According to Robert Simm, a licensed broker at GenerationHealth, 38 Medicare Advantage plans are open to Pender County residents with Part A and Part B for 2027. 28 of them have a $0 monthly plan premium, 31 are rated 4 stars or higher, and the lowest in-network out-of-pocket maximum is $3,900, against Medicare’s $9,850 cap. Check your doctors and hospital in each plan’s network before you choose. Robert Simm, licensed NC health insurance broker, NPN #10447418, at (828) 761-3326.
2027 Medicare Advantage at a glance
Medicare Advantage plans in Burgaw, NC for 2027
GenerationHealth’s 2027 Pender County data shows 38 Medicare Advantage plans open to anyone with Part A and Part B in Burgaw and the rest of Pender County. 28 have a $0 monthly plan premium, 31 are rated 4 stars or higher by Medicare, and the lowest out-of-pocket maximum is $3,900.
38Medicare Advantage plans
28with a $0 monthly premium
31rated 4 stars or higher
Not counted above: 26 Special Needs Plans for people with Medicaid or certain chronic conditions.
Out-of-pocket maximums by plan type
The out-of-pocket maximum is the most you pay for covered in-network care in a year. Medicare caps it at $9,850 for 2027. Across Pender County the average plan sets it at $7,945.
Plan type
Plans
Average maximum
Lowest available
HMO
6
$7,150
$4,700
HMO-POS
9
$7,483
$3,900
PPO
23
$8,333
$5,200
PPO figures are the in-network maximum. In- and out-of-network costs combined are capped at up to $14,800.
Which plans give you the most flexibility?
PPO — most flexible (23 plans). See doctors and hospitals outside the network at a higher cost, usually without a referral. Good if you travel, split time between homes, or want to keep a specialist who is not in every network.
HMO-POS — some flexibility (9 plans). Built around a network, but covers some services out of network, usually at a higher cost. Referrals are often still required.
HMO — least flexible, often lowest costs (6 plans). Covers care inside the network only, except emergencies and urgent care, and usually needs referrals. In Pender County, HMOs have the lowest average out-of-pocket maximum of any plan type ($7,150).
Does the plan include Novant Health?
Novant Health runs hospitals in Pender County, including Novant Health Pender Medical Center, Novant Health New Hanover Regional Medical Center, and Novant Health Cape Fear Hospital. Each health system contracts plan by plan, so two plans from the same insurance company can treat the same hospital differently. Check the exact plan before you enroll, and check again every fall because networks change for January 1.
Each system publishes the Medicare plans it accepts: Novant Health’s Medicare plan list. Those lists can lag behind, so confirm with the plan too.
Source: GenerationHealth analysis of CMS 2027 Medicare Advantage plan data for Pender County (premiums, star ratings and out-of-pocket maximums), updated 2026-10-12. Counts exclude Special Needs Plans unless noted. Plans and networks vary by ZIP code; confirm details with the plan, Plan Match, or Medicare.gov.
Who to Call in Pender County
The Part Medicare.gov Can’t Answer
I call the billing office. Medicare.gov lists which plans a hospital accepts — it can’t tell you whether your specific cardiologist is taking new patients on that plan in January.
Which Novant Health facilities serve Pender County?
Novant Health is the health system on record for Pender County, and 3 facilities in the county carry its name — which does not mean they all sit on the same plan contracts.
01
Novant Health Pender Medical Center
02
Novant Health New Hanover Regional Medical Center
03
Novant Health Cape Fear Hospital
Service lines in Pender County
Cancer Care (Zimmer Cancer Institute) Heart Care (Novant Health Heart & Vascular Institute) Emergency Services Primary Care Orthopedics
💡 Novant Health network notes
Novant Health’s published Medicare list for North Carolina names AARP Medicare Plans from UnitedHealthcare, Aetna Medicare HMO/PPO, Blue Medicare, Cigna Medicare Advantage, Devoted Health, HealthTeam Advantage, Humana Medicare Advantage, UnitedHealthcare, two institutional special-needs plans (Liberty Advantage, Longevity Health) and three PACE programs. Novant states the list is for reference only, is subject to change, and that it may participate in some but not all products a health plan offers. Verified 2026-09-02.
One Novant hospital is treated differently from the rest. Novant Health states that all its providers are in-network with Cigna Medicare Advantage except Novant Health New Hanover Medical Center, and that its facilities and physicians are contracted with UnitedHealthcare except Novant Health New Hanover Regional Medical Center. So a Cigna or UnitedHealthcare Medicare Advantage plan can cover Novant across the state and still not cover the Novant hospital in Wilmington. Verified 2026-09-02.
Novant Health participates in all of Aetna’s Medicare Advantage plans but is out of network with one: Aetna Medicare Prime HMO. Seeing “Aetna Medicare Advantage” on a plan list is therefore not enough — the specific product matters. PACE of the Southern Piedmont carries a similar carve-out, excluding Novant Health New Hanover Regional and Novant Health Pender Medical Center. Verified 2026-09-02.
A Novant price estimate is not the whole bill. Novant states that its estimator reflects only Novant Health facility fees and does not include Novant Health physician or ancillary provider fees — naming anaesthesia as an example — and that its published hospital charges are hospital charges only, excluding physician fees and other non-hospital facility charges. Facility and professional fees are separate at Novant, so an estimate for the room is not an estimate for the people in it. That is a budgeting gap rather than a coverage risk — at an in-network facility federal law caps the ancillary specialties at your in-network cost-sharing. The coverage risk at Novant is the facility question above: whether the specific Novant hospital you would use is in your plan, which for New Hanover Regional on Cigna or UnitedHealthcare it is not. Verified 2026-09-02.
Novant Health runs three separate insurance customer-service desks — one for Novant Health, one for Novant Health New Hanover Regional Medical Center, and one for Community Hospital of Stokes. Where a system splits its billing support that way, it usually splits its contracts too, which is exactly what the New Hanover carve-outs show. Verified 2026-09-02.
The numbers
What does the data actually show for this Medicare question?
Original Medicare
Medicare Advantage
Network
Any provider taking Medicare nationwide
Pender County contracted providers
Out-of-pocket cap
Set by Medigap (very low)
$9,850 in-network max (2027)
Monthly premium
Higher — Medigap + Part D + Part B
Lower — often $0 above Part B
Referrals required
No
HMO yes; PPO usually no
Drug coverage
Separate Part D plan
Usually built in (MAPD)
Extras (dental/vision/hearing)
Not included
Often included
Best fit
Predictable bills, frequent specialist use
Healthy retiree, wants low premium
2027 Medicare numbers
What are the 2027 Medicare numbers for Pender County residents?
$202.90
Part B premium per month
2026 standard rate (CMS has not published 2027 yet). Higher with IRMAA based on income.
$283
Part B annual deductible
2026 figure. You pay this before Medicare covers 80% of outpatient care.
$9,850
MA in-network out-of-pocket max
2027 cap on in-network Medicare Advantage spending.
$2,400
Part D out-of-pocket cap
2027 cap on prescription costs — but tier placement still matters.
10 minutes. You'll know where you stand.
Rob Simm · Licensed NC Medicare Broker · NPN #10447418
Licensed in NC · No pressure · Your data never sold
What is Plan Match?
✓ Snap a photo of your meds and providers — no typing
✓ Every plan at your ZIP, ranked by your costs
✓ Just date of birth and ZIP code to start
✓ Free, private, results in 3 minutes
5 mistakes Pender County residents make
Avoid these before you enroll.
Three are specific to Pender County. Two apply to every NC resident. All five are fixable — if you catch them before enrollment.
Last reviewed: 2026-10-12 · Robert Simm, Licensed NC Medicare Broker, NPN #10447418
⚠ Pender County mistakes I see every AEP
Mistake 01 Pender-specific
Picking a Medicare Advantage plan that drops Novant Health mid-year.
Why it hurtsMA carrier contracts with Novant Health can change inside a plan year. Pender County residents have lost in-network access to specialists they relied on, with no prorated premium refund.
What to doBefore enrolling, confirm contract dates with the carrier directly. PPOs and Medigap plans both reduce this risk.
Mistake 02 Pender-specific
Assuming Medigap won’t cover Novant Health.
Why it hurtsMedigap plans are not networks. As long as the doctor accepts Original Medicare, they accept Medigap. Some Pender residents pay $150+ per month extra on an HMO they didn’t need.
What to doIf keeping Novant Health access matters, Medigap Plan G or Plan N gives you the broadest stable access. No referrals, no network worries.
Mistake 03 Pender-specific
Attending hotel-ballroom Medicare seminars instead of meeting a Pender-based broker.
Why it hurtsMulti-county seminars are licensed agent recruiting funnels — the follow-up agent is paid more for certain carriers, so you leave with the plan that pays them best, not the plan that fits Pender County.
What to doMeet a Pender County–based broker in person, or have them come to your home. One-on-one always beats ballroom.
Mistake 04 NC-wide
Missing the Part B late enrollment penalty if you’re working past 65.
Why it hurtsIf you don’t sign up for Part B during your Initial Enrollment Period and don’t have qualifying employer coverage, you owe a 10% penalty for every 12 months you delayed — for the rest of your life. A 3-year delay = 30% higher Part B premium forever.
What to doIf you’re working past 65, get a Certification of Creditable Coverage from HR before you stop work. That document protects you from the penalty.
Mistake 05 NC-wide
Missing your 6-month Medigap open enrollment window.
Why it hurtsYou have one 6-month window after you turn 65 and enroll in Part B to buy any Medigap plan with no medical underwriting. Miss it and NC insurers can deny you coverage — or charge dramatically more — if you develop a health condition. This is the single most expensive mistake I prevent.
What to doUnderstand your window the day you turn 65. Even if you pick MA now, know the Medigap door closes 6 months later. Call me before that window closes.
The difference
What’s the difference between doing it alone and working with an independent NC broker?
What you need
Doing it alone
Robert Simm — NC #10447418
Plans you can compare
Whatever Medicare.gov lists, no NC context
Every major NC carrier, filtered to your situation
Pender County network knowledge
Generic federal directories, often 6 months stale
Direct contract verification with each carrier
2027 numbers applied to your budget
Generic rules — no IRMAA math, no spousal coordination
Run with your real income and household
Part D formulary check
Manual entry per drug, per plan
I pre-check every prescription on every eligible plan
Same person next year
Different agent every call
Same broker, same answer, every AEP
Cost
$0 (just your time and risk)
$0 — paid by carrier
⚠ Penalty & Deadline Warning
If you delay Medicare Part B without creditable employer coverage, you’ll pay a 10% lifetime penalty for every 12 months you delayed — added to your Part B premium for the rest of your life. The 2026 standard Part B premium is $202.90/month, so a 24-month delay raises it to roughly $243/month, permanently. Your Initial Enrollment Period is a 7-month window: 3 months before your 65th birthday month, the birthday month itself, and 3 months after.
💡 Broker Tip · Provider Verification
Before you enroll in any Medicare Advantage plan, give me the names of every doctor you see — primary care, cardiologist, oncologist, endocrinologist — and I’ll call each one’s billing office directly to verify they accept the plan. Provider directories on Medicare.gov run 4–6 months stale, and “in-network” on the directory doesn’t always mean the provider is accepting new patients on that plan.
Common questions
Frequently asked questions
How many Medicare Advantage plans are available in Burgaw, NC for 2027?
Pender County has 38 Medicare Advantage plans for 2027 that anyone with Medicare Part A and Part B can join. 28 of them have a $0 monthly plan premium and 31 are rated 4 stars or higher. There are also 26 Special Needs Plans for people who have Medicaid or certain chronic conditions.
What Medicare Advantage plans in Burgaw, NC have the lowest out-of-pocket expenses?
The lowest in-network out-of-pocket maximum on a 2027 plan in Pender County is $3,900, and the average across all 38 plans is $7,945. By plan type: HMO plans start at $4,700 (average $7,150); HMO-POS plans start at $3,900 (average $7,483); PPO plans start at $5,200 (average $8,333). Medicare caps the in-network maximum at $9,850 for 2027. A low maximum protects you in a bad year; your copays decide what a normal year costs.
Which Medicare Advantage plans in Burgaw, NC are priced well?
28 of the 38 plans in Pender County have a $0 monthly plan premium for 2027. You still pay your Part B premium. A $0 premium is not automatically the cheapest choice: compare the out-of-pocket maximum (as low as $3,900 here) and the copays for the doctors and drugs you actually use.
Which Medicare Advantage options in Burgaw, NC have good flexibility?
23 PPO plans let you see doctors outside the network at a higher cost, usually without referrals. In-network costs are capped at your plan’s maximum; in- and out-of-network costs combined are capped at up to $14,800. 9 HMO-POS plans use a network but cover some services out of network. 6 HMO plans cover care inside the network only, except emergencies and urgent care, and usually need referrals for specialists.
What Medicare Advantage plans in Burgaw, NC are rated the best?
31 of the 38 plans in Pender County carry a 2027 Medicare star rating of 4 stars or higher. Star ratings measure quality and member experience across the whole plan, not whether your doctors are in network, so check the network first.
Which Medicare Advantage plans in Burgaw, NC include Novant Health?
Novant Health runs hospitals in Pender County, and each health system contracts plan by plan, so two plans from the same insurance company can treat the same hospital differently. Check the specific plan before you enroll. With an HMO, non-emergency hospital care is covered in network only; an HMO-POS or PPO can also cover an out-of-network hospital, at a higher cost.
When can I change my Medicare Advantage plan in Burgaw, NC?
During Medicare’s Annual Enrollment Period, October 15 to December 7, 2026, for coverage starting January 1, 2027. If you are already in a Medicare Advantage plan, you get one more change from January 1 to March 31, 2027. Turning 65, moving, or losing other coverage can open a Special Enrollment Period.
Does this answer change if I live in Pender County specifically?
Yes — carrier networks, Medigap rates, and Medicare Advantage plan availability all vary by zip code. The figures and plan recommendations on this page are calibrated to Pender County, NC.
How do I verify any Medicare agent is licensed in NC?
No. Brokers are paid by the insurance carrier when you enroll, and the commission is identical whether you enroll directly, through Medicare.gov, or through a broker.
It pays to talk to the right broker
Does it matter which Medicare carrier you choose?
It doesn’t — because I get paid by the insurance carrier to manage your plan. Most call centers get paid more to steer your business toward certain carriers based on volume and contracts. The only thing I’m optimizing for is making sure you’re covered correctly when you actually need it. That’s what keeps people coming back. And referring their neighbors.
Nearby counties
Medicare Advantage in the counties next to Pender
Moving, or splitting time between two counties? Plans are approved county by county, so compare the county you will actually live in.
Compliance disclaimer: We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE (1-800-633-4227) for information on all of your options. GenerationHealth.me and Robert Simm are independent agents not affiliated with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent may contact you. Information on this page is for educational purposes only and should not be considered legal or financial advice. Plan availability, premiums, and benefits vary by location and carrier.
Licensed in North Carolina, Texas & Georgia·NPN 10447418·AHIP Certified for Plan Year 2027
12+ Years · 500+ Families Served · Your Data Never Shared
Robert Simm is the licensed insurance broker behind GenerationHealth (generationhealth.me), an independent brokerage serving Medicare, ACA Marketplace, and supplemental health coverage across North Carolina, Texas, and Georgia under NPN 10447418.
Rob works directly with every client — no call center, no lead handoff. Plan comparisons on this site are built from CMS Plan Benefit Package data compiled by GenerationHealth, not from carrier marketing material.
GenerationHealth is not connected with or endorsed by the United States government or the federal Medicare program. 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 or 1–800–MEDICARE, 24 hours a day / 7 days a week, or consult www.medicare.gov to get information on all of your options.
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