North Carolina State Health Plan Member Education Center
We know NC State Health Plan members have had a lot of information to process in recent months. Following the introduction of the NC State Health Plan's new tiered provider structure and the updated agreement with Atrium Health announced in September, we have heard from many members who still have questions about costs, provider access, specialty care and what actions they should take during open enrollment.
That's why Atrium Health has created this dedicated NC State Health Plan Member Education Center.
Our goal is simple: provide personalized guidance so you can understand your options, make informed decisions, and feel confident about your healthcare choices.
The Latest: Keeping the Care You Know. Protecting the Affordability You Need.
We're pleased to announce the Atrium Health Affordability Protection Program, a new and exciting initiative that ensures members don’t have to choose between the care team they trust and affordability.
Beginning January 1, 2027, enrolled members will have the lowest copays and lowest overall cost-share for care at any Atrium Health facility or provider — less than any other health system across North Carolina.
How the New Atrium Health Affordability Protection Program Works
The Atrium Health Affordability Protection Program is a commitment that lowers the cost-share and co-pays for care enrolled NC State Health Plan members receive at Atrium Health. Through the program, copays for primary care, specialty care, outpatient and inpatient services will be less than amounts members would otherwise pay under the NC State Health Plan's Preferred Tier.
If you are enrolled in the NC State Health Plan’s Standard or Plus Plans, here’s what that looks like:
NC State Health Plan Copay Comparison with Atrium Health’s Affordability Protection Program
Eligibility requirements: To be eligible for the new Atrium Health Affordability Protection Program, you must be enrolled in the NC State Health Plan. The program is available to:
- Active NC State Health Plan members
- Enrolled spouses
- Enrolled dependents
- Retirees younger than age 65 who are enrolled in the NC State Health Plan
- The Affordability Protection Program is not available to retirees aged 65 and older who are enrolled in the NC State Health Plan's Medicare Advantage plans.
Enrollment process: NC State Health Plan members that meet the above eligibility do not need to opt in, sign up or complete a separate enrollment process to participate in the Atrium Health Affordability Protection Program. If you are enrolled in the NC State Health Plan and seek care at Atrium Health, affordability protections will be applied automatically and reflected in your bill.
What the New Atrium Health Affordability Protection Program Means for You
The idea is simple: enrolled NC State Health Plan members will have the lowest cost-share (i.e., copay) when seeking care from Atrium Health, regardless of the NC State Health Plan's tier designation or how they describe the cost of care at Atrium Health.
While the collaborative agreement we reached with the NC State Health Plan in September did take steps to preserve access to many important services, including primary care, behavioral health, emergency services, children's hospitals and rural hospitals, NC State Health Plan members would still face higher costs for certain Atrium Health services beginning in 2027, particularly for specialty care and in communities where Atrium Health hospitals and physicians were assigned to a non-preferred tier.
The new Atrium Health Affordability Protection Program is designed to help address that remaining affordability gap.
Examples
An enrolled member in the Standard Plan under the NC State Health Plan’s tiered structure receiving outpatient surgical care at a non-preferred facility would face a $1,000 copay, a deductible up to $5,000 for an individual and then 30% coinsurance. Under the new Atrium Health Affordability Protection Program, that cost would be reduced to a $400 copay — thousands of dollars less.
Another example is an enrolled NC State Health Plan member on the Standard Plan receiving inpatient care at one of Atrium Health’s urban hospitals under the non-preferred benefit would be responsible for a $1,500 copay, up to a $5,000 deductible and 30% coinsurance under the State Health Plan's tiered provider structure. Under the new Atrium Health Affordability Protection Program, that cost would be reduced to a $500 copay.
Before You Make Any Changes, Talk With Us
Every member's situation is unique.
Before changing physicians to another care provider, canceling appointments, transferring care or making decisions during open enrollment, we encourage you to speak with an Atrium Health representative.
Our team can help you understand your specific provider relationships and eligibility to participate in the Atrium Health Affordability Protection Program.
We believe members deserve personalized guidance, not generalized information. Our goal is to ensure every enrolled NC State Health Plan member has the information needed to make the best decision for themselves and their family.
Frequently Asked Questions
About the Atrium Health Affordability Protection Program
The new Atrium Health Affordability Protection Program is an initiative designed to help enrolled NC State Health Plan members continue receiving care from Atrium Health while addressing additional healthcare costs created by the NC State Health Plan’s new tiered provider structure.
The program is designed to preserve affordability, access and patient choice by reducing the need for members to change providers, particularly when being referred for specialty care.
Beginning January 1, 2027, enrolled members will have the lowest copays and lowest overall cost-share for care at any Atrium Health facility or provider — less than any other health system across North Carolina.
When the NC State Health Plan first announced its tiered provider structure, Atrium Health was not included in either the Access Tier or Preferred Tier despite caring for NC State Health Plan members and their families across North Carolina. Atrium Health submitted several proposals, including an offer to match Preferred Tier pricing so NC State Health Plan members could continue accessing Atrium Health care at the same cost as other Preferred Tier providers, but those proposals were not accepted by the NC State Health Plan.
The subsequent agreement announced on September 14 reflects the NC State Health Plan's final decision regarding Atrium Health's participation in the new network structure after collaborative discussions between our organizations. While that agreement preserved access to many important services, including primary care, behavioral health, emergency services, children's hospitals and rural hospitals, NC State Health Plan members would still face higher costs for certain Atrium Health services beginning in 2027 — particularly for specialty care and in communities where Atrium Health hospitals and physicians were assigned to a non-preferred tier. The new Atrium Health Affordability Protection Program is designed to address and eliminate any remaining affordability gap.
Atrium Health’s new Affordability Protection Program will be available to enrolled NC State Health Plan members beginning January 1, 2027.
To be eligible for the new Atrium Health Affordability Protection Program, you must be enrolled in the North Carolina State Health Plan. The program will be available to:
- Active employees enrolled in the NC State Health Plan
- Enrolled spouses
- Enrolled dependents
- Retirees younger than age 65 who are enrolled in the NC State Health Plan
- The program will not be available to retirees age 65 and older who are enrolled in the NC State Health Plan’s Medicare Advantage plans.
No. Enrolled NC State Health Plan members do not need to opt in, sign up or complete a separate enrollment process to participate in the new Atrium Health Affordability Protection Program.
If you are enrolled in the NC State Health Plan and meet the program's eligibility requirements, the affordability protections will be applied automatically when you receive eligible care at Atrium Health.
The most important enrollment-related action enrolled NC State Health Plan members need to take is selecting an Atrium Health primary care provider during the NC State Health Plan's open enrollment period.
Yes. The Atrium Health Affordability Protection Program is designed to support enrolled NC State Health Plan members across North Carolina, regardless of where they live or the care they need. The level of support does not vary by location. This includes Atrium Health Wake Forest Baptist facilities.
Whether you receive care in a rural community or a major metropolitan area, the program is designed to provide the same affordability protections and help you continue receiving care from the Atrium Health physicians, specialists, hospitals and care teams you trust.
Yes. Download the Affordability Protection Program Flyer (PDF) English / Spanish for a simple overview of how enrolled NC State Health Plan members can receive the lowest copays and overall cost-share when receiving care from Atrium Health providers and facilities beginning January 1, 2027.
Care, coverage and costs
Yes. The goal of the Atrium Health Affordability Protection Program is to help enrolled NC State Health Plan members continue receiving care from the physicians, specialists and care teams they know and trust.
This is especially important when care extends beyond your primary care provider. Whether you need specialty care, ongoing treatment for a chronic condition, or more advanced services, the program is designed to help preserve access to the Atrium Health providers involved in your care while addressing the higher costs that could otherwise result from the NC State Health Plan's tiered provider structure.
In short, the new Atrium Health Affordability Protection Program is intended to reduce the need for members to change providers or leave Atrium Health because of cost concerns, helping support continuity of care across primary care, specialty care, hospital services and other eligible healthcare needs.
Specialty care was one of the most common concerns raised by NC State Health Plan members. The new Atrium Health Affordability Protection Program is intended to help enrolled members continue accessing specialty care by addressing increased costs resulting from the NC State Health Plan's tiered provider structure.
Yes. The NC State Health Plan does not designate tiers for emergency care. If a member has an emergency, members should always go to the nearest emergency department, and the entire care event will be covered the same at all hospitals regardless of tier.
The agreement we reached with the NC State Health Plan in September preserved access to advanced clinical services that are often available only through Atrium Health, including cancer care, cystic fibrosis care, transplant programs and specialized heart care.
The Atrium Health Affordability Protection Program builds on that access by helping ensure enrolled NC State Health Plan members can continue receiving this highly specialized care at the lowest cost-sharing available, regardless of the NC State Health Plan's tier designations.
Yes. While the September agreement preserves ACCESS level of benefits for maternity care at Atrium Health through the end of 2027, the new Atrium Health Affordability Protection Program builds on that tier designation with even better cost share. As a result of this program, enrolled NC State Health Plan members can continue receiving maternity care at Atrium Health with the lowest cost-sharing available, regardless of the NC State Health Plan's tier designations.
This means families can continue receiving care from the physicians, hospitals and care teams they trust while avoiding what could otherwise be thousands of dollars in additional costs during one of life's most important healthcare moments.
Yes. While the September agreement designated Atrium Health's children's hospitals and the specialized pediatric care provided through those facilities at the Access tier level, the new Atrium Health Affordability Protection Program goes a step further, helping ensure enrolled NC State Health Plan members can continue receiving children's and pediatric specialty care at the lowest cost-sharing available, regardless of the NC State Health Plan's tier designations.
Families can continue accessing the pediatricians, specialists, children's hospitals and care teams they trust while benefiting from the affordability protections provided through the program.
Yes. While the September agreement designated behavioral health services at Atrium Health at the Access tier level, the new Atrium Health Affordability Protection Program builds on that access by helping ensure enrolled NC State Health Plan members can continue receiving behavioral healthcare at the lowest cost-sharing available, regardless of the NC State Health Plan's tier designations.
The Atrium Health Affordability Program only applies to care provided by Atrium Health. When you see other physicians not employed by Atrium Health, this program does not apply.
Open enrollment
If you currently have an Atrium Health primary care provider, you can simply select that same provider during open enrollment.
If you do not currently have an Atrium Health primary care provider, our new Affordability Protection Program makes Atrium Health the lowest-cost sharing option available to enrolled NC State Health Plan members, allowing you to choose an Atrium Health provider with confidence.
Members should review all open enrollment materials provided by the NC State Health Plan and carefully consider the coverage options that best meet their healthcare needs. As you do, it is important to keep in mind that State Health Plan materials do not reflect Atrium Health’s new Affordability Protection Program or the impact it could have on their costs.
If you currently have an Atrium Health primary care provider, you can simply select that same provider during open enrollment.
If you’d like to start care with Atrium Health, you should select an Atrium Health primary care provider during open enrollment. Need help finding an Atrium Health provider? Search our provider directory for the greater Charlotte area or the Triad area, or call 844-235-6997.
The new Atrium Health Affordability Protection Program does not replace or change your NC State Health Plan coverage. Instead, it is a separate Atrium Health initiative designed to help address the affordability gap created by the NC State Health Plan's tiered provider structure. For enrolled members, the program helps ensure that receiving care at Atrium Health remains the lowest-cost sharing and copay option available, even when Atrium Health providers or facilities are not included in the NC State Health Plan's Preferred or Access Tiers.
Yes. Whether you are selecting an Atrium Health primary care provider for the first time or an existing patient, the most important thing for you is to make that selection during this year’s open enrollment period.
If you’d like to start care with Atrium Health, you should select an Atrium Health primary care provider during open enrollment. Need help finding an Atrium Health provider? Search our provider directory for the greater Charlotte area or the Triad area, or call 844-235-6997.
Yes. To help ensure your Atrium Health primary care provider is correctly listed for the upcoming plan year, we encourage you to reselect your provider during open enrollment. We also recommend reviewing the information provided by the NC State Health Plan and contacting the plan directly if you have any questions about enrollment or plan requirements.
Get Help
We will continue to update this NC State Health Plan Member Education Center with the latest information. If you have questions about your Atrium Health primary care provider, specialty physician or need additional support, please contact 980-680-1988.