Medicare Advantage Plans Move to Humana in 2021

In March, the State Health Plan announced the award of the Medicare Advantage Fully Insured Plan and Related Services contract to Humana effective January 1, 2021. Medicare Advantage members will continue their current benefits with UnitedHealthcare for the remainder of this year.

The potential cost savings under the new contract is approximately $600 million over the three-year contract. These savings will help protect the State Health Plan’s fiscal sustainability and provide savings back to you in the form of substantially reduced dependent premiums making it more affordable for your loved ones.

If you are currently on the Medicare Advantage Base Plan or the 70/30 Plan, you will REMAIN on that plan and do not need to take action during Open Enrollment. If you are currently on the Medicare Advantage Enhanced Plan, you will be moved to the Medicare Advantage Base Plan for the 2021 benefit year. The Enhanced Plan includes some changes, including some copay reductions and increases and you should re-evaluate this plan. If you would like to elect the Enhanced Plan for 2021, you will need to do so during Open Enrollment.

Open Enrollment is set for October 15-31, 2020. Members will receive more information in the mail on this transition prior to Open Enrollment. Watch for it! Below are a few Frequently Asked Questions about this transition.

Medicare Advantage Plan Rate Comparison

The State Health Plan Board of Trustees has approved the Medicare Advantage Plan rates, which are highlighted below. Premium rates for the 70/30 Plan have not yet been determined as they are driven by the state budget. Premiums will be located in your Decision Guide, which will be mailed to your home prior to Open Enrollment.

Plan Options & Dependent Coverage

2020 Rates

2021 Rates

Medicare Advantage Base Plan Retirees & Medicare Dependents

Subscriber Only

$0.00

$0.00

Subscriber + Child(ren)

$112.00

$4.00

Subscriber + Spouse

$112.00

$4.00

Subscriber + Family

$224.00

$8.00

Medicare Advantage Enhanced Plan Retirees & Medicare Dependents

Subscriber Only

$74.00

$73.00

Subscriber + Child(ren)

$256.00

$146.00

Subscriber + Spouse

$256.00

$146.00

Subscriber + Family

$438.00

$219.00

The premiums shown above apply to retirees and disabled members for whom the State of North Carolina pays 100% of the cost of coverage based on years of service, where the retiree or disabled member and dependents are eligible for Medicare. If you do not have enough years of service to qualify for non-contributory coverage, or you pay 100% of your coverage for other reasons, you are responsible for any premium owed.

Frequently Asked Questions

Why was this change made?

Why was this change made?

The award of the contract was made to Humana after a required and competitive bidding process per state contracting and procurement rules. As a result of the procurement process, the State Health Plan Board of Trustees awarded the contract in March to Humana.

The new contract is expected to generate $590 million in savings over the next three years. Medicare Advantage members will also enjoy a substantial decrease in dependent premiums as a result of this new contract.

Who does this affect?

Who does this affect?

This affects State Health Plan subscribers and their dependents on Medicare Advantage Base and Enhanced plans.

When is this change effective?

When is this change effective?

This is effective January 1, 2021. Medicare Advantage members will continue their current benefits with UnitedHealthcare for the remainder of 2020.

Can I continue to see my provider?

Can I continue to see my provider?

Both Medicare Advantage plans will continue to offer a passive network of providers, which allows members to continue seeing their current providers regardless of being in or out of Humana’s network. Similar to what members experience today, the provider will need to be participating with Medicare and agree to bill Humana.

What if my provider says they do not accept Humana?

What if my provider says they do not accept Humana?

Give this flier to your provider. 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.

Are the benefits changing?

Are the benefits changing?

The Medicare Advantage Base Plan will offer the same benefits members enjoy today. The Medicare Advantage Enhanced Plan does have a few changes, and, in both plans, medication coverage may differ slightly from what you experience today. You will be notified of these changes.

When will I receive more information?

When will I receive more information?

Members will receive more information on this transition prior to Open Enrollment. Watch for more information in the mail. For the latest updates, sign up to receive the Plan’s free, monthly Member Focus e-newsletter.