The North Carolina State Health Plan will raise out-of-pocket costs and copays for its Medicare Advantage offering in 2027.
The board of trustees voted on the changes June 5. The medical out-of-pocket maximum will increase from $4,000 to $4,500 for the base plan and $3,300 to $3,700 for the enhanced plan. The proposal included a new $50 Part B drugs copay, as well.
Inpatient acute hospital admissions, specialist visit, advanced imaging and radiology copays will also increase for both plans. Out of these, advanced imaging copays will increase the most, rising $75 for the base plan.
The state health plan covers state employees through a self-insured model. It works with Humana on the two MA plans, which total roughly 177,000 enrollees, as of April 2026.
MA changes are projected to save the state health plan about $31.5 million, according to a June 5 news release from the North Carolina state treasurer.
With the benefit changes, pricing would be about $60 per month for the base plan and $143 per month for the enhanced plan. The news release said premiums would be confirmed in a July 10 meeting.
Previously, the state health plan projected a shortfall of more than $1 billion for 2026 and 2027, according to a February 2025 presentation.
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