Turning 65 in North Carolina: your Medicare checklist

When is my Initial Enrollment Period?

Your Initial Enrollment Period (IEP) is 7 months long: the 3 months before the month you turn 65, your birthday month, and the 3 months after. When your coverage starts depends on when you sign up:

• In the 3 months before your birthday month: coverage starts the first day of your birthday month.
• In your birthday month or the 3 months after: coverage starts the first day of the month after you sign up.

If you miss your IEP and don't have job-based coverage from current work, you may have to wait for the General Enrollment Period (January 1 to March 31) and pay a Part B late penalty of 10% for each full 12 months you could have had Part B, for as long as you have it. See Medicare enrollment periods.

What should I do month by month?

1. 12 to 6 months before: gather your information. List your doctors, prescriptions and pharmacy. Create a my Social Security account at ssa.gov/myaccount and check your work record. If you'll have State Health Plan retiree coverage, log in to ORBIT and watch for the Plan's turning-65 mail.
2. 4 months before: decide on Part B timing. If you or your spouse are still working with job-based coverage, ask the employer's benefits office whether that plan pays first and whether you should delay Part B. See working past 65.
3. 3 months before: sign up. Your IEP opens. Sign up for Part A and Part B with Social Security, unless you're enrolled automatically or are delaying Part B because of coverage from current work. State Health Plan retirees: the Plan assigns you to its Base Plan about now.
4. 2 to 1 months before: choose your coverage. Decide between Original Medicare with a Medigap policy and a Part D plan, or a Medicare Advantage plan sold in your county. State Health Plan retirees choose among the Plan's Medicare options between 90 and 31 days before their Medicare start; 30 days before, the choice is locked.
5. Your birthday month: coverage starts. If you signed up early, Medicare starts the first of the month. Your 6-month Medigap open enrollment period starts when your Part B does.
6. 3 months after: your IEP ends. This is the last month to sign up without waiting, and your first chance to join a Part D or Medicare Advantage plan ends, unless you have other creditable coverage.
7. 6 months after Part B starts: your Medigap window closes. North Carolina has no birthday rule or yearly switching right, so this is your one guaranteed chance at 65 or older to buy any Medigap policy without health questions.

What if I already get Social Security?

If you get Social Security or Railroad Retirement benefits at least 4 months before you turn 65, you're enrolled in Part A and Part B automatically, and your Medicare card arrives about 3 months before your coverage starts. The Part B premium ($202.90 a month for most people in 2026) is usually taken out of your benefit. If you have job-based coverage from current work and want to delay Part B, follow the instructions that come with the card.

About 93% of North Carolina's state and local government workers are covered by Social Security on their jobs (Congressional Research Service, 2023 data), so most North Carolina teachers and public employees qualify for premium-free Part A and follow the same rules as private-sector workers. If you retired early and already claimed Social Security, expect your card in the mail. If you're waiting to claim, you must sign up yourself.

How do I sign up?

Social Security handles Medicare sign-up. You can:

• Apply online at ssa.gov/medicare/sign-up.
• Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
• Visit a Social Security office. Find the nearest with Social Security's office locator.

State Health Plan retirees turning 65

The State Health Plan for Teachers and State Employees covers eligible retirees of TSERS, the Consolidated Judicial Retirement System and the Legislative Retirement System. Once you're on Medicare, the Plan offers three Medicare-primary options: two group Medicare Advantage PPO plans with drug coverage, which the Plan calls the Base Plan and the Enhanced Plan, and the 70/30 Plan, which pays after Original Medicare.

• You're assigned to the Base Plan about 90 days before your Medicare becomes primary. Between 90 and 31 days before, you can choose a different option; 30 days before, you're locked in.
• Parts A and B must be in effect to enroll in the Base or Enhanced Plan. Without them, you're placed on the 70/30 Plan. On the 70/30 Plan without Part B, the Plan pays as if you had Part B, so you'd pay the difference.
• Don't join an outside Medicare Advantage or Part D plan without checking with the Plan. Doing so removes you from its group Medicare Advantage plan and moves you to the 70/30 Plan. The Plan also warns members not to give or confirm personal information to callers, because you could end up enrolled in a plan you don't want.
• A Medicare-eligible spouse on your coverage also needs Parts A and B, or is placed on the 70/30 Plan.
• What you pay for retiree coverage depends on your hire date and service: none, half or all of the premium. If you were first hired on or after January 1, 2021, you aren't eligible for retiree health coverage. LGERS retirees' coverage, if any, depends on the former employer.

The Plan's Open Enrollment for 2027 ran October 12 to 30, 2026; after you're settled at 65, plan changes happen in the Plan's own window, not Medicare's. See State Health Plan retirees and Medicare and State Health Plan vs. individual Medicare plans.

What if I'm still working at 65?

If you or your spouse are still working and have health coverage from that job, the employer's size decides who pays first. With 20 or more employees, the job-based plan pays first and you can usually delay Part B without a penalty; you get 8 months to sign up after the job or the coverage ends. With fewer than 20, Medicare usually pays first. COBRA and retiree coverage don't count as coverage from current work. If you still work for the State, the State Health Plan recommends taking Part A and delaying Part B while you're an active employee. See working past 65.

When should I buy Medigap?

Your best chance is your Medigap open enrollment period: the 6 months starting the first month you're both 65 and enrolled in Part B. During it, any company selling Medigap in North Carolina must sell you any policy it offers, without health questions. After it ends, North Carolina has no birthday rule and no annual right to switch, so a company can usually review your health and decline you, unless a guaranteed-issue right applies (for example, your Medicare Advantage plan leaves your area).

North Carolina law adds some protections when you buy (N.C.G.S. Chapter 58, Article 54):

• 30-day free look: you can return a new policy within 30 days for a full refund (G.S. 58-54-30).
• Age-based pricing disclosed: companies may choose how to price, but an attained-age policy, whose premium rises as you age, must say so and show a 10-year illustration (G.S. 58-54-25).
• Pre-existing conditions: a policy can't exclude a pre-existing condition for more than 6 months (G.S. 58-54-10), and the wait is shortened or waived if you had prior creditable coverage.

If you choose Medicare Advantage first, you have a 12-month trial right to switch back to Original Medicare and buy Medigap with a guarantee. See Medigap in North Carolina and Medigap vs. Medicare Advantage in North Carolina.

How many plans can I choose from?

It depends heavily on your county. For 2027, CMS lists 106 Medicare Advantage plans open to everyone in North Carolina from 16 companies. A resident of Wake County can choose from 35 of them and a resident of Mecklenburg County from 50, while Carteret County has 11. North Carolina is its own Part D region, with 11 standalone Part D plans from 6 companies statewide. Check your county on the county pages, and see Medicare Advantage in North Carolina and Part D in North Carolina.

If you choose Original Medicare, join a standalone Part D plan during your IEP unless you have other creditable drug coverage, such as from a current employer, the VA, TRICARE or an Indian health program. Otherwise you may pay a late enrollment penalty for as long as you have Part D.

Can I get help paying costs?

Veterans and military retirees

North Carolina is home to Fort Bragg, Camp Lejeune, Seymour Johnson Air Force Base and Marine Corps Air Station Cherry Point, and to many military retirees. If you have TRICARE, you need Part A and Part B to keep TRICARE For Life once you're eligible for Medicare. VA health care and Medicare are separate; you can have both, and many veterans keep Part B so they can see providers outside the VA. See military, veterans and TRICARE in North Carolina.

Your turning-65 checklist

1. Mark your IEP dates. Put the first and last months on your calendar, plus the end of your 6-month Medigap window.
2. Sign up for Part A and Part B. Apply with Social Security, or confirm you're enrolled automatically.
3. Check your other coverage. Call your employer, the State Health Plan, your former local government employer, the VA or TRICARE.
4. Choose your coverage. Original Medicare with Medigap and Part D, or Medicare Advantage, or your State Health Plan option.
5. Check for help paying. See if you qualify for MQB or Extra Help.
6. Keep your papers together. Your Medicare card, letters, creditable coverage notices and any State Health Plan confirmations.

When you're ready to look at coverage, see plans for your ZIP code, or you can request a call from a licensed insurance agent to go over plans from the companies they work with. Moving here at 65? See moving to North Carolina with Medicare. See also Medicare eligibility and Medicare basics.

Sources

• Medicare.gov — When does Medicare coverage start?
• Medicare.gov — Sign up for Medicare
• Social Security — Sign up for Medicare
• Social Security — Office locator
• Medicare.gov — Avoid late enrollment penalties
• Medicare.gov — When can I buy Medigap?
• North Carolina General Assembly — G.S. Chapter 58, Article 54 (free look, rating disclosure, pre-existing conditions)
• North Carolina General Assembly — G.S. 58-54-45, Medigap by reason of disability
• State Health Plan — Retiree presentation (turning 65, Base Plan assignment, Parts A and B, outside plans)
• State Health Plan — 2027 plan comparison for Medicare-primary members
• State Health Plan — Retiree health benefits fact sheet (eligibility by hire date)
• NC Retirement Systems — Health benefit coverage for other retirement systems (LGERS)
• Congressional Research Service — Social Security Coverage of State and Local Government Employees (R46961)
• NCDHHS — MA-2252, Non-MAGI Medicaid income and reserve limits (effective April 1, 2026)
• NC Medicaid — How to apply
• NC Medicaid — Medicaid health plans and programs (NC Medicaid Direct)
• TRICARE — TRICARE For Life
• CMS — CY2027 Medicare Advantage and Part D Landscape files

Frequently asked questions

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