reason of disability" and doesn't mention end-stage renal disease (ESRD) separately. If you have Medicare only because of ESRD, ask the company, or NCDOI, whether the rule applies to you. At 65 you get the regular 6-month open enrollment and can choose any plan a company sells. More on Medigap under 65 in North Carolina.
When else can I buy Medigap without health questions?
Federal guaranteed-issue rights apply in North Carolina and protect you in these situations. A company can't deny you, charge you more for your health or make you wait for pre-existing-condition coverage:
- Your Medicare Advantage plan leaves Medicare or stops serving your area, or you move out of its service area, and you return to Original Medicare.
- Employer or union coverage that pays after Medicare ends, including retiree and COBRA coverage.
- Trial right: you joined a Medicare Advantage plan or PACE when first eligible at 65, or dropped Medigap to try Medicare Advantage for the first time, and you leave within the first year.
- Your Medigap company goes bankrupt, ends your coverage through no fault of your own, or broke the rules or misled you.
You can apply as early as 60 days before your coverage ends and no later than 63 days after. Depending on the situation, you can buy Plan A, B, D or G (C or F instead of D or G if you were eligible for Medicare before 2020), or in the trial-right case any policy sold in North Carolina. Keep the letter or notice showing when your other coverage ends; the company will ask for it.
Plans ending for 2027: some Medicare Advantage plans are leaving North Carolina counties or ending for 2027, and at least 30,654 North Carolinians must choose new coverage. Every county still has Medicare Advantage plans in 2027. If your plan sent a non-renewal letter, you likely have this guaranteed right for 63 days after the plan ends. See North Carolina plans ending in 2027 and guaranteed Medigap if your plan leaves.
How are Medigap premiums priced in North Carolina?
For the same plan letter, benefits are identical from company to company, but prices are not. Each company chooses one of three methods: community-rated (generally the same premium regardless of age), issue-age-rated (based on your age when you buy) or attained-age-rated (based on your current age, so it rises as you get older). North Carolina doesn't require one method. It does require full written disclosure of attained-age pricing (G.S. 58-54-25(f)), and companies file their rates every year to show they meet the state's loss-ratio standards (G.S. 58-54-20(b)). See Are Medigap rates based on age in North Carolina?
What do the Medigap plan letters cover?
Medigap policies are standardized and named by letter. A Plan G from one company has the same benefits as a Plan G from any other. Every plan pays Part A coinsurance and hospital costs for an extra 365 days after Medicare benefits are used up, plus at least part of the Part B coinsurance, the first 3 pints of blood and hospice coinsurance.
| Plan | Part A deductible | Part B deductible | Part B excess charges | Skilled nursing coinsurance | Foreign travel emergency |
|---|---|---|---|---|---|
| A | No | No | No | No | No |
| B | Yes | No | No | No | No |
| C* | Yes | Yes | No | Yes | 80% |
| D | Yes | No | No | Yes | 80% |
| F* | Yes | Yes | Yes | Yes | 80% |
| G | Yes | No | Yes | Yes | 80% |
| K | 50% | No | No | 50% | No |
| L | 75% | No | No | 75% | No |
| M | 50% | No | No | Yes | 80% |
| N | Yes | No | No | Yes | 80% |
- *Plans C and F can't be sold to people who became eligible for Medicare on or after January 1, 2020. If you were eligible before then, you may still buy them.
- Plans K and L pay 50% and 75% of most costs and have a yearly out-of-pocket limit: $8,360 for Plan K and $4,180 for Plan L in 2027. After you reach it and the Part B deductible, the plan pays 100% of covered services for the rest of the year.
- Plan N pays the Part B coinsurance except for a copayment of up to $20 for some office visits and up to $50 for emergency room visits that don't lead to an inpatient admission. Compare it on Plan G vs. Plan N.
- High-deductible Plan G (and Plan F, for those who can buy it) has the same benefits after you pay a yearly deductible of $3,050 in 2027.
- Foreign travel emergency coverage pays 80% of emergency care outside the U.S. during the first 60 days of each trip, after a $250 yearly deductible, up to a $50,000 lifetime limit.
- Part B excess charges are amounts that providers who don't accept Medicare's payment as full payment may bill, up to the federal limit of 15% above the Medicare-approved amount.
Keeping Medigap if you move
Medigap has no network. It pays its share for Medicare-covered care anywhere in the U.S. from a provider who accepts Medicare, which helps people who see specialists across state lines or split the year between North Carolina and another state. If you move out of North Carolina, you can generally keep your policy as long as you keep Original Medicare; buying a different one usually means health questions. See moving out of North Carolina with Medigap and, if you're coming here, moving to North Carolina with Medicare.
Medigap or Medicare Advantage?
Medicare Advantage plans use networks and service areas, have a yearly out-of-pocket limit, and usually include drug coverage. Medigap plus a Part D plan works with any provider who accepts Medicare. Because North Carolina has no birthday rule, the choice you make at 65 matters: if you start in Medicare Advantage and later want Medigap, you may face health questions unless you have a trial right or another guaranteed-issue right. Compare them on Medigap vs. Medicare Advantage in North Carolina.
Where can I get help with Medigap in North Carolina?
- North Carolina Department of Insurance: licenses Medigap companies and agents and handles complaints. Use its assistance and complaint page.
- Medicare: 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) and the federal guide Choosing a Medigap Policy at Medicare.gov.
To see Medigap policies sold where you live, see plans for your ZIP code. To compare Medigap policies from the companies they work with, you can request a call from a licensed insurance agent. You can also meet licensed insurance agents in North Carolina.
Sources
- N.C. General Assembly — G.S. Chapter 58, Article 54, Medicare Supplement Insurance Minimum Standards
- N.C. General Assembly — G.S. 58-54-45, By reason of disability
- N.C. Office of Administrative Hearings — 11 NCAC 12 (Section .0800, rule .0843, Medicare supplement)
- N.C. Department of Insurance — Assistance or file a complaint
- Medicare.gov — Get ready to buy (Medigap open enrollment)
- Medicare.gov — When can I buy a Medigap policy?
- Medicare.gov — Compare Medigap plan benefits
- Medicare.gov — Learn how Medigap works
- CMS — Out-of-pocket limits for Medigap Plans K and L, 2027
- CMS — Deductible for Medigap high-deductible options, 2027
- CMS — Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare
Every question in this guide
- Are Medigap rates based on age in North Carolina?
- Can I get Medigap under 65 in North Carolina?
- Can I get a Medicare Supplement with pre-existing conditions in North Carolina?
- Can I switch Medigap plans in North Carolina?
- Does North Carolina have a Medigap birthday rule?
- Medigap Plan G vs. Plan N in North Carolina
- What happens to my Medigap if I move out of North Carolina?
- When can I buy a Medicare Supplement plan in North Carolina?
Frequently asked questions
What is the Medigap open enrollment period?
It is a one-time, 6-month window that starts the first month you are both 65 or older and enrolled in Part B. During it, a company must sell you any Medigap policy it offers and can't charge you more because of your health. It doesn't repeat every year.
Is Medigap Plan F still available in North Carolina?
Only to people who were eligible for Medicare before January 1, 2020. People new to Medicare since then can't buy Plan F or Plan C, because federal law no longer lets new enrollees' policies pay the Part B deductible. Plan G is the closest option for them.
What is a Medicare SELECT policy?
Medicare SELECT is a Medigap policy that requires you to use certain hospitals, and in some cases certain doctors, to get full benefits, usually for a lower premium. G.S. 58-54-50 lets the Commissioner of Insurance set standards for SELECT policies. If you buy one, you can change your mind within 12 months and switch to a standard Medigap policy.
Can a Medigap company cancel my policy because of my health?
No. Standardized Medigap policies renew automatically every year, even if you have health problems. The company can drop you only if you stop paying premiums, weren't truthful on your application, or the company goes bankrupt.
Does Medigap cover prescription drugs?
No. Medigap policies sold since 2006 don't include drug coverage, so most people with Medigap also join a standalone Part D plan.
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