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Independent Medicare Broker
Medicare · Durham NC · 2026
Durham County Medicare Advantage Plans — 2026 Data Report
Real numbers. Real Durham 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 Durham 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 — Durham County, North Carolina · 2026
GenerationHealth’s CY2026 Durham County, NC data shows 74 Medicare Advantage plans available for 2026, offered by 12 carriers — Aetna Medicare, Blue Cross and Blue Shield of North Carolina, Experience Health, HealthSpring, HealthTeam Advantage, Humana, Liberty Medicare Advantage, Longevity Health Plan, PruittHealth Premier, Troy Medicare, UnitedHealthcare, Wellcare. 58 of those plans (78%) have $0 monthly premiums, and the average premium across all plans is $22/month. But premium alone doesn’t tell you what you’ll actually spend. Estimated annual out-of-pocket costs in Durham County range from $378 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 Durham 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
Durham County is Duke Health territory — but “Duke Health” on a plan directory can mean Duke University Hospital, Duke Regional, or dozens of clinics, and Medicare Advantage carrier contracts don’t always cover all of them. Before you enroll, give me the specific Duke facility and doctor you use and I’ll verify the exact contract. A plan that covers Duke Raleigh doesn’t necessarily cover your specialist at Duke Clinic on Erwin Road.
— Rob Simm, Licensed NC Medicare Broker · (828) 761-3326
The numbers
Durham County Medicare Advantage plans, ranked by typical annual cost
| Plan | Carrier | Premium | Medical deductible | Drug deductible | Typical annual | Range (low – high) |
|---|---|---|---|---|---|---|
| Troy Medicare (HMO) H4676-001-0 |
Troy Medicare | $0/mo | — | $0 | $378 | $192 – $909 |
| Humana Gold Plus H1036-335 (HMO-POS) H1036-335-2 |
Humana | $0/mo | — | $250 | $425 | $139 – $1,155 |
| 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 |
| Humana Gold Plus H6622-060 (HMO-POS) H6622-060-0 |
Humana | $0/mo | — | $350 | $486 | $179 – $1,320 |
| 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 |
| AARP Medicare Advantage from UHC NC-0015 (HMO-POS) H5253-117-0 |
UnitedHealthcare | $0/mo | — | $440 | $541 | $189 – $1,482 |
| Wellcare Simple Open (PPO) H1914-007-0 |
Wellcare | $0/mo | — | $615 | $565 | $305 – $1,290 |
What will prescriptions cost on the top Durham County plans?
| Drug | Humana Humana Gold Plus H1036-335 (HMO-POS) |
Troy Medicare Troy Medicare (HMO) |
Humana HumanaChoice H5525-050 (PPO) |
|---|---|---|---|
| apixaban 5 MG Oral Tablet [Eliquis] | $47/mo Tier 3 |
$40/mo Tier 3 |
$47/mo Tier 3 |
| atorvastatin 20 MG Oral Tablet | $0.00/mo Tier 1 |
$10/mo Tier 1 |
$0.00/mo Tier 1 |
| empagliflozin 25 MG Oral Tablet [Jardiance] | $47/mo Tier 3 |
$40/mo Tier 3 |
$47/mo Tier 3 |
| lisinopril 10 MG Oral Tablet | $0.00/mo Tier 1 |
$10/mo Tier 1 |
$0.00/mo Tier 1 |
| metformin hydrochloride 500 MG Oral Tablet | $0.00/mo Tier 1 |
$10/mo Tier 1 |
$0.00/mo Tier 1 |
What dental, vision and hearing benefits are included in Durham County plans?
| Plan | PCP copay | Specialist | OTC | Dental max | Vision | Hearing aid | Fitness |
|---|---|---|---|---|---|---|---|
| Troy Medicare (HMO) Troy Medicare |
$0 | $0 | $20/qtr | — | $200 | $0 | SilverSneakers |
| Humana Gold Plus H1036-335 (HMO-POS) Humana |
$0 | $5 | $0/qtr | $2,500 | $250 | $699 | Go365 |
| HumanaChoice H5525-050 (PPO) Humana |
$0 | $25 | —/qtr | $1,250 | $200 | $799 | Go365 |
| HealthSpring Preferred Select (HMO) HealthSpring |
$0 | $15 | $120/qtr | — | $250 | $1,800 | SilverSneakers |
| Humana Gold Plus H6622-060 (HMO-POS) Humana |
$0 | $35 | —/qtr | $1,250 | $400 | $599 | Go365 |
Which Durham County doctors and hospitals are in network?
Durham is Duke Health’s home county — Duke University Hospital, Duke Regional, Duke Raleigh and the Duke Primary Care network account for most care here. UNC Health in Chapel Hill is close enough that many Durham residents use both, particularly for specialties where one system has the stronger programme.
Being in Duke’s home county does not mean every plan covers Duke. Academic medical centres contract selectively, and a plan can include Duke Regional while restricting access to a specific Duke specialty clinic. The distinction rarely appears in plan marketing.
Which specific 2026 plans include Duke Health and UNC 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.
If you are being treated at Duke for something ongoing, that is the constraint that decides the plan. Lead with it when you call — I am based in Durham and I check this one most often.
| Specialty | In-network providers (county) |
|---|---|
| Primary care (including NPs/PAs) | 148 |
| Orthopedics | 6 |
| Mental health | 19 |
| Other specialties | 87 |
2026 Medicare numbers
What are the 2026 Medicare numbers for Durham 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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You'll know where you stand.
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5 mistakes Durham County residents make
Avoid these before you enroll.
Three are specific to Durham 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 Durham-specific
Picking a Medicare Advantage HMO that drops Duke specialists mid-year.
Why it hurtsDuke Health is in-network for several Durham MA-HMO plans in January, then quietly drops out of one or two by July. If your oncologist or cardiologist is at Duke Cancer Institute or Duke Heart Center and your plan changes networks, you either pay full cost or restart treatment with a new specialist. I see this every year in Durham.
What to doBefore you enroll, ask the broker to verify Duke network status with the carrier — not just the directory — and ask whether the contract is locked through Dec 31. PPOs cost a little more but are far less likely to leave you stranded.
Mistake 02 Durham-specific
Assuming a Medigap plan won’t cover Duke because it’s a teaching hospital.
Why it hurtsMedigap plans (Plan G, Plan N, etc.) are not networks. As long as a Duke physician accepts Original Medicare assignment — and the vast majority do — they accept any Medigap plan. Some Durham residents pay $200+ extra per month on an HMO they didn’t need, thinking Medigap excluded Duke.
What to doIf keeping Duke specialists matters, Medigap Plan G or Plan N gives you the broadest, most stable access in the Triangle. No referrals, no network worries.
Mistake 03 Durham-specific
Driving to Raleigh or Cary for “cheaper” Medicare seminars run by call centers.
Why it hurtsMany Durham residents end up at multi-county marketing events held in hotel ballrooms across the Research Triangle. These are licensed agent recruiting funnels — the agent who calls the next day is paid more for certain carriers. You leave with the plan that pays them best, not the plan that fits Duke or Durham VA.
What to doMeet a Durham-based broker in person at their Durham office, or have them come to your home. 2731 Meridian Pkwy, Durham NC is in the RTP corridor and central to most of the county.
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 |
| Durham 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 Durham County
How many Medicare Advantage plans are available in Durham County in 2026?
GenerationHealth’s CY2026 Durham County, NC data shows 74 plans from 12 carriers (Aetna Medicare, Blue Cross and Blue Shield of North Carolina, Experience Health, HealthSpring, HealthTeam Advantage, Humana, Liberty Medicare Advantage, Longevity Health Plan, PruittHealth Premier, Troy Medicare, UnitedHealthcare, Wellcare) available for 2026.
What is the cheapest Medicare Advantage plan in Durham County?
By estimated annual cost, Troy Medicare (HMO) (H4676-001-0) from Troy Medicare comes in around $378/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 Durham County?
Yes — 58 of the 74 available plans (78%) 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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