What the law says
N.C.G.S. 135-48.1(18) defines a "retiree" for State Health Plan purposes as a retired teacher, state employee or legislator who receives a monthly benefit from TSERS, the Consolidated Judicial Retirement System, the Legislative Retirement System or an Optional Retirement Program, and who "earned contributory retirement service in one of these retirement systems prior to January 1, 2021, and did not withdraw that service." The Plan's retirement fact sheet puts it simply: employees hired on or after January 1, 2021, are not eligible for health plan benefits in retirement.
| First hired | Retiree health coverage |
|---|---|
| Before Oct. 1, 2006, with 5+ years of service | Eligible, non-contributory |
| Oct. 1, 2006 to Dec. 31, 2020 | Eligible after 5 years; you pay 100% (5 to under 10 years), 50% (10 to under 20) or none (20+) |
| On or after Jan. 1, 2021 | Not eligible |
Is there a bill to change it?
Senate Bill 139 of the 2025–2026 session, "Restore State Emp/Teacher Retiree Med Benefit," was filed February 24, 2025, and referred to the Senate Rules and Operations Committee on February 25, 2025. As of November 13, 2026, the General Assembly's site shows no further action. It is a proposal, not law, and the cutoff still applies.
What to plan for instead
- Before 65: if you retire early, you'll need other coverage, such as a spouse's employer plan or a Marketplace plan at HealthCare.gov. Losing coverage generally opens a Marketplace Special Enrollment Period.
- At 65: sign up for Medicare Part A and Part B in your Initial Enrollment Period, which starts 3 months before your birthday month. If you're still working with job-based coverage, you can delay Part B without a penalty until that coverage ends.
- Choose how to fill Medicare's gaps: a Medicare Advantage plan, or Original Medicare with Medigap and Part D. North Carolina has no Medigap birthday rule, so your 6-month Medigap open enrollment matters. For 2027, CMS data show 106 Medicare Advantage plans open to everyone in North Carolina and 11 standalone Part D plans.
- Budget for premiums: without a retiree plan, you pay Part B ($202.90 a month for most people in 2026) plus any plan premium.
See turning 65 in North Carolina and State Health Plan retirees and Medicare. To compare plans from the companies they work with, you can request a call from a licensed insurance agent.
Related questions
Do LGERS retirees get State Health Plan coverage?
Local government retirees.
What Medicare plans does the Plan offer?
For eligible retirees.
Does the Plan pay for Part B?
What retirees pay.
Sources
- N.C. General Statutes 135-48.1, definitions (retiree)
- State Health Plan — Retiree Health Benefits Fact Sheet
- North Carolina General Assembly — Senate Bill 139 (2025–2026 session), status
- NC Retirement Systems — Health benefit coverage for eligible retirees
- HealthCare.gov — Special Enrollment Period
- Medicare.gov — When does Medicare coverage start?
More questions in this guide
- Can I drop the State Health Plan and buy my own Medicare plan in NC?
- Can my spouse stay on the State Health Plan when I go on Medicare?
- Do federal retirees in North Carolina need Medicare Part B with FEHB?
- Do LGERS retirees get State Health Plan coverage with Medicare?
- Do North Carolina state retirees need Medicare Part B?
- Does the NC State Health Plan pay for Medicare Part B?
- What happens to my State Health Plan coverage when I turn 65?
- What Medicare plans does the NC State Health Plan offer retirees?
Part of the guide: State Health Plan retirees and Medicare in North Carolina · All questions
Frequently asked questions
I was hired before 2021, left, and came back after. Am I eligible?
The law looks at service earned before January 1, 2021, that you did not withdraw. If you took a refund of that earlier service, you may not qualify. Ask Retirement Systems at (919) 814-4590 to review your record.
Does this change my pension?
No. The 2021 cutoff applies to retiree health coverage under the State Health Plan, not to your TSERS retirement benefit.
Can I stay on the State Health Plan while I'm still working?
Yes, if your job is eligible for Plan coverage. The 2021 cutoff is part of the law's definition of a retiree, so it affects coverage after you retire, not your coverage as an active employee.
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