How the Plan covers a split family
| Your spouse is... | Plan options for your spouse |
|---|---|
| Not on Medicare (for example, younger than you) | The same non-Medicare options as active employees: the Standard PPO Plan or the Plus PPO Plan. For 2027, non-Medicare members were moved to the Standard PPO Plan unless they chose the Plus PPO Plan at Open Enrollment. |
| On Medicare | The Medicare-primary options: the Base Plan, the Enhanced Plan or the 70/30 Plan. Medicare-primary family members are enrolled in the same option. |
The Plan's word for this is "split family": one or more family members are Medicare-primary while others aren't, so they have different coverage. The Plan's rate sheets price Medicare-primary subscribers with a spouse, children or family, including non-Medicare dependents on a PPO.
When your spouse becomes eligible for Medicare
- Your spouse signs up for Part A and Part B. The Plan requires both for its Medicare Advantage options. A Medicare-eligible spouse without both in place is defaulted to the 70/30 Plan, where claims are paid as if Part B had paid.
- The Plan moves your spouse to a Medicare option. For people turning 65, the Plan assigns the Base Plan about 90 days before Medicare becomes primary, and allows changes until 30 days before.
- Check that you're in the same option. Because Medicare-primary family members stay together, a choice for one of you can affect the other.
If your spouse has other coverage
If your spouse has a job with health coverage, that job's plan may pay first. Medicare's rules let someone covered through a spouse's current job delay Part B without a penalty, but your State Health Plan retiree coverage is not coverage from current work. If your spouse is covered by more than one retiree plan, the Plan suggests checking that its Medicare Advantage options won't cause a loss of other coverage.
The full guide: State Health Plan retirees and Medicare. For help comparing coverage for both of you, you can request a call from a licensed insurance agent.
Related questions
What happens to Plan coverage at 65?
The move to the Base Plan.
Can I drop the Plan for my own Medicare plan?
How it affects your family.
Do state retirees need Part B?
The same rules apply to spouses.
Sources
- State Health Plan — Planning for retirement (pre-65) presentation, 2026
- State Health Plan — 2027 Open Enrollment Medicare outreach presentation
- State Health Plan — Retiree Health Benefits Fact Sheet
- State Health Plan — 2027 Benefit Information: Medicare Members
- Medicare.gov — Retiree insurance and Medicare
More questions in this guide
- Are NC state employees hired after 2021 eligible for retiree health coverage?
- Can I drop the State Health Plan and buy my own Medicare plan in NC?
- 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
Can I add my spouse to my State Health Plan coverage after I retire?
Only during the Plan's Open Enrollment or after a qualifying life event (retirement itself is one), and the Plan requires dependent eligibility documents. The Plan's 2027 Open Enrollment ran October 12 to 30, 2026.
Does my spouse pay a premium?
Generally yes. Dependent coverage has its own premium tier on the Plan's 2027 rate sheets, even when the retiree's own coverage is non-contributory.
What happens to my spouse if I join an outside Medicare plan?
The Plan moves you to the 70/30 Plan and warns that this can have a significant financial impact for you or your spouse. Because Medicare-primary family members are enrolled in the same option, ask the Plan how your spouse would be affected before you enroll.
Medicare in your North Carolina county
Plans, local agents and help, county by county: Wake · Mecklenburg · Guilford · Forsyth · Durham · Cumberland · Buncombe · Union · Johnston · Cabarrus · New Hanover · Gaston · Onslow · Iredell · Alamance · Pitt · Davidson · Brunswick · Catawba · Rowan · All 100 counties →
