What are the basic Medicare eligibility requirements?

To be eligible for Medicare, you must be at least 65 years old and a U.S. citizen or a permanent legal resident who has lived in the United States for at least five continuous years.

How does my work history affect my Medicare eligibility?

If you have paid Medicare taxes for about 10 years, you typically qualify for premium-free Part A hospital insurance. Those with shorter work histories may still qualify by paying monthly premiums.

Can individuals under 65 qualify for Medicare?

Yes. Individuals under 65 can qualify if they have received Social Security Disability Insurance (SSDI) benefits for 24 months or have specific medical conditions such as End-Stage Renal Disease (ESRD) or ALS.

What is the Initial Enrollment Period for Medicare?

The Initial Enrollment Period begins three months before your 65th birthday and ends three months after it—a seven-month window that allows you to enroll without late-enrollment penalties.

What is the main difference between Original Medicare and Medicare Advantage?

Original Medicare is administered by the federal government and includes Part A and Part B. Medicare Advantage (Part C) is offered by private insurers and combines hospital, medical, and often drug coverage with different cost structures and networks.

How does hospitalization coverage differ under each program?

Original Medicare uses benefit periods with deductibles and coinsurance after 60 days, while Medicare Advantage typically charges daily copays for a limited number of days and caps annual out-of-pocket costs.

What is the 90-day hospitalization rule under Original Medicare?

After 90 days in one benefit period, you begin using 60 lifetime reserve days at a higher daily cost. Once those are used, you pay all remaining hospital costs yourself.

Does Medicare Advantage have an annual spending limit?

Yes. Every Medicare Advantage plan includes a maximum out-of-pocket (MOOP) limit. In 2025 it can be up to $8,850 for in-network care, after which the plan pays 100% of covered services.

What is the main difference between Original Medicare and Medicare Advantage?

Original Medicare is administered by the federal government and includes Part A and Part B. Medicare Advantage (Part C) is offered by private insurers and combines hospital, medical, and often drug coverage with different cost structures and networks.

How does hospitalization coverage differ under each program?

Original Medicare uses benefit periods with deductibles and coinsurance after 60 days, while Medicare Advantage typically charges daily copays for a limited number of days and caps annual out-of-pocket costs.

What is the 90-day hospitalization rule under Original Medicare?

After 90 days in one benefit period, you begin using 60 lifetime reserve days at a higher daily cost. Once those are used, you pay all remaining hospital costs yourself.

Does Medicare Advantage have an annual spending limit?

Yes. Every Medicare Advantage plan includes a maximum out-of-pocket limit. In 2025 it can be up to 8850 dollars for in-network care, after which the plan pays 100 percent of covered services.

What’s the difference between Medicare Advantage and Medicare Supplement in Durham, NC?

Medicare Advantage (Part C) plans replace Original Medicare and often include drug coverage and extras like dental or vision. Medicare Supplement Plan G works with Original Medicare, covering most out-of-pocket costs like copays and coinsurance.

Can I switch from my employer plan to Medicare in Raleigh without penalties?

Yes — but timing is crucial. You must enroll in Medicare Part B within 8 months after your employer coverage ends to avoid late penalties.

Are there $0 premium Medicare plans available in Raleigh, NC?

Yes. Several carriers in Durham offer $0 premium Medicare Advantage plans that include hospital, doctor, and prescription benefits, depending on ZIP code and eligibility.

Does Generation Health charge for Medicare plan comparisons?

No. Medicare consultations with Generation Health are free. You’ll get personalized help reviewing your doctors, prescriptions, and plan options — with no obligation.

What are the key parts of family health insurance?

Premiums, deductibles, copays, and out-of-pocket maximums determine how much a family spends on health insurance each year.

How do I find affordable ACA coverage?

Visit GenerationHealth.me/aca-marketplace-quotes to compare ACA plans and see if you qualify for subsidies that lower your monthly premium.

Do family health plans include dental and vision?

Most standard health plans do not include dental and vision. Families should add standalone coverage to complete their protection.

What is the main difference between Medicare Plan G and Medicare Advantage?

Medicare Plan G works with Original Medicare to cover most out-of-pocket costs after the Part B deductible. Medicare Advantage replaces Original Medicare with a private plan that includes copays, networks, and often drug and extra benefits.

Is Medicare Plan G better than Medicare Advantage?

Plan G is better if you want predictable costs and doctor freedom. Medicare Advantage can be better if you want lower premiums and built-in extras like dental and vision.

What are the four main parts of Medicare?

Medicare consists of four primary parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage). Each part covers different aspects of healthcare needs.

How do I enroll in Medicare, and what are the important enrollment periods?

You can enroll in Medicare during your Initial Enrollment Period, which begins three months before your 65th birthday and lasts for seven months. There are also General Enrollment Periods from January 1 to March 31 each year and Special Enrollment Periods for unique circumstances like continued employment or qualifying life events.

What are the costs associated with each Medicare part?

Part A is often premium-free for most beneficiaries but includes a $1,676 deductible per benefit period. Part B has a standard $185 monthly premium and a $257 annual deductible in 2025. Costs for Part C (Medicare Advantage) and Part D (drug coverage) vary by plan and include potential copays and premiums.

What are the penalties for missing Medicare enrollment deadlines?

Missing Medicare enrollment deadlines can result in permanent financial penalties. For Part D, the penalty adds 1% of the national base beneficiary premium for each month without coverage, applied permanently. Late enrollment in Part B also triggers ongoing higher monthly premiums.

Medicare & Health Insurance Plans in Raleigh, NC

Medicare & Health Insurance Plans in Raleigh, NC | Generation Health

Local Help Comparing Medicare Advantage, Supplement, and ACA Plans

Navigating Medicare in Raleigh doesn’t have to be complicated. At Generation Health, licensed broker Rob Simm helps seniors and families across the Triangle compare Medicare Advantage (Part C), Medicare Supplement (Plan G), and ACA Marketplace health insurance options.

Whether you’re new to Medicare, transitioning from employer coverage, or dual-eligible for Medicare and Medicaid, you’ll receive personalized local guidance that makes every step clear and stress-free.

Why Raleigh Residents Choose Generation Health

Free, no-pressure Medicare reviews with local expertise
Personalized help comparing Medicare Advantage and Medigap options
Guidance on Part D drug coverage and Special Needs Plans (C-SNP, D-SNP)
Support for residents of Raleigh, Cary, Apex, Wake Forest, and the Triangle
Expert help avoiding Part B penalties and enrollment mistakes

Medicare Plan Options in Raleigh

Medicare Advantage (Part C)
Private plans that combine hospital, doctor, and prescription coverage — often with $0 monthly premiums and extras like dental, vision, hearing, and OTC cards.

Medicare Supplement (Plan G)
Predictable coverage that helps pay what Original Medicare doesn’t, such as copays, coinsurance, and deductibles. Great for those who value nationwide access and low out-of-pocket costs.

Marketplace (ACA) Health Insurance
For those under 65 or retiring early, ACA Marketplace plans provide affordable coverage with income-based subsidies and preventive care benefits.

Frequently Asked Questions

Q1. What’s the best Medicare plan option for Raleigh seniors?
It depends on your doctors, prescriptions, and travel needs. Medicare Advantage plans work best for those who prefer bundled benefits, while Medicare Supplement Plan G offers maximum flexibility and coverage stability.

Q2. When should I leave my employer plan and switch to Medicare in Raleigh?
You should enroll in Medicare as soon as you lose employer coverage or turn 65. Missing your enrollment window can lead to lifelong penalties on your Part B premium.

Q3. Can I get a $0 premium Medicare plan in Wake County?
Yes. Many Medicare Advantage carriers in Raleigh offer zero-premium plans with comprehensive coverage. Availability depends on your ZIP code and eligibility.

Q4. Does Generation Health charge a fee for Medicare help?
No. Generation Health provides free, unbiased Medicare consultations to help you understand your options and enroll with confidence.

About the Author

Licensed Health Insurance Broker – Founder of Generation Health

Rob Simm is a trusted Medicare and health insurance broker serving North Carolina, Virginia, Georgia, and Texas. As the founder of GenerationHealth.me, Rob focuses on clarity, compliance, and client-first education — helping seniors make confident Medicare choices that fit their lifestyle.

When he’s not meeting with clients, Rob leads local Medicare workshops and community enrollment events across the Triangle and Blue Ridge regions.

📞 Call or text Rob: (828) 761-3324
🌐 Visit: GenerationHealth.me

Medicare & Health Insurance Plans in Raleigh, NC | Generation Health

Local Help Comparing Medicare Advantage, Supplement, and ACA Plans

Why Raleigh Residents Choose Generation Health

Medicare Plan Options in Raleigh

Frequently Asked Questions

About the Author

GenerationHealth.me

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