North Carolina residents have several free places to get Medicare help, and each does a different job. Here's what Medicare, SHIIP, licensed agents, insurance companies and Social Security can and can't do for you.
Written by the licensed agents at Health Plans of NC, an insurance agency authorized by Blue Cross NC.
Medicare's Open Enrollment runs October 15 through December 7, and for many North Carolina residents it's the busiest decision season of the year. Mailboxes fill with plan brochures, TV ads promise extra benefits, and the phone rings more often. The good news is that you don't have to pay anyone to help you sort through it. Several free sources of help are available, and each has a different role.
This guide explains who does what, so you can pick the right help for your question and avoid anyone who isn't acting in your interest.
The federal Medicare program runs its own help line at 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, every day except some federal holidays. Representatives can explain coverage rules, look up plans in your area, and help you enroll in a Medicare Advantage or Part D plan.
Medicare.gov's Plan Finder lists every Medicare Advantage, Part D and Medigap option offered at your ZIP code. You can enter your prescriptions and pharmacies to estimate yearly drug costs. It's the most complete list available, because it isn't limited to the companies any one person or business works with.
The Plan Finder also shows each plan's star rating, Medicare's 1-to-5 score for quality and member experience. If you create a Medicare.gov account, you can save your drug list and pharmacies so it's quicker to compare plans again next year.
The Seniors' Health Insurance Information Program (SHIIP) is part of the North Carolina Department of Insurance. Trained volunteers in all 100 counties offer one-on-one Medicare counseling at no charge. You can reach SHIIP at 855-408-1212 or search for a local counselor by county on the NC Department of Insurance website.
SHIIP counselors are not licensed insurance agents, and they don't sell or endorse any product, plan or company. That makes SHIIP a good first stop for neutral explanations, help understanding a notice, or questions about programs that lower costs. Appointments can fill up during Open Enrollment, so call early. SHIIP can also help with Medicare billing and claims questions, appeals, and fraud concerns.
A licensed agent can compare plans, check whether your doctors and prescriptions are covered, and complete your enrollment. Agents who sell Medicare Advantage and Part D plans are paid by the insurance companies they represent, so you don't pay the agent a fee. Your premium is the same whether you enroll through an agent, through Medicare, or directly with the plan.
Ask which companies they represent. Most agents and agencies work with a set group of insurers rather than every plan in your area. Medicare rules require them to tell you this, so ask how many organizations and plans they can offer.
Expect a Scope of Appointment. Before a sales meeting about Medicare Advantage or Part D plans, agents must document which types of products you've agreed to discuss. They can't use that meeting to pitch other products you didn't ask about.
Check the license. You can verify an agent's North Carolina license through the NC Department of Insurance. Agents who sell Medicare plans must also complete annual training and certification with each company they represent.
Some agents also handle Medicare Supplement (Medigap) policies, which aren't on the same enrollment calendar as Medicare Advantage. That's useful if you're weighing both options.
Each insurance company has a member services line and a sales line for its own plans. The plan is the best source for questions about its network, drug formulary, prior authorization rules, and your claims. It can't tell you whether a different company's plan would suit you better.
If a service or drug is denied, the plan's member services line can explain how to file an appeal. Your plan's Evidence of Coverage spells out its full rules.
If you already have a plan, check the Annual Notice of Change it sends each fall. It lists what's changing for next year, such as premiums, copays, drug coverage and the provider network.
Signing up for Medicare Parts A and B goes through the Social Security Administration at SSA.gov or 1-800-772-1213. Social Security also takes applications for Extra Help, the federal program that lowers Part D premiums and drug copays for people with limited income and resources.
Medicare Savings Programs, which can help pay Part B premiums, are handled through NC Medicaid and your county Department of Social Services. SHIIP counselors can help you work out whether you might qualify for either program before you apply.
Medicare won't call to sell you a plan. Medicare doesn't make unsolicited sales calls or ask for your Medicare number over the phone.
Guard your Medicare number. Treat it like a credit card number. Share it only with people you've chosen to work with, such as your doctor, pharmacy, plan or an agent you contacted.
Be wary of unsolicited visits and calls. Medicare's marketing rules bar agents from showing up at your door uninvited or calling you out of the blue to sell a plan.
Ignore urgent pressure. Nobody should tell you you'll lose Medicare unless you act today. Open Enrollment runs until December 7, and you can check any claim with 1-800-MEDICARE or SHIIP.
Check who's behind an ad. TV ads and mailers that look official often come from private companies, not Medicare. Find out who's making an offer before you share personal information.
If you suspect fraud, report it to 1-800-MEDICARE or contact SHIIP for help.
"What are all my choices?" Start with Medicare.gov's Plan Finder or 1-800-MEDICARE.
"I want a neutral explanation." Call SHIIP.
"Help me compare and enroll." A licensed agent can compare the plans they offer and complete the paperwork, at no cost to you.
"How do I sign up for Parts A and B, or get Extra Help?" Contact Social Security.
"What does my current plan cover?" Call your plan's member services line.
Many people use more than one. For example, some check the full list on Medicare.gov, talk through the trade-offs with a SHIIP counselor, and then enroll with a licensed agent. For the basics of the choice itself, see our guide to Original Medicare vs. Medicare Advantage in NC.
Read your Annual Notice of Change. Note any change in premiums, copays, drug coverage or doctors.
Make a list. Write down your doctors, prescriptions and dosages, and preferred pharmacies before you talk to anyone.
Compare your options. Use the Plan Finder, or ask SHIIP or a licensed agent to walk through them with you. Our Medicare pages by county show what's offered locally.
Enroll by December 7. Changes made during Open Enrollment take effect January 1.
We do not offer every plan available in your area. Currently we represent 10 organizations which offer 56 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
This article is for general information and is not insurance, legal, or tax advice. Contact a licensed agent or the Health Insurance Marketplace for guidance specific to your situation.