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Independent Medicare Broker
Medicare · Wake NC · 2026
Wake County Medicare Advantage Plans — 2026 Data Report
Real numbers. Real Wake County context.
Where are you in your Medicare journey?
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01 · New to Medicare
I’m turning 65 soon and haven’t enrolled yet
→ 15-minute enrollment walkthrough for Wake County
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02 · Already Enrolled
I’m on Medicare and want to compare 2026 plans
→ AEP review: which plans keep your doctors
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03 · Helping Family
I’m helping my parent or spouse choose
→ Family call — I talk with both of you at once
Prefer to just talk? (828) 761-3326
• Robert Simm · Licensed in NC, TX, GA · NPN #10447418
• Independent · All Carriers
• No SSN Required
• $0 Cost to Compare
• 500+ NC Families Helped
The direct answer
Direct answer — Wake County, North Carolina · 2026
GenerationHealth’s CY2026 Wake County, NC data shows 77 Medicare Advantage plans available for 2026, offered by 11 carriers — Aetna Medicare, Alignment Health Plan, Blue Cross and Blue Shield of North Carolina, Experience Health, HealthSpring, Humana, Liberty Medicare Advantage, Longevity Health Plan, PruittHealth Premier, UnitedHealthcare, Wellcare. 62 of those plans (81%) have $0 monthly premiums, and the average premium across all plans is $21/month. But premium alone doesn’t tell you what you’ll actually spend. Estimated annual out-of-pocket costs in Wake County range from $340 to $5,640 depending on your medications, providers, and how often you use care. Robert Simm, licensed NC health insurance broker, NPN #10447418, at (828) 761-3326.
Who to Call in Wake 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.
Phone · (828) 761-3326
NPN · #10447418
Licensed · NC, TX, GA · AHIP certified
Verify · NAIC SBS lookup
Cost · $0 — carriers pay the commission
Office · 2731 Meridian Pkwy, Durham NC 27713
THE BROKER'S ANSWER
Wake County has the most carrier options in the state, which sounds like a good thing until you realize it makes choosing harder. You’ve got UNC Health, WakeMed, and Duke Raleigh all serving the same ZIP codes with different carrier contracts. The plan that covers your UNC oncologist might not cover your WakeMed cardiologist. I cross-check every provider across every plan before you pick one.
— Rob Simm, Licensed NC Medicare Broker · (828) 761-3326
The numbers
Wake County Medicare Advantage plans, ranked by typical annual cost
| Plan | Carrier | Premium | Medical deductible | Drug deductible | Typical annual | Range (low – high) |
|---|---|---|---|---|---|---|
| Alignment Health Platinum (HMO) H5296-003-0 |
Alignment Health Plan | $0/mo | — | $0 | $340 | $141 – $916 |
| Alignment Health Platinum Select (HMO) H5296-010-0 |
Alignment Health Plan | $0/mo | — | $225 | $367 | $158 – $948 |
| Humana Gold Plus H1036-335 (HMO-POS) H1036-335-2 |
Humana | $0/mo | — | $250 | $425 | $139 – $1,155 |
| Alignment Health smartHMO (HMO) H5296-006-0 |
Alignment Health Plan | $0/mo | — | $615 | $436 | $207 – $1,057 |
| Humana Gold Plus H1036-233 (HMO-POS) H1036-233-0 |
Humana | $0/mo | — | $350 | $441 | $164 – $1,230 |
| HumanaChoice H5525-050 (PPO) H5525-050-0 |
Humana | $0/mo | — | $350 | $456 | $169 – $1,260 |
| HealthSpring Preferred Select (HMO) H9725-014-0 |
HealthSpring | $0/mo | — | $295 | $471 | $256 – $1,082 |
| HumanaChoice H5525-083 (PPO) H5525-083-0 |
Humana | $0/mo | — | $450 | $490 | $183 – $1,324 |
| HumanaChoice Giveback H5525-035 (PPO) H5525-035-0 |
Humana | $0/mo | — | $450 | $496 | $189 – $1,330 |
| HealthSpring Preferred (HMO) H9725-009-4 |
HealthSpring | $0/mo | — | $295 | $501 | $261 – $1,142 |
What will prescriptions cost on the top Wake County plans?
| Drug | Humana Humana Gold Plus H1036-335 (HMO-POS) |
Alignment Health Plan Alignment Health Platinum (HMO) |
Alignment Health Plan Alignment Health Platinum Select (HMO) |
|---|---|---|---|
| apixaban 5 MG Oral Tablet [Eliquis] | $47/mo Tier 3 |
$45/mo Tier 3 |
$45/mo Tier 3 |
| atorvastatin 20 MG Oral Tablet | $0.00/mo Tier 1 |
$5/mo Tier 6 |
$5/mo Tier 6 |
| empagliflozin 25 MG Oral Tablet [Jardiance] | $47/mo Tier 3 |
$45/mo Tier 3 |
$45/mo Tier 3 |
| lisinopril 10 MG Oral Tablet | $0.00/mo Tier 1 |
$0.00/mo Tier 6 |
$0.00/mo Tier 6 |
| metformin hydrochloride 500 MG Oral Tablet | $0.00/mo Tier 1 |
$5/mo Tier 6 |
$5/mo Tier 6 |
What dental, vision and hearing benefits are included in Wake County plans?
| Plan | PCP copay | Specialist | OTC | Dental max | Vision | Hearing aid | Fitness |
|---|---|---|---|---|---|---|---|
| Alignment Health Platinum (HMO) Alignment Health Plan |
$0 | $15 | $40/qtr | $2,000 | $300 | $1,750 | SilverSneakers |
| Alignment Health Platinum Select (HMO) Alignment Health Plan |
$0 | $20 | $40/qtr | $2,000 | $300 | $1,750 | SilverSneakers |
| Humana Gold Plus H1036-335 (HMO-POS) Humana |
$0 | $5 | $0/qtr | $2,500 | $250 | $699 | Go365 |
| Alignment Health smartHMO (HMO) Alignment Health Plan |
$0 | $30 | $40/qtr | — | $100 | — | SilverSneakers |
| Humana Gold Plus H1036-233 (HMO-POS) Humana |
$0 | $20 | —/qtr | — | $400 | $799 | Go365 |
Which Wake County doctors and hospitals are in network?
Wake County has three large systems in play. WakeMed operates Raleigh Campus, Cary Hospital, North Hospital and a wide physician network. UNC Health runs UNC REX in Raleigh and facilities in Holly Springs and Apex. Duke Health draws Wake residents east to Durham for specialist and tertiary care.
Three systems means three separate network checks, and Wake residents routinely use more than one. It is entirely normal here to have a WakeMed primary care doctor, a UNC REX surgeon and a Duke specialist — and a plan that covers all three is not the default.
Which specific 2026 plans include WakeMed, UNC Health and Duke Health in network changes by carrier and by plan, and carriers update their directories through the year. Rather than publish a list that goes stale, I check it live: call and I will verify your doctors against each carrier’s current 2026 directory before you enrol.
Wake also grows fast, and a lot of residents moved here recently and kept doctors elsewhere. If that is you, say so — it usually points toward a PPO.
| Specialty | In-network providers (county) |
|---|---|
| Primary care (including NPs/PAs) | 193 |
| Endocrinology | 1 |
| Orthopedics | 9 |
| Mental health | 23 |
| Oncology | 1 |
| Other specialties | 118 |
2026 Medicare numbers
What are the 2026 Medicare numbers for Wake County residents?
$202.90
Part B premium per month
2026 standard rate. Higher with IRMAA based on income.
$283
Part B annual deductible
You pay this before Medicare covers 80% of outpatient care.
$9,250
MA in-network out-of-pocket max
2026 cap on in-network Medicare Advantage spending.
$2,100
Part D out-of-pocket cap
No more catastrophic Rx costs in 2026 — but tier placement still matters.
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5 mistakes Wake County residents make
Avoid these before you enroll.
Three are specific to Wake County. Two apply to every NC resident. All five are fixable — if you catch them before enrollment.
Last reviewed: 2026-06-02 · Robert Simm, Licensed NC Medicare Broker, NPN #10447418
Mistake 01 Wake-specific
Picking an MA plan that drops WakeMed Heart & Vascular halfway through the plan year.
Why it hurtsWakeMed contracts shift between MA carriers more often than UNC or Duke. Wake County residents on the wrong plan have had cardiology appointments cancelled and procedures rescheduled.
What to doCall the WakeMed Patient Resource Line and confirm contract dates with each carrier. Or use Medigap, which does not depend on a network contract.
Mistake 02 Wake-specific
Assuming Duke Raleigh and Duke Health Cary are interchangeable with main Duke campus for plan purposes.
Why it hurtsDuke Raleigh Hospital is in-network on different MA contracts than Duke University Hospital. Wake residents have shown up for surgery at Duke Raleigh assuming the prior auth covered both — it didn’t.
What to doGet carrier confirmation per facility, not per “Duke.” When in doubt, choose Medigap and remove the network variable entirely.
Mistake 03 Wake-specific
Buying a Medicare Advantage plan at a hotel seminar in Raleigh without confirming UNC REX coverage.
Why it hurtsUNC REX is a major Wake County system but coverage varies dramatically between MA plans. The hotel-seminar plan often does not cover REX specialists and you find out at your first appointment.
What to doBring your full doctor list to a one-on-one meeting before signing anything. Verify each provider with the carrier.
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 |
| Wake County network knowledge | Generic federal directories, often 6 months stale | Direct contract verification with each carrier |
| 2026 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 about Medicare in Wake County
How many Medicare Advantage plans are available in Wake County in 2026?
GenerationHealth’s CY2026 Wake County, NC data shows 77 plans from 11 carriers (Aetna Medicare, Alignment Health Plan, Blue Cross and Blue Shield of North Carolina, Experience Health, HealthSpring, Humana, Liberty Medicare Advantage, Longevity Health Plan, PruittHealth Premier, UnitedHealthcare, Wellcare) available for 2026.
What is the cheapest Medicare Advantage plan in Wake County?
By estimated annual cost, Alignment Health Platinum (HMO) (H5296-003-0) from Alignment Health Plan comes in around $340/year for a typical 70-year-old beneficiary. That number includes premium, expected medical cost-share, and the average across a common-drug basket — your actual cost depends on what you take and how often you use care.
Are there $0 premium Medicare Advantage plans in Wake County?
Yes — 62 of the 77 available plans (81%) have $0 monthly premiums. Premium isn’t the same as out-of-pocket cost, though, so check the typical-annual-cost column in the table above before picking one on premium alone.
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.
Related Medicare guides
Medicare Enrollment in NC – Complete 2026 Guide
Medicare Plans in North Carolina 2026
2North Carolina Medicare Savings Programs 2026
Medigap Plan G vs Plan N in NC
Medicare Special Enrollment Periods in NC – 2026 Guide
Extra Help / LIS in NC – 2026 Eligibility Guide
Working Past 65 – Medicare Enrollment in NC
Licensed Medicare Agents in North Carolina
Medicare Plans in North Carolina 2026
2North Carolina Medicare Savings Programs 2026
Medigap Plan G vs Plan N in NC
Medicare Special Enrollment Periods in NC – 2026 Guide
Extra Help / LIS in NC – 2026 Eligibility Guide
Working Past 65 – Medicare Enrollment in NC
Licensed Medicare Agents in North Carolina
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