People on the state health plan may experience another change in providers.

North Carolina Health Plan Considers New Insurer

The North Carolina Health Plan might be on the lookout for a new insurer, just a little over a year after partnering with Aetna.

If changes occur, it could mean shifts in coverage for 750,000 individuals as early as January 2028.

Aetna took over the management of the state health care plan in January 2025, following a decision by officials to revoke the multibillion-dollar contract from Blue Cross Blue Shield, which had been at the helm for many years. Officials indicated that Aetna performed better on various evaluations related to cost and technology.

This transition happened under the guidance of former Treasury Secretary Dale Falwell, who was succeeded last year by state Treasurer Brad Breiner.

“This administration has different priorities and seeks a contract that aligns more with those priorities,” stated Brinner spokeswoman Loretta Boniti.

The state health plan has already started looking into new pharmacy benefit services as of last month.

Philip Brand, a spokesperson for Aetna’s parent company CVS, mentioned that such proposals are routine and they typically don’t comment on prospective bids.

“We collaborated closely with State Health Plan staff to successfully transition to a third-party administrator for the first time in decades, and we remain focused on enhancing the overall health and well-being of State Health Plan members,” Brand noted.

However, reopening the bidding process doesn’t guarantee that Aetna will lose the contract, nor does it imply that the state will return to Blue Cross North Carolina should a change occur.

“The plan is looking for partners to help align incentives among members, providers, and plans. Future collaborations will aid in improving health outcomes and delivering an excellent experience for both members and providers while ensuring financial sustainability,” Boniti explained.

There have been moments of tension between Blue Cross and Mr. Falwell, particularly regarding concerns over pricing and transparency. In 2023, during Falwell’s tenure, the state Health Planning Commission decided to shift the multibillion-dollar contract to Aetna starting in 2025. Blue Cross subsequently filed a lawsuit alleging procedural errors and an unfair scoring method used in the decision process.

Yet, Blue Cross lost that case in 2024, and Aetna officially took over in 2025, coinciding with Breiner’s arrival in office.

The key distinction between the two was that Blue Cross maintained a vast network of healthcare providers in rural areas, while Aetna was more prominent in urban locations. Aetna proposed a higher fee to the state compared to Blue Cross but also accepted steeper penalties for unachieved objectives.