What the State Health Plan says
Once Medicare is your primary coverage, Part B matters for every State Health Plan option, in different ways:
| Plan option | Without Part B |
|---|---|
| Base Plan or Enhanced Plan (group Medicare Advantage) | You can't enroll. Part A and Part B must be in effect, and you must keep them. |
| 70/30 Plan | The Plan pays claims as if Part B had paid first, so you owe Part B's share (generally 80% of approved outpatient and doctor costs). |
If you or a covered spouse retire Medicare-eligible without Part A and Part B in place by your retiree coverage date, the Plan defaults you to the 70/30 Plan, possibly retroactively and at extra cost, and you may not be able to change until the next Plan Open Enrollment.
When to sign up
- Retiring at 65 or older. Medicare becomes primary in your first month of retirement, while your agency's coverage still applies. Ask Social Security for Part B to start on your retirement date. The Plan suggests applying for retirement through ORBIT up to 120 days ahead.
- Already retired and turning 65. Enroll in Part A and Part B during your Initial Enrollment Period, which starts 3 months before your birthday month. The Plan places you in the Base Plan when Medicare starts.
- Still working for the State. The Plan stays primary while you work, so you can delay Part B and enroll when you retire. See working past 65.
What Part B costs, and the cost of skipping it
The standard Part B premium is $202.90 a month in 2026, more with an income-related amount (IRMAA); CMS publishes 2027 amounts in the fall. The State Health Plan doesn't pay it. If you skip Part B when you're first eligible and aren't covered by current work, you can generally sign up only from January 1 to March 31 and pay a late penalty of 10% for each full 12 months you went without it, for as long as you have Part B. Retiree coverage doesn't count as current-work coverage. Estimate it with the penalty calculator.
More on the Plan's options: State Health Plan retirees and Medicare. To review how individual Medicare plans would fit, you can request a call from a licensed insurance agent.
Related questions
Does the State Health Plan pay for Part B?
Who pays the premium and IRMAA.
What happens to Plan coverage at 65?
The move to the Base Plan.
What Medicare plans does the Plan offer?
The three options for 2027.
Sources
- State Health Plan — Planning for retirement (pre-65) presentation, 2026
- State Health Plan — 2027 Open Enrollment Medicare outreach presentation
- State Health Plan — Retiree Health Benefits Fact Sheet
- Medicare.gov — Retiree insurance and Medicare
- Medicare.gov — Avoid late enrollment penalties
More questions in this guide
- Are NC state employees hired after 2021 eligible for retiree health coverage?
- Can I drop the State Health Plan and buy my own Medicare plan in NC?
- 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?
- 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
When should a state employee retiring at 65 or older sign up for Part B?
Early enough for Part B to start by your retirement date. Medicare becomes primary in your first month of retirement, and the Plan says Part A and Part B should be in effect as of your retirement date. You can sign up as early as 60 days before the date you want.
I'm still working for the State at 65. Do I need Part B now?
No. While you're actively working, the State Health Plan is primary, so the Plan says you can take Part A and delay Part B until you retire. Sign up so Part B starts on your retirement date; you'll use a Special Enrollment Period without a penalty.
What if I'm on Medicare because of a disability?
The Plan becomes secondary from your Medicare eligibility date. If you don't take Part B, the Plan says you are responsible for the amount Part B would have paid.
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