The three options for 2027
| Option | Type | How it works |
|---|---|---|
| Base Plan | Group Medicare Advantage PPO with group Part D | Replaces Original Medicare for Part A and B services. The Plan places retirees turning 65 here by default. |
| Enhanced Plan | Group Medicare Advantage PPO with group Part D | Works like the Base Plan, with different cost sharing and premium. |
| 70/30 Plan | The Plan's own PPO and drug list | Original Medicare pays first; the 70/30 Plan may pay part of what's left after its deductible, coinsurance and copays. Its drug coverage is not Part D but is creditable. |
Both Medicare Advantage options are national PPOs: the Plan says you can see any provider who accepts Medicare and agrees to bill the plan. The Plan's 2027 comparison chart lays out each option's cost sharing, and your Annual Notice of Changes lists what changed for 2027, including some copays and the yearly out-of-pocket maximums.
What you pay depends on you, not just the option
Your share of the premium is set by your hire date and years of service (none, half or all of it), and covered family members have their own premiums. The Plan publishes separate 2027 rate sheets for each contribution level. Everyone also keeps paying the Medicare Part B premium. See does the Plan pay for Part B?
How to choose or change
- Turning 65 as a retiree: you're placed in the Base Plan; tell the Plan at least 30 days before your Medicare starts if you want another option.
- Retiring at 65 or older: you're placed in the Base Plan if your retirement is approved 60 or more days before your retiree coverage starts, otherwise in the 70/30 Plan, with time to change before coverage begins.
- Already enrolled: change at the Plan's Open Enrollment. For 2027 it ran October 12 to 30, 2026, and has closed; Medicare's October 15 to December 7 period doesn't reopen it.
Thinking about an individual plan instead? Read State Health Plan vs. individual Medicare plans first; for 2027, CMS data show 106 individual Medicare Advantage plans open to everyone in North Carolina. You can also request a call from a licensed insurance agent. The full guide: State Health Plan retirees and Medicare.
Related questions
Do state retirees need Part B?
What each option requires.
Can I drop the Plan for my own Medicare plan?
What you'd give up.
What happens to Plan coverage at 65?
Deadlines before Medicare starts.
Sources
- State Health Plan — 2027 Benefit Information: Medicare Members
- State Health Plan — 2027 Open Enrollment Medicare outreach presentation
- State Health Plan — 2027 Plan Comparison, Medicare-primary subscribers
- State Health Plan — Planning for retirement (pre-65) presentation, 2026
- State Health Plan — 70/30 Plan for Medicare Retirees
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 happens to my State Health Plan coverage when I turn 65?
Part of the guide: State Health Plan retirees and Medicare in North Carolina · All questions
Frequently asked questions
What changed for the 70/30 Plan in 2027?
Medicare-primary members on the 70/30 Plan were moved to the Base Plan on January 1, 2027, unless they acted during the Plan's October 12 to 30, 2026 Open Enrollment. The 70/30 Plan also adds a three-tier provider network for 2027.
Can a Medicare retiree choose the Plus PPO Plan?
No. The Plan says the Plus PPO Plan isn't available to Medicare-eligible members under the State Retirement System. A spouse or child who isn't on Medicare can be on the Standard or Plus PPO Plan.
Do I need a separate Part D plan with the State Health Plan?
No. The Plan says all three Medicare options include prescription drug coverage. Joining a separate Part D plan would cancel your Plan Medicare Advantage coverage and move you to the 70/30 Plan.
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