State Health Plan eyes premium hike, adds digital care platform

Healthcare premiums for 770,000 North Carolina State Health Plan (NCSHP) members in 2026 will be decided at the next NCSHP Board of Trustees meeting on Aug. 15.

They are likely to increase because they haven’t increased in eight years. At the board’s meeting in May, North Carolina State Treasurer Brad Briner said cash reserves had been used to offset any changes to the plan, but the plan is almost out of reserves, necessitating the change.

He said at the meeting that premium increases for the lowest-paid employees were only expected to rise $5 per month rather than the $20 per month that was originally projected when they last met in February, thanks to work by the SHP team and the federal subsidy.

In addition, the plan’s projected deficit — $507 million in 2026 and between $800 million and $900 million in 2027 made the changes necessary not only to the premiums, but for co-pays and deductibles as well, which were voted on in May.

With the change for Active and Non-Medicare members, those under the 70/30 plan would see their annual deductibles go from $1,500 for singles and $4,500 for families to $3,000 and $9,000, respectively. Under the 80/20 plan, deductibles will go from $1,250 for singles and $3,740 for families to $1,500 and $4,500 respectively.

Primary care office visits and specialist visits would see little or no increase.

The plans will also have a name change. The 70/30 plan will now be known as the Standard PPO Plan and the 80/20 will be known as the Plus PPO Plan.

At Tuesday’s Council of State meeting, Briner told members that there shouldn’t be any surprises and that they should land where they thought they would.

He also thanked the General Assembly for helping fund the Plan by passing their “mini-budget,” which is awaiting Democrat Gov. Josh Stein’s signature. The governor signed it on Wednesday,

Additionally, Briner said they have asked “just about every provider in the state” for lower rates, and many have agreed, and they are “working on the rest.”

He also told Council of State members that a partnership with Lantern, a digital specialty care platform, will also benefit the Plan’s members. Briner says the new agreement with Lantern will offer members no‑cost access to a vetted network of surgeons and specialists. Lantern also provides personalized support through dedicated care advocates and nurse navigators, while helping control costs for both members and the plan.

“The State Health Plan is the largest private payer in the state,” Briner said. “We have 770,000 people on the plan. They are price sensitive, no surprise, and we pay better than Medicaid and Medicare, and so we’re a sought after source of patients for every provider in the state. So, we seek to take that and make a recipe out of it, to have better competition in the healthcare business.”

He said that is something that the healthcare business, in general, has been reluctant to embrace.

“Lantern’s going to help us do that,” Briner stated. “The idea is to have high-quality providers compete for our business. Lowest price wins. We’ll pass that low price on to the members of the State Health Plan in the form of no deductibles, no co-pays for major surgeries that we’re going to cover with Lantern.”

He added that the SHP will experience a cost reduction materially as a result, and that’s the recipe where everybody wins, including providers because the Plan bring tremendous volume to them as well.

“Lantern is a great partnership,” the Treasurer noted. “We’re excited to begin that. We will announce results and who will benefit from preferred access to our members over time, but it will get us to a better expense trajectory, which has always been the goal.”

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