Higher deductibles, changes to co-pays approved for NC State Health Plan members
The North Carolina State Health Plan Board of Trustees on Tuesday approved changes for the 2026 plan year that will affect hundreds of thousands of state employees and retirees.
Officials said the proposed changes, which include significant increases to deductibles, aim to tackle the health plan’s projected $507 million deficit in 2026. They also presented additional long-term reforms they said are designed to get ahead of future shortfalls.
“I understand this is all very different,” Tom Friedman, the plan’s executive administrator, said. “But we have to do something different here to be successful.”
Premium increases for members are also on the table. The board is expected to vote on those during its August meeting.
The changes apply to active employees, non-Medicare retirees, and Medicare-eligible retirees.
For active and non-Medicare members, there will be several adjustments to the current 70/30 and 80/20 plans, which will be renamed the “Standard” and “Plus” plans, respectively.
The “Standard” plan will see the annual deductible rise from $1,500 to $3,000, along with increases to the out-of-pocket maximum, adjustments to co-pays, and other changes.
More than 482,000 active employees and dependents are covered under the health plan, along with more than 56,000 non-Medicare retirees and their dependents.
For Medicare-eligible retirees — a group that includes more than 197,000 people and their dependents — the plan offers three options: the Medicare Retiree Base PPO Plan (formerly the 70/30) and two Medicare Advantage plans, the Base and Enhanced plans offered by Humana.
Contrary to earlier expectations, the Medicare Advantage plans will see almost no changes, just a minor tweak. This follows new federal rules that improved financial forecasts, according to health plan staff.
However, the Medicare 70/30 PPO Plan will undergo significant changes. It will see a much higher deductible, increased out-of-pocket costs, and other benefit adjustments.
Kimberly Jones, a trustee appointed by former Democratic Gov. Roy Cooper, was the only member to vote against the benefit changes.
“I know the changes to benefits the board made today are hard, but I’m confident that these changes, coupled with new provider opportunities we’re working on, will place the Plan on a stronger financial path moving forward,” State Treasurer Brad Briner, who chairs the board, said in a statement. “We’re evolving from what we’ve learned and focusing on what works: trusted provider relationships, financial predictability and meaningful support for our members’ health.”
As for proposed premium increases, they would be tiered based on salary. The increase for the lowest-paid workers is expected to be as low as $5 per month, Briner said. More details will be available in August, when the board votes on the matter.
This story was originally published May 20, 2025 at 12:05 PM with the headline "Higher deductibles, changes to co-pays approved for NC State Health Plan members."