NC State Health Plan adds Duke Health to its access tier, meaning members will pay more for WakeMed

July 15, 2026 - 20:16

North Carolina's State Health Plan has finalized a major change to its network structure, adding Duke Health to its highest access tier while moving WakeMed to a lower one. The board approved the new tiered benefits system last week, with the changes set to take effect in 2027.

Under the new arrangement, plan members will pay higher out-of-pocket costs when they choose WakeMed facilities. Duke Health, meanwhile, joins the "access tier," which offers lower copays and deductibles. The decision follows months of negotiations and analysis of cost and quality data across the state's major hospital systems.

Officials say the goal is to steer patients toward hospitals that provide high-quality care at lower overall costs. WakeMed had been in the preferred tier during previous contract periods, but the board's latest vote shifts its status. The move is expected to affect thousands of state employees, teachers, and retirees who rely on WakeMed for routine and emergency care.

The plan covers more than 750,000 members, making it one of the largest health insurance purchasers in North Carolina. Hospital systems have long competed for favorable placement in its network, since tier status directly influences patient volume. Duke Health's inclusion in the top tier is seen as a win for the system, which has expanded its community hospital footprint in recent years.

WakeMed responded by noting its commitment to affordable care and said it would continue working with the plan to address concerns. The changes will not take effect for more than two years, giving members time to adjust their choices.