Medicare & Medicaid in North Carolina (NC)
2026 healthcare costs, coverage, and spending data for North Carolina.
$13,698
Spending/Capita
2,179,006
Medicare Enrollees
2,938,675
Medicaid Enrollees
5.6%
Uninsured Rate
Medicare Premiums in North Carolina
Part B Premium
$185/mo
Part D Premium (Avg)
$44/mo
Medigap Premium (Avg)
$285/mo
Medicaid Expansion: Yes - North Carolina expanded Medicaid under the ACA
Procedure Costs in North Carolina
Hospital
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Liver Transplant | $211,982 | $169,586 | $42,396 |
| Kidney Transplant | $109,900 | $87,920 | $21,980 |
| Heart Valve Replacement | $78,554 | $62,843 | $15,711 |
| Coronary Artery Bypass Graft (CABG) | $66,726 | $53,381 | $13,345 |
| Defibrillator Implantation (ICD) | $46,434 | $37,147 | $9,287 |
| Total Knee Replacement | $43,404 | $34,723 | $8,681 |
| Spinal Fusion | $37,530 | $30,024 | $7,506 |
| Pacemaker Implantation | $36,262 | $29,010 | $7,252 |
| Total Hip Replacement | $35,584 | $28,467 | $7,117 |
| Sepsis Treatment | $27,224 | $21,780 | $5,445 |
| Lumbar Disc Surgery | $27,070 | $21,656 | $5,414 |
| Colectomy | $25,087 | $20,070 | $5,017 |
| Carotid Endarterectomy | $24,322 | $19,457 | $4,864 |
| Hip Fracture Repair | $24,157 | $19,325 | $4,831 |
| Mastectomy | $23,655 | $18,924 | $4,731 |
Outpatient
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Arthroscopic Knee Surgery | $9,140 | $7,312 | $1,828 |
| TURP (Prostate) | $8,684 | $6,947 | $1,737 |
| Endoscopic Sinus Surgery | $8,288 | $6,631 | $1,658 |
| Lithotripsy (Kidney Stones) | $6,889 | $5,511 | $1,378 |
| Tonsillectomy | $6,360 | $5,088 | $1,272 |
| Bunionectomy | $6,081 | $4,865 | $1,216 |
| Dialysis Access Surgery | $5,039 | $4,031 | $1,008 |
| Nasal Polyp Removal | $4,772 | $3,817 | $954 |
| Septoplasty | $4,573 | $3,659 | $915 |
| Carpal Tunnel Release | $4,474 | $3,579 | $895 |
| Hemorrhoid Surgery | $4,206 | $3,365 | $841 |
| Adenoidectomy | $4,028 | $3,222 | $806 |
| Pilonidal Cyst Surgery | $3,411 | $2,729 | $682 |
| Ganglion Cyst Removal | $3,247 | $2,597 | $649 |
| Varicose Vein Treatment | $3,134 | $2,507 | $627 |
Imaging
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| PET Scan | $4,056 | $3,245 | $811 |
| Nuclear Stress Test | $2,123 | $1,699 | $425 |
| CT Angiography | $1,816 | $1,453 | $363 |
| MRI Brain | $1,666 | $1,332 | $333 |
| MRI Hip | $1,586 | $1,268 | $317 |
| CT Scan Abdomen/Pelvis | $1,449 | $1,159 | $290 |
| MRI Spine (Cervical) | $1,444 | $1,155 | $289 |
| MRI Spine (Lumbar) | $1,345 | $1,076 | $269 |
| MRI Knee | $1,336 | $1,069 | $267 |
| MRI Shoulder | $1,125 | $900 | $225 |
| Bone Scan | $992 | $794 | $198 |
| CT Scan Head | $904 | $724 | $181 |
| CT Scan Chest | $870 | $696 | $174 |
| CT Colonography (Virtual) | $691 | $553 | $138 |
| Fluoroscopy | $504 | $403 | $101 |
Physician/Office
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Annual Wellness Visit | $310 | $310 | $0 |
| Sleep Study Consultation | $277 | $222 | $55 |
| Allergy Testing | $253 | $203 | $51 |
| Bone Density Test (DEXA Scan) | $248 | $198 | $50 |
| Mental Health Counseling | $239 | $191 | $48 |
| Office Visit (New Patient) | $237 | $190 | $47 |
| Mammogram (Screening) | $230 | $230 | $0 |
| Wound Care Visit | $216 | $173 | $43 |
| Psychiatry Visit | $201 | $161 | $40 |
| Shingles Vaccination | $189 | $189 | $0 |
| Vision Exam (Diabetic) | $186 | $149 | $37 |
| Occupational Therapy Session | $183 | $146 | $37 |
| Speech Therapy Session | $166 | $133 | $33 |
| Skin Cancer Screening | $163 | $130 | $33 |
| Physical Therapy Session | $154 | $123 | $31 |
Laboratory
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| BNP (Heart Failure Marker) | $60 | $48 | $12 |
| Blood Type and Crossmatch | $55 | $44 | $11 |
| Blood Culture | $53 | $42 | $11 |
| Vitamin D Level | $51 | $41 | $10 |
| Glucose Tolerance Test | $47 | $38 | $9 |
| Iron Studies (Ferritin) | $43 | $34 | $9 |
| Thyroid Panel (TSH) | $38 | $31 | $8 |
| Liver Function Panel | $36 | $29 | $7 |
| Troponin Level | $34 | $28 | $7 |
| Comprehensive Metabolic Panel | $33 | $26 | $7 |
| Basic Metabolic Panel | $31 | $24 | $6 |
| PSA (Prostate-Specific Antigen) | $30 | $24 | $6 |
| Pap Smear Lab Processing | $30 | $24 | $6 |
| Lipid Panel | $29 | $23 | $6 |
| Urine Drug Screen | $28 | $22 | $6 |
Compare North Carolina With Other States
Frequently Asked Questions
How much does Medicare spend per person in North Carolina?
In 2026, the average Medicare spending per beneficiary in North Carolina is $13,698.
How many people are enrolled in Medicare in North Carolina?
North Carolina has approximately 2,179,006 Medicare beneficiaries.
Did North Carolina expand Medicaid?
Yes, North Carolina expanded Medicaid under the Affordable Care Act.
What is the uninsured rate in North Carolina?
The uninsured rate in North Carolina is 5.6%.
What is the average Medigap premium in North Carolina?
The average Medigap (Medicare Supplement) premium in North Carolina is $285 per month.