What happens to your Plan coverage
| What you do | What happens |
|---|---|
| Join an individual Medicare Advantage plan | Your Plan Medicare Advantage coverage ends and you're moved to the 70/30 Plan. You're still a Plan member, and the Plan warns of a possible "significant financial impact." |
| Join an individual Part D plan | Same: Medicare allows only one Medicare drug plan, so the Plan moves you to the 70/30 Plan. |
| Opt out of the State Health Plan | No Plan coverage. You can opt back in only at a Plan Open Enrollment or after a qualifying life event. |
| Buy Medigap | Medigap works only with Original Medicare, so not with the Plan's Medicare Advantage options. With the 70/30 Plan, the Plan says Medigap is generally not needed. |
Your covered family members are affected too: the Plan enrolls Medicare-primary family members in the same option, so ask how a change affects your spouse before you act.
When you can join an individual plan
- Medicare Open Enrollment: October 15 to December 7, 2026, for coverage starting January 1, 2027.
- When you first get Medicare, in your Initial Enrollment Period.
- Leaving employer or union coverage: a Special Enrollment Period lasting 2 full months after the month the coverage ends.
The Medigap catch in North Carolina
North Carolina has no Medigap birthday or yearly switching rule. Your 6-month Medigap open enrollment starts the first month you're both 65 and in Part B; after that, a company can ask health questions and turn you down unless you have a guaranteed-issue right, such as retiree coverage that pays after Medicare ending (apply within 63 days). If you're past your open enrollment, get Medigap approved in writing before you leave the Plan. See when can I buy Medigap in North Carolina?
Before you decide
- Confirm your contribution status. Whether you pay none, half or all of the Plan premium is the starting point for any comparison.
- Compare the whole year. Premiums for you and dependents, likely copays and drug costs, under each choice. See State Health Plan vs. individual Medicare plans.
- Check doctors and drugs in any individual plan. For 2027, CMS data show 106 Medicare Advantage plans open to everyone in North Carolina and 11 standalone Part D plans; availability varies by county.
- Never confirm personal details on a cold call. The Plan warns retirees could be enrolled in a plan they don't want and lose their Plan coverage.
To compare individual plans from the companies they work with, you can request a call from a licensed insurance agent. The full guide: State Health Plan retirees and Medicare.
Related questions
What Medicare plans does the Plan offer?
The three 2027 options.
Can my spouse stay on the Plan?
How family coverage works.
Does the Plan pay for Part B?
Costs you keep either way.
Sources
- State Health Plan — 2027 Open Enrollment Medicare outreach presentation
- State Health Plan — Planning for retirement (pre-65) presentation, 2026
- Medicare.gov — Special Enrollment Periods
- Medicare.gov — Choosing a Medigap Policy (guaranteed-issue rights)
- N.C. General Statutes Chapter 58, Article 54 (Medicare supplement insurance)
More questions in this guide
- Are NC state employees hired after 2021 eligible for retiree health coverage?
- 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?
- What Medicare plans does the NC State Health Plan offer retirees?
Part of the guide: State Health Plan retirees and Medicare in North Carolina · All questions
Frequently asked questions
Can I use Medicare Open Enrollment to leave the State Health Plan?
You can join an individual Medicare Advantage or Part D plan between October 15 and December 7, 2026, for January 1, 2027. That doesn't change your State Health Plan option, which was set at the Plan's October 12 to 30 Open Enrollment; your Plan Medicare Advantage coverage would end and you'd be moved to the 70/30 Plan.
Do I get a Special Enrollment Period if I leave the State Health Plan?
Medicare.gov lists a Special Enrollment Period when you leave coverage from an employer or union: you can join a Medicare Advantage or Part D plan for 2 full months after the month that coverage ends. Confirm with 1-800-MEDICARE that it applies to your situation before you drop Plan coverage.
Will I owe a Part D late penalty if I leave the Plan?
Not if you join Part D without a gap of 63 days or more. The Plan's Medicare Advantage options include group Part D, and the 70/30 Plan's drug coverage is creditable.
Medicare in your North Carolina county
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