2020 Open Enrollment: Medicare Members

Icons representing the State Health Plan

If you are satisfied with the plan in which you are currently enrolled, you may keep it and no action is required. If you wish to change your plan, add or remove dependents, or opt out of the State Health Plan you must do so during Open Enrollment, which will be held November 2-19, 2019.

The changes you make during Open Enrollment are for benefits effective January 1, 2020, through December 31, 2020.

Click here to get started to complete Open Enrollment

2020 Plan Options

As a Medicare-eligible member, you have three plan options in 2020:

The UnitedHealthcare® (UHC) Group Medicare Advantage (PPO) Base Plan

The UnitedHealthcare® (UHC) Group Medicare Advantage (PPO) Enhanced Plan

The 70/30 Plan, administered by Blue Cross and Blue Shield of NC

Important News for 2020

  • There are no benefit changes for the UHC Group Medicare Advantage Plans for 2020.
  • There has been a slight increase in premium rates for the UHC Medicare Advantage Plans. This is due to the Health Insurance Provider Fee, which is a federally mandated tax on fully insured Medicare Advantage products.
  • There have been several benefit changes for the 70/30 Plan:
    • You will have access to the SAME network that you have today, which is called the Blue Options network administered by Blue Cross NC. This includes statewide coverage and all hospitals.
    • Preventive services will be covered at 100% (copays have been eliminated)
    • Primary Care Provider (PCP) copay reduction from $45 down to $30 when you visit the PCP listed on your ID card
    • Medical coinsurance and pharmacy maximums are now combined into one maximum out-of-pocket amount
    • Changes have been made to the deductible and some copays

2020 70/30 Benefit Booklet

2020 Plan Comparison

2020 Uniform Summary of Coverage - 70/30 Plan

Medicare Primary Open Enrollment Webinar Presentation


Non-Medicare Primary Dependents

If you have non-Medicare Primary dependents on your plan, they have different options: the 80/20 Plan and the 70/30 Plan. If they are currently enrolled in the 80/20 Plan, they will be moved to the 70/30 Plan for the 2020 benefit year. Action will need to be taken during Open Enrollment if they want to be enrolled in the 80/20 Plan for the 2020 benefit year. More information regarding these plan options can be found at www.shpnc.org.

Pharmacy Resources for the 70/30 Plan

*For drug lookup tool: If a drug is not covered, the following advisory will appear under Plan Notes: “Not covered: Ask your doctor about alternatives.”

CVS Caremark is the State Health Plan’s Pharmacy Benefit Manager.

The State Health Plan utilizes a custom, closed formulary (drug list). The formulary indicates which drugs are excluded from the formulary and not covered by the Plan. All other drugs that are on the formulary are grouped into tiers. Your medication’s tier determines your portion of the drug cost.

Please Note: These tools include information based on the 2019 formulary and are subject to change prior to January 1, 2020.

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