North Carolina -- June 11, 2026: State employees are expressing significant apprehension following the NC State Health Plan board's approval of new Medicare Advantage plan benefits. These changes are sparking concerns among local retirees about potential increases in out-of-pocket costs and their ability to maintain relationships with local healthcare providers.
The State Health Plan indicates the 2027 Medicare Advantage changes are projected to save approximately $54 million. However, retirees and advocates argue that the added financial burden will be challenging for individuals living on fixed incomes, many of whom have not seen pension cost-of-living increases for years. Jackson Cozort, Associate Executive Director and Director of Government Relations for the N.C. Retired Governmental Employees Association, stated that the proposed increases would place “a disproportionate burden” on a population with little ability to absorb extra costs.
Specific Medicare Advantage changes approved by the board include raising the annual out-of-pocket maximum from $4,000 to $4,500 on the base plan and from $3,300 to $3,700 on the enhanced plan. Additionally, a $50 copay will be introduced (increasing from $0) for drugs covered under Medicare Part B. Inpatient hospital copays are set to increase by $25 to $40 per day, and other specialist and outpatient copays will rise by $10 to $75, depending on the service and plan.
For Asheville-area retirees, a primary concern centers on access to local providers. While the Medicare Advantage changes themselves do not introduce a new provider tiering system, the State Health Plan is also moving other members into a network structure that categorizes providers as Preferred, Access, or Non-Preferred. This system can alter how much people pay based on where they seek care. Reports indicate that choosing a Non-Preferred provider could result in thousands more in costs, while Access providers would keep costs roughly similar to current levels.
Local retirees are particularly worried about how these network changes could impact their ability to continue seeing their established local doctors and utilize familiar hospitals. The potential for higher costs associated with certain providers under the new structure raises questions about maintaining continuity of care and existing patient-provider relationships.