2021 Benefit Information: Medicare Members

2021 Plan Options

As a Medicare-eligible member, you have three plan options in 2021:

The Humana® Group Medicare Advantage (PPO) Base Plan

The Humana® Group Medicare Advantage (PPO) Enhanced Plan

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

Important News for 2021

  • Humana will offer the State Health Plan’s Group Medicare Advantage Plans for 2021.
  • Because of this change there will be substantial savings for dependent premiums on the Medicare Advantage plans in 2021!
    • Medicare-eligible subscriber and spouse, $4 (down from $112 in 2020)
    • Medicare-eligible subscriber and child, $4 (down from $112 in 2020)
    • Medicare-eligible subscriber and family, $8 (down from $224 in 2020)
  • If your provider says that they do not accept Humana, give them this flier. Sharing this information can help your provider understand how this plan works. Humana will also be doing an extensive provider education campaign to tell providers about this change and to remind them how our plans work.
  • Humana is open to take your questions about your 2021 Medicare Advantage Plan benefits. Please note that their system does not have your personal information and they will only be able to provide general benefit information. Humana Customer Service is available Monday-Friday 8 a.m.-9 p.m. ET at 888-700-2263.
  • There have been several benefit changes for the 70/30 Plan:
    • If you select a Clear Pricing Project (CPP) provider as your Primary Care Provider listed on your ID card, your visits are free!
    • If you visit a Clear Pricing Project specialist, 70/30 Plan members will only pay $47 for a CPP specialist ($94 for a non-CPP specialist).
    • The copay for insulin has been waived, which means for a 30-day supply of insulin, members will have a $0 copay!


2021 70/30 Plan Resources

*The prescription medications listed or their tier placement may change from time to time due to a change in cost and/or classification of medication.

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.

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