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By Will Doran, WRAL state government reporter
Healthcare premiums could be going up again next year for hundreds of thousands of North Carolinians insured by the State Health Plan.
The plan’s board is scheduled to meet Friday, when it is expected to vote on new premium rates, changes to other benefits such as deductibles, and a new system that could see members’ out-of-pocket costs drop at some hospitals and clinics while rising at others, according to a meeting agenda. If approved, all would apply starting in 2027
The health plan serves more than 750,000 state workers, retirees and their family members
State Treasurer Brad Briner indicated during a meeting of the state’s executive branch leaders Tuesday that new premium hikes are likely to be approved. He referenced the Health Plan’s deficit, as well as the premium hikes that went into effect earlier this year to take a chunk out of that deficit. The higher premiums weren’t popular with state workers, but Briner said they were necessary — and need to keep rising
“The plan was teetering on the verge of insolvency a year and a half ago, when we made some reasonably unpopular decisions that have helped put that plan in better shape for 2026,” he told fellow members of the Council of State. “We’ve got to get it in better shape for 2027 and thereafter, too. So, Friday is about that.”
The health plan’s board voted last month to raise deductibles and drug co-pays for retirees on the Medicare Advantage version of the State Health Plan
Friday’s votes will focus on the Standard and Plus plans for active employees
Pushing people to change doctors
The health plan’s board could also vote on new contracts with health providers — part of a new strategy the state is using to drive down costs. It’s already in place for some surgical providers but could soon be in place for all healthcare in the state. Under the plan, some companies would be designated “preferred” providers. In exchange for charging the state lower rates, the State Health Plan will steer patients to their hospitals and clinics
But to make that happen, the state has to be able to make members change their doctors. So the State Health Plan could also designate some healthcare providers as non-preferred, and charge people extra to keep going there for care
Briner said Tuesday that his hope is that once the details are finalized, people on the State Health Plan who use only “preferred” providers will see their out-of-pocket maximum costs drop by thousands of dollars, falling to the rates of 15 years ago — despite years of inflation since then
“If you are willing to change providers to a preferred provider, you will be able to save a third or more of your out-of-pocket costs,” Briner said. “If you do that, it’ll look like 2012 for your healthcare bills. That is tremendous progress, against a landscape that has fought us the whole way.”
Contract fight coming?
Friday’s agenda also indicates the board might vote to change which insurance company or companies will be in charge of administering the health plan, as well as its separate pharmacy plan, starting in 2028
In 2023 the board voted to take those contracts away from Blue Cross & Blue Shield for the first time in 40 years and hand them to Aetna, as State Treasurer Dale Folwell engaged in a public spat with BCBS over cost transparency concerns. The treasurer’s office oversees the health plan. But Folwell is out of office now, replaced by fellow Republican Briner in the 2024 elections
The decision to switch to Aetna was a contentious call that led to legal battles, but ultimately Aetna prevailed and was awarded the multibillion-dollar contract. The treasurer’s office, however, indicated earlier this year that Briner doesn’t necessarily agree with the rubric used in 2023 that resulted in Aetna scoring higher than BCBS
“This administration has different priorities and would prefer a contract that is more in line with those priorities,” Briner spokesperson Loretta Boniti told WRAL in March.At the time, a spokesman for Aetna parent company CVS said Aetna had “successfully executed the first [contract] transition in decades, and we remain committed to improving the overall health and well-being of the State Health Plan.”
