2023 Open Enrollment Information: Medicare Members

2023 Open Enrollment Information: Medicare Members

As a Medicare-eligible member, you will continue to have three plan options in 2023:

  • The Humana® Group Medicare Advantage (PPO) Base Plan (90/10)*

  • The Humana® Group Medicare Advantage (PPO) Enhanced Plan (90/10)*

  • The Base PPO Plan (70/30), administered by Blue Cross and Blue Shield of NC

*The Humana Group Medicare Advantage Plans have a benefit value equivalent to a 90/10 plan.

2023 Open Enrollment for Medicare Members

All Medicare members currently enrolled in the Base PPO Plan (70/30) administered by Blue Cross NC will be automatically enrolled into the Humana® Group Medicare Advantage (PPO) Base Plan (90/10)* effective January 1, 2023. If you want to change plans or need to make changes regarding your dependents, you will need to take action during Open Enrollment, which will be held October 10-28, 2022. 

All members currently enrolled in the Humana Medicare Advantage (Base or Enhanced) Plan (90/10)* will REMAIN on that plan for 2023. If you want to change plans or need to make changes regarding  your dependents, you will need to take action during Open Enrollment. If you are covering non-Medicare dependents on the Enhanced PPO Plan (80/20) you will be required to take action during Open Enrollment to re-elect that dependent coverage.

If you have non-Medicare Primary dependents on your plan, they have different options: the Enhanced PPO Plan (80/20) and the Base PPO Plan (70/30). If they are currently enrolled in the Enhanced PPO Plan (80/20), they will be moved to the Base PPO Plan (70/30) for the 2023 benefit year. You will need to take action during Open Enrollment if your non-Medicare Primary dependents want to be enrolled in the Enhanced PPO Plan (80/20) for the 2023 benefit year. More information regarding these plan options can be found here.

Please note: Although the 80/20 and 70/30 plan names have changed, they are the same plans offered previous to State Health Plan members.

If you are not currently enrolled in the Humana Group Medicare Advantage Plans (90/10), you need to take another look! They have a benefit value equivalent to a 90/10 plan, which could mean significant savings for you! Register for a webinar to learn more of what you might be missing!

Humana Group Medicare Advantage Plan (90/10) vs Base PPO Plan (70/30)

 

Humana Group Medicare Advantage (90/10)* Plans

Base PPO Plan (70/30)

NO Medical or Pharmacy deductibles

 

Spousal Coverage for $4 (Humana Base Plan)

 

Customized plan for you combining Medicare Parts A and B along with Medicare Part D (prescription coverage) into one plan

 

Ability to see providers outside the network for the same copay or coinsurance as in-network providers as long as the provider participates in Medicare and agrees to file claims with Humana

 

Free enrollment in SilverSneakers

 

Hearing aid benefit

 

Routine eye exams

 

Routine hearing exams

 

Lower Urgent Care and ER Copays

 

Humana Well Dine Meal Program where you can receive 2 meals per day for 14 days (total of 28 meals) delivered after an inpatient stay in a hospital or nursing facility

 

In-home Personal Care for $0; a minimum of 3 hours per day, up to a maximum of 6 hours for certain in-home support services following a discharge from a skilled nursing facility or from an inpatient hospitalization

 

Prescription Drug coverage

No referral needed to see a specialist

Preventive services covered at 100%

Disease and case management services

Preferred and non-preferred insulin has a $0 copay for a 30-day supply

 

2022 Base PPO Plan (70/30) Resources

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.

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

These documents and tools include information based on the 2022 formulary and are subject to change prior to January 1, 2023.

Medicare Open Enrollment Outreach Events

Learn more about your 2023 health plan options! Plan to attend one of the State Health Plan’s Medicare Outreach events. Select the link below for the date and time that works best for you to register!

In-Person Outreach Events

These onsite events are intended to help Medicare-eligible members select the best plan for them during 2023 State Health Plan Open Enrollment. Representatives from both the State Health Plan and Humana will be in attendance to assist attendees.

Make sure to register soon, as seating is limited. While registration is encouraged, no ticket is required for this event. Temperatures may vary at each venue, so be sure to bring a light jacket. Please note: no refreshments provided.

Click here to view and register for an in-person outreach event near you

Online Webinars

These online webinars webinars will provide an overview of your 2023 benefits and will include presentations from State Health Plan staff as well as Humana. The content shared during these webinars is the same information that is shared during the in-person Open Enrollment meetings held across the state. 

 On the registration page, click the drop-down menu to select a date and time that works for you! If you need assistance with registering for a webinar, please call the RSVP Hotline at 866-720-0114, Monday - Friday, between 8 a.m. and 5 p.m. ET.

Click here to view and register for an online webinar

Telephone Town Hall Events

Telephone Town Hall meetings are like listening to a radio show over the phone. You'll simply provide your phone number when you register and we'll call you to join the Telephone Town Hall at the start of the event or you can simply call 800-303-1480 at a date and time that is most convenient to you!

Members who have registered and members with a valid phone number in the State Health Plan's enrollment system (eBenefits) will receive a call prior to an event, which will prompt you to join. However, if the phone number we have on file is a mobile number, you must register and agree to be contacted for the meeting via your mobile number. Please note that your phone number will remain confidential and will only be used to contact you for the Telephone Town Hall meeting.

There are two Telephone Town Hall meetings you can register for. Click the link below for date that works best for you!

Click to register for the October 4, 2022 meeting

Click to register for the October 25, 2022 meeting