*Network disruptions and announcements are subject to change.*
The first Monday of AEP brought no shortage of changes for North Carolina agents. During our webinar, “Important Updates: NC Disruption,” we reviewed several major network developments, carrier changes, and ongoing uncertainty surrounding North Carolina State Health Plan retirees. These updates could have an impact on your conversations throughout AEP.
Here’s a recap of the key takeaways.
Major Network Additions Agents Should Know
Several carriers have expanded their provider network, creating new opportunities for agents and consumers.
Alignment Healthcare Expands Charlotte-Area Network
Alignment Healthcare has made several additions to its HMO network, including:
- OrthoCarolina
- Urology Specialists of the Carolinas
- Tryon Medical Group
- Iredell Health System
While some providers may not yet appear in Alignment’s online directory, agents were advised that carrier representatives can assist with provider verification when needed. These additions strengthen Alignment’s presence in the Charlotte market and may create new opportunities for clients looking for access to these provider groups.
Devoted Adds Charlotte Eye, Ear, Nose & Throat (CEENTA)
Devoted Healthcare announced that Charlotte Eye, Ear, Nose & Throat (CEENTA) is now participating in its HMO network.
This is particularly important as Devoted’s Chronic Special Needs Plans (C-SNPs) and Dual Special Needs Plans (D-SNPs) continue to attract the attention of many beneficiaries in 2027.
Access to this major specialty provider group strengthens the value proposition of this carrier’s plans.
CarolinaEast Hospital Joins Blue Cross Blue Shield and UnitedHealthcare
Agents serving Eastern North Carolina received encouraging news as both Blue Cross Blue Shield of North Carolina and UnitedHealthcare announced agreements with CarolinaEast Hospital in New Bern.
According to updates shared during the webinar:
- CarolinaEast physicians are already in network
- Hospital participation is expected to begin January 1
- This provides Medicare Advantage members in the area with valuable continuity of care options
For beneficiaries in Craven County and surrounding areas, this development helps alleviate concerns about access to local care.
Important Network Changes and Losses
While some carriers expanded, others experienced notable disruptions.
HealthSpring Loses Duke Health
HealthSpring agents should be aware that Duke Health will be leaving the carrier’s network.
This change could affect beneficiaries throughout:
- Durham
- Raleigh
- Burlington
- Surrounding Triangle markets
Agents were encouraged to verify provider participation carefully before submitting applications, as network changes may not appear immediately within carrier portals.
Humana and Mission Health PCPs Part Ways
In Western North Carolina, Humana members may face challenges involving Mission Health primary care providers.
Current guidance indicates:
- Mission Health primary care physicians are out of network with Humana
- Mission specialists remain in network
- Mission Hospital remains in network
This distinction is important because beneficiaries who wish to keep a Mission-affiliated primary care physician may need to have alternative plan options or prepare for higher out-of-network costs depending on their coverage.
State Retirees: What We Know Right Now
*Regarding this section: This information is subject to change, and nothing has been confirmed.*
The most discussed topic of the webinar was the ongoing confusion surrounding North Carolina State Health Plan retirees.
State Health Plan to Take Atrium Out of Network
The State Health Plan has confirmed that Atrium Health is out of network for the Aetna commercial plan used by state employees and retirees.
According to the webinar discussion, this decision was made by the State of North Carolina, not Aetna. For retirees relying on the Aetna 70/30 plan, Atrium access remains one of the largest concerns heading into 2027.
Questions Remain About Humana Group Medicare Advantage Members
One of the biggest unanswered questions is whether state retirees enrolled in the Humana Group Medicare Advantage plan will maintain access to Atrium providers.
As of right now:
- No clear guidance had been provided by the state
- State retirees have received mixed messages
- Carrier and industry sources offered conflicting information
- No official confirmation had been issued regarding Atrium’s status under the group Humana Medicare Advantage plan
The message to agents was simple: proceed cautiously and avoid presenting assumptions as fact until formal clarification becomes available.
Enrollment Deadline Extended
Another development is that North Carolina’s original decision deadline has been extended.
State retirees now have until November 6 to make their enrollment elections. Given the confusion surrounding the situation, future extensions would not be surprising, although none have been announced.
*Regarding this section: This information is subject to change, and nothing has been confirmed.*
Agent Opportunities During the Disruption
While uncertainty can be frustrating, it also creates opportunities for meaningful client conversations.
Agents were encouraged to:
- Review state retiree options carefully
- Evaluate whether a Medicare Advantage plan may provide stronger coverage than relying solely on the Aetna 70/30 option
- Compare medication costs before recommending MA-only versus MAPD plans
- Discuss provider access concerns on an individual basis
- Help spouses evaluate whether remaining on the State Health Plan is the most cost-effective solution
For this AEP, there is no one-size-fits-all answer. The best solution will depend on each client’s provider preferences, medications, healthcare utilization, and financial goals.
Other Network Updates Discussed
Other topics addressed during the Q&A section of the call included:
- Humana and UNC remain out of network on the individual side
- State retirees on the Humana Group Medicare Advantage plan may still have access to UNC facilities
- UnitedHealthcare remains in network with UNC at this time
- Agents should continue monitoring developments surrounding the proposed WakeMed and Atrium merger, as future network implications are uncertain
Takeaway and Moving Forward
If there’s one takeaway from this webinar, it’s that North Carolina’s Medicare landscape continues to change rapidly during AEP. Network changes, state retiree uncertainty, and carrier updates are creating new challenges, but also new opportunities for agents willing to stay informed and guide clients through complex decisions.
As additional information is released, especially regarding Atrium’s status for Humana State Health Plan retirees, agents should expect further updates. In the meantime, verifying networks, reviewing drug costs, and having thoughtful one-on-one conversations with clients will be more important than ever this AEP season.
Missed the webinar? Watch the full video here.
Remember to stay connected with us for future NC market updates as we continue to track and inform you of developing changes throughout AEP.
*Network disruptions and announcements are subject to change.*
