Atrium Health has announced a new Affordability Protection Program for eligible North Carolina State Health Plan members who receive care through Atrium Health. The program is scheduled to take effect January 1, 2027.

The program is designed to reduce out-of-pocket costs for eligible State Health Plan members receiving care at Atrium Health under the Plan’s new provider tier structure. According to Atrium Health, the organization will cover certain deductibles, coinsurance, and other cost differences so that eligible members pay less for qualifying care.

The program does not change State Health Plan benefits or the amount the Plan pays for care.

What State Health Plan Members Should Know

Key details include:

• The program is scheduled to begin January 1, 2027.
• Eligible members do not need to enroll, opt in, or complete additional paperwork. The affordability protections will be applied automatically to eligible care.
• The program is available to eligible active State Health Plan members, enrolled spouses and dependents, and retirees younger than age 65 who are enrolled in the State Health Plan.
• Individuals with Medicare, Medicaid, Medicare Advantage, managed Medicaid, TRICARE, or another similar federally supported plan are not eligible, whether that coverage is primary or secondary.
• The program applies across Atrium Health facilities and practices in North Carolina, including Atrium Health Wake Forest Baptist facilities.
• The program is funded by Atrium Health and is not affiliated with, authorized by, or endorsed by the NC State Treasurer, NC State Health Plan, or State of North Carolina.

Atrium Health also advises State Health Plan members to review their open enrollment materials carefully and consider the coverage options that best meet their healthcare needs.

Learn More

NC State Health Plan members and healthcare practices can review program details, eligibility information, cost examples, and frequently asked questions on Atrium Health’s State Health Plan Education Center.

About This Update

Northwest AHEC shares information that may be relevant to healthcare professionals and practices across our region. Questions about eligibility, benefits, or individual coverage should be directed to the appropriate health plan or healthcare organization.