Updated: January 28, 2026
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North Carolina offers 23 Medicare Advantage plans from 11 providers, including HMO, HMO-POS, PPO, PFFS and Regional PPO options. Nine plans have $0 monthly premiums, while costs reach $117 depending on the provider and plan type.
Humana offers top HMO-POS plans at $3 monthly with 4.24 stars, while Wellcare leads PPO options at $31 per month, providing greater flexibility in choosing doctors.
Choosing the right Medicare Advantage plan in North Carolina depends on your health care needs. Consider which doctors and specialists you want to see, the medications you take regularly, and how much you're comfortable spending on monthly premiums and out-of-pocket costs.
Based on CMS star ratings, premiums, MOOP costs and coverage features, we identified the best Medicare Advantage plans in North Carolina. Alignment Health Plan offers the top HMO option with a perfect 5.0 CMS star rating, $0 monthly premium and $3,900 maximum out-of-pocket limit.
Humana leads for HMO-POS plans with a 4.24 star rating, while Wellcare offers PPO coverage with a 3.5 star rating. These providers deliver affordable premiums with comprehensive coverage across the state.
| HMO | Alignment Health Plan | 5.00 | $0 | $3,900 | Alignment Health Platinum (HMO) |
| HMO-POS | Humana | 4.24 | $3 | $6,925 | Humana Gold Plus H1036-335 (HMO-POS) |
| PPO | Wellcare | 3.50 | $31 | $4,201 | Wellcare Assist Open (PPO) |
Medicare Advantage plans cover hospital stays, doctor visits and prescription drugs in one comprehensive package. These private insurance alternatives to Original Medicare must provide the same basic coverage while adding dental, vision and hearing benefits.
Best HMO
CMS Star Rating
Plan Types
Best HMO-POS
CMS Star Rating
Plan Types
Best PPO
CMS Star Rating
Plan Types
North Carolina's HMO Medicare Advantage market has strong quality providers, with star ratings ranging from 3.0 to 5.0 stars and 17 of the 19 available plans earning 4 stars or higher. You'll find 15 plans charging $0 monthly premiums across 7 providers, keeping the median premium at $0. Maximum out-of-pocket costs average $5,338 annually and range from $3,200 to $9,250, giving residents affordable options with strong quality ratings.
| Alignment Health Plan | 5.00 | $0 | $3,900 | 3 | 4.79 |
| Devoted Health | 5.00 | $0 | $6,543 | 3 | 4.42 |
| Cigna HealthCare | 4.00 | $6 | $3,346 | 4 | 4.33 |
| Troy Medicare | 3.00 | $0 | $3,950 | 1 | 4.24 |
| Blue Cross Blue Shield | 4.00 | $0 | $8,876 | 2 | 4.00 |
| Aetna | 4.00 | $24 | $5,631 | 5 | 3.83 |
| Experience Health | 3.50 | $7 | $6,500 | 1 | 3.72 |
With a defined network of local doctors, HMO plans offer consistent care coordination through your chosen primary care physician in North Carolina. You'll need referrals for specialist visits, but these plans have lower premiums and out-of-pocket costs than other options. They're ideal if you value having one doctor manage your overall health and want to keep health care expenses affordable.
Quality stands out among North Carolina's 27 HMO-POS Medicare Advantage plans, with 14 earning 4-star CMS ratings and none falling to 3 stars. Four providers offer these options, and 19 plans cost nothing monthly. Maximum out-of-pocket expenses average $6,701 but range widely from $2,900 to $9,250.
| Humana | 4.24 | $3 | $6,925 | 9 | 4.40 |
| Wellcare | 3.50 | $0 | $4,200 | 1 | 4.25 |
| UnitedHealthcare | 4.01 | $11 | $5,781 | 15 | 4.10 |
| Blue Cross Blue Shield | 4.00 | $21 | $5,311 | 2 | 3.80 |
If you want lower monthly costs than PPO plans but more flexibility than standard HMOs, HMO-POS plans might be your sweet spot. You'll pay less in premiums while gaining the ability to see out-of-network specialists when needed, though those visits cost more. These plans work well for seniors who primarily stick with network providers but appreciate having options for specialized care that isn't available locally. You won't need referrals for out-of-network visits, giving you more control over your healthcare decisions.
North Carolina's 26 PPO Medicare Advantage plans offer more provider choice than HMO options but come with higher costs. Monthly premiums range from $0 to $255 with a median of $0, while out-of-pocket maximums average $6,656 and span from $3,000 to $9,250. Quality remains strong across the state's PPO market, with 14 plans earning 4 or more CMS stars. The breakdown includes 8 plans with 4.5-star ratings, 6 plans with 4 stars, 11 plans with 3.5 stars, and 1 plan with 3 stars.
| Wellcare | 3.50 | $31 | $4,201 | 3 | 5.00 |
| Aetna | 4.50 | $2 | $6,817 | 4 | 4.63 |
| HealthTeam Advantage | 4.00 | $8 | $4,032 | 3 | 4.49 |
| Blue Cross Blue Shield | 4.50 | $48 | $6,300 | 1 | 4.34 |
| UnitedHealthcare | 4.32 | $105 | $4,928 | 6 | 4.32 |
| Cigna HealthCare | 3.00 | $0 | $5,078 | 1 | 4.26 |
| Humana | 3.50 | $13 | $9,250 | 8 | 4.00 |
While PPO plans come with higher premiums, they're best for people who want complete provider freedom without referral requirements. You can see any specialist directly and access out-of-network doctors when needed, though staying in-network saves money. These plans work well if you travel frequently or prioritize unrestricted access to specialized care over lower monthly costs.
Your medical needs, budget and doctor preferences all matter when choosing Medicare Advantage coverage in North Carolina.
Call your doctors and hospitals directly. Ask if they accept your specific Medicare Advantage plan. Same insurer, different networks. Each plan has its own provider list.
A $0 premium plan might cost you $3,000 yearly in copays and deductibles. Calculate your real annual costs by adding medication expenses and specialist visit fees. Some plans charge $50 monthly premiums but save you money through lower out-of-pocket costs.
Search your medications on each plan's formulary before enrolling. Tier 1 drugs cost $5 to $10 per prescription, while Tier 4 drugs can run $100 or more. Some medications require prior authorization, which delays access by several days.
HMOs cost less but lock you into primary care referrals. Need flexibility? HMO-POS plan type let you see out-of-network doctors occasionally. PPOs charge higher premiums but skip the referral requirements entirely, which works better if you travel or see multiple specialists.
Medicare rates plans on a 1-5 star scale. Plans with 4 or 5 stars handle claims faster, offer better customer service and deliver superior health outcomes. Members report higher satisfaction with top-rated plans.
Many North Carolina Medicare Advantage plans include dental, vision, hearing, fitness memberships and over-the-counter allowances. Compare extras based on what you need most for your health situation.
Out-of-pocket maximums cap your annual medical spending at $3,000 to $8,000 depending on the plan. Lower caps mean better financial protection. Higher caps reduce your monthly premium but expose you to larger bills if you need surgery or hospitalization.
Plan type determines Medicare Advantage costs across the Tar Heel State. HMO plans offer the most affordable option with $0 median premiums and $6 average monthly costs, plus they carry the lowest out-of-pocket maximums at $5,338 annually. HMO-POS plans cost more at $19 average monthly but have higher $6,701 MOOP limits, while PPO plans top the spectrum at $28 average monthly premiums with $6,656 out-of-pocket maximums. PPOs charge more because they let you see out-of-network providers and access specialists without referrals.
| HMO | $0 | $6 | $5,338 |
| HMO-POS | $0 | $19 | $6,701 |
| PFFS | $7 | $7 | $7,550 |
| PPO | $0 | $28 | $6,656 |
| Regional PPO | $117 | $117 | $9,250 |
Get answers about how to enroll, what's covered and enrollment timing for Medicare Advantage plans across North Carolina.
Enroll with Medicare Part A and B first, then compare plans on Medicare.gov during Annual Enrollment (Oct. 15 to Dec. 7) or other qualifying periods.
Medicare Advantage plans cover everything Original Medicare does, plus most include prescription drugs and extras like dental, vision and fitness benefits.
Medicare Advantage replaces Original Medicare with bundled coverage from private insurers, while Medicare Supplement (Medigap) works alongside Original Medicare to cover deductibles and copays.
North Carolina offers multiple Medicare Advantage enrollment periods: Oct. 15 to Dec. 7 annually, Jan. 1 to March 31 for current enrollees, and seven months around your 65th birthday.
We analyzed Medicare Advantage plans using a weighted scoring system that considers three main factors:
This scoring system helps you compare plans objectively while accounting for what matters most: what you'll pay and the quality of care you'll receive.
About Mark Fitzpatrick
Mark Fitzpatrick, a Licensed Property and Casualty Insurance Producer, is MoneyGeek's resident Personal Finance Expert. He has analyzed the insurance market for over five years, conducting original research for insurance shoppers. His insights have been featured in CNBC, NBC News and Mashable.
Fitzpatrick holds a master’s degree in economics and international relations from Johns Hopkins University and a bachelor’s degree from Boston College. He's also a five-time Jeopardy champion!
He writes about economics and insurance, breaking down complex topics so people know what they're buying.
