Planning for Retirement

Retired or Preparing for Retirement

This page is designed to assist members as they prepare for retirement and for members who are already retired, but becoming Medicare eligible. The sections below contain important information categorized by age and by Medicare eligibility.

Please note that all new retirees who are eligible for State Health Plan coverage will be automatically enrolled into a plan at the time of retirement even if a member did not have Plan coverage as an active employee.

If you still have questions about your health plan options, eligibility or premium rates, you may contact the Eligibility and Enrollment Support Center at 855-859-0966.

When You Plan to Retire and Are Not Yet 65

You are encouraged to talk with your Health Benefits Representative (HBR) or Human Resources department ahead of time to plan the proper steps. Retiring members who are eligible for coverage under 65 will be automatically enrolled in the health plan they were enrolled in as an active employee along with any covered dependents, regardless of contribution status.

When You Approach 65 and Plan to Continue Working

Many State Health Plan members continue working after the age of 65. The State Health Plan mails you a Medicare eligibility letter prior to your 65th birthday. The letter asks that you confirm your eligibility for Medicare benefits.

If you are actively working for the state after 65, the Plan will continue to be your primary coverage and Medicare will be secondary. This means you can choose to enroll in Medicare Part A but you can delay enrollment into Medicare Part B until you actually retire from state employment. However, it will be important to remember to enroll in Medicare Part B to become effective as of your retirement date.

When You Plan to Retire and Are 65 or Older

It is recommended to talk with your HBR or Human Resources department ahead of your retirement to plan your steps and submit your retirement paperwork at least 120 days prior to your planned retirement date.

Medicare Primary members have several options for health plan coverage. These options include the following plans:

  • UnitedHealthcare® (UHC) Group Medicare Advantage (PPO) Base Plan
  • UnitedHealthcare® (UHC) Group Medicare Advantage (PPO) Enhanced Plan
  • 70/30 Plan

In order for a retiree to be eligible for the UHC Group Medicare Advantage (PPO) Plans, the retiree must be enrolled in Medicare Parts A and B.

To enroll in Medicare, please contact the Social Security Administration at 800-772-1213 or www.socialsecurity.gov.

If you are eligible for State Health Plan benefits under the State Retirement Systems, then you will be auto-enrolled into either the UHC Group Medicare Advantage (PPO) Base Plan or the 70/30 PPO Plan.  The plan will be dependent upon when your retirement paperwork is processed and approved by the State Retirement Systems. Please see the table below.

Medicare Eligibility and Automatic Enrollment

Member Eligibility Paperwork Status Auto-Enrollment Decision Timeline
Retiring members and/or dependents who are Medicare-eligible AND Retirement paperwork (6E Form and any other required documents) is processed and approved 60 days or greater from their  retiree health plan benefit effective date, THEN THEY WILL BE Automatically enrolled into the UHC Group Medicare Advantage (PPO) Base Plan. For qualified retirees, the plan is premium-free for retiree-only coverage. Retirees will have up to 30 days PRIOR to their benefit effective date to change plans if they desire.
Retiring members who are Medicare-eligible AND Retirement paperwork (6E Form and any other required documents) is processed and approved less than 60 days prior to their retiree health plan benefit effective date, THEN THEY WILL BE Automatically enrolled in the 70/30 Plan. For qualified retirees, this plan is also premium-free for retiree-only coverage. Retirees will have up until the day before the health plan effective date to elect a Medicare Advantage option.

Note: If no action is taken, retirees will remain in the UHC Group Medicare Advantage (PPO) Base Plan or 70/30 Plan for the remaining portion of the plan year. Changes to plan elections for the following plan year can then be made during the next Open Enrollment period. If the retiree has dependents that are non-Medicare Primary, they will be automatically enrolled into the health plan they were enrolled in as an active dependent.

Important reminder: Your health plan benefit effective date is the first of the month following your retirement effective date. For example: If your retirement date is January 1, your health plan benefit effective date is February 1. Please note that for active members who will be Medicare eligble at the time of retirement, Medicare becomes primary the last month that a retiring active member is covered by his or her agency and the Medicare reduced rate applies. Members should be aware of the Medicare primary change and the need to elect Medicare Part B to be effective as of the date of their retirement.

When You Are Already Retired and Turning 65

If you are already retired and about to turn 65, you will become eligible for Medicare and your options under the State Health Plan will change. The State Health Plan will automatically enroll you into the UHC Group Medicare Advantage (PPO) Base Plan to become effective when you become Medicare-eligible/Medicare Primary. You will receive written notification of this auto-enrollment from the State Health Plan approximately 80 to 90 days before your Medicare becomes effective and be given an opportunity to make a change. However, if you want to make a change, you will need to notify us no later than 30 days before your Medicare coverage is to become effective. This plan is premium-free for qualified retiree-only coverage.

NOTE: It will be very important for you to enroll in Medicare Part A and Medicare Part B as soon as you are permitted. The earliest you may enroll in Medicare is any time during the three months prior to your 65th birthday month. To enroll in Medicare, contact the Social Security Administration at 800-772-1213.

Important Resources

Resource Subject Phone Number
State Health Plan Eligibility and Enrollment Support Center For questions regarding enrollment or eligibility, to make address changes or for assistance with the eBenefits enrollment system. 855-859-0966
Blue Cross and Blue Shield of North Carolina For questions regarding the 70/30 Plan. 888-234-2416
UnitedHealthcare For questions regarding the Medicare Advantage Base and Enhanced plans. 866-747-1014
Social Security Administration For questions regarding Social Security. The U.S. Social Security Administration administers Social Security, a social insurance program consisting of retirement, disability and survivors' benefits. (800) 772-1213
Seniors' Health Insurance Information Program (SHIIP) For questions regarding Medicare enrollment. 855-408-1212

Remember: It is essential for the State Health Plan to have your most up-to-date contact information (i.e., both physical and mailing addresses, phone numbers, email address) to ensure you receive important benefit details and other information. To report any changes, contact the Eligibility and Enrollment Support Center at 855-859-0966.