Some retired NC state workers will pay more for health insurance. Working enrollees could save.
Retirees using Medicare Advantage health insurance under the State Health Plan will see significant increases next year. The Plan's
Copays will increase for a range of medical services. For example, the daily copay for an inpatient hospital stay of 1 to 10 days will go up from
Out-of-pocket maximums will go up, too, rising
"For many retirees, healthcare costs are not simply another line item in their household budget," he said. "They're among the most significant expenses they face."
Retirees have gone a long time without a cost-of-living increase, she said.
The Medicaid Advantage increases "are going to turn our folks on their head," Beasley said.
State employees and teachers who are still working and enrolled in the State Health Plan would pay less out of pocket when they seek care from "preferred providers" under a strategy for reducing costs health plan administrators discussed Friday. The plan covers about 750,000 people, including about 575,000 state employees, teachers, and their dependents.
Health systems and specialists designated as "preferred providers" will offer care at lower costs to the insurance plan.
To help convince insurance plan members to use those providers, members would also pay less. For example, the deductible for an individual would drop to
"Everyone of our active members should have the opportunity to save material amounts of money under this new strategy," state Treasurer
Big changes ahead for State Health Plan as trustees work to lower costs
This is the latest effort by plan administrators to help control medical costs and reverse the drain on health plan reserves.
Health insurance premiums increased this year for the first time in seven years. Trustees are expected to vote on another premium increase next month.
Workers are paying premiums on a sliding scale pegged to their salaries this year for the first time.
The latest change separates medical systems into four tiers: preferred, access, non-preferred, and out-of-network. It would be considerably more expensive for members to use non-preferred or out-of-network doctors and hospitals. The health plan will announce which health systems will be on the preferred list next month after contracts are signed.
Briner acknowledged that the new tiered system could be confusing for members, and anticipated that health systems that end up in the "non-preferred" category will complain.
However, every major provider was invited to compete for a contract, Briner said. Providers who end up on the non-preferred list didn't bid at all or decided to keep their prices high.
Over time, health plan administrators hope to have 90% of members using "preferred" or "access" providers, said
"We cannot afford to continue to pay the highest prices for things," Friedman said.
Courtesy of NC Newsline


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