If you're already retired
- Enroll in Part A and Part B. Your Initial Enrollment Period starts 3 months before your birthday month. If you've received Social Security benefits for at least 4 months before 65, Social Security enrolls you automatically; otherwise apply at ssa.gov or 1-800-772-1213.
- Get the Plan's notice. About 80 to 90 days before your Medicare start date, the Plan writes to say it is enrolling you in the Base Plan, a group Medicare Advantage PPO with Part D drug coverage.
- Choose by 30 days before. Between that notice and 30 days before Medicare starts, you can switch to the Enhanced Plan or the 70/30 Plan. Thirty days out, the Plan locks in your assigned or chosen option.
- Keep Part B. The Medicare Advantage options require Part A and Part B. On the 70/30 Plan without Part B, you'd owe what Part B would have paid.
Your non-Medicare PPO ends for you, but not for a covered spouse or child who isn't on Medicare; they keep their non-Medicare Plan coverage.
If you're still working for the State
The Plan mails a Medicare eligibility letter before your 65th birthday. While you're actively working, the State Health Plan stays primary and Medicare is secondary. The Plan recommends enrolling in Part A and suggests delaying Part B until you retire. Plan ahead so Part B starts on your retirement date: Medicare becomes primary in your first month of retirement, and if Part A and Part B aren't in effect by your retiree coverage date, you may be defaulted to the 70/30 Plan for the rest of the plan year.
If you got Medicare before 65
If you have Medicare because of a disability, the Plan has been secondary since your Medicare eligibility date, and the Part B rule already applies: without Part B, you owe what Part B would have paid. If you're thinking about Medigap, North Carolina gives people who got Medicare before 65 a new 6-month Medigap open enrollment when they turn 65.
Why the deadlines matter
The Plan's choices close well before Medicare's own windows: the Plan's 2027 Open Enrollment ended October 30, 2026, while Medicare Open Enrollment runs to December 7. Joining an individual Medicare Advantage or Part D plan on your own moves you off the Plan's Medicare Advantage option to the 70/30 Plan. Read State Health Plan retirees and Medicare and turning 65 in North Carolina. To review your options, you can request a call from a licensed insurance agent.
Related questions
Do state retirees need Part B?
What each option requires.
What Medicare plans does the Plan offer?
Base, Enhanced and 70/30.
Can my spouse stay on the Plan?
Split-family rules.
Sources
- State Health Plan — Planning for retirement (pre-65) presentation, 2026
- State Health Plan — 2027 Benefit Information: Medicare Members
- State Health Plan — 2027 Open Enrollment Medicare outreach presentation
- Medicare.gov — When does Medicare coverage start?
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?
- 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 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
When does Medicare start if my birthday is on the first of the month?
The Plan notes that Medicare starts the first day of the month you turn 65, or the month before if your birthday falls on the first. Someone born on May 1 is Medicare-eligible April 1.
What if I miss the 30-day deadline?
You stay in the Base Plan, and you can generally change options only at the Plan's next Open Enrollment, which for 2027 coverage ran October 12 to 30, 2026.
Does my spouse's coverage change when I turn 65?
Not because of your birthday. A spouse who isn't on Medicare keeps non-Medicare Plan coverage. When your spouse becomes Medicare-eligible, the same rules apply to him or her: Parts A and B, and the move to a Medicare option.
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 →
