A health plan is a group of doctors, hospitals and other providers. They work together to give youthe health care you need.
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NC Medicaid Managed Care helps you get the most out of your Medicaid benefits. Instead of oneMedicaid program there are many health plans to choose from.
All health plans are required to have the same Medicaid services, such as office visits, blood testsand X-rays. Health plans may also offer added services such as programs to help you quit smoking,eat healthier and have a healthy pregnancy. Health plans work with different doctors and healthcare providers. Each plan has its own network of qualified doctors and health care providers. Tokeep your doctor, clinic or other provider, find out which plans they work with. Then choose oneof those plans.
Some people will be in NC Medicaid Direct because it provides services that meet specific needs.For example, it provides the same services currently covered for developmental disability, mentalillness, traumatic brain injury and substance use disorder. To learn more about NC Medicaid Direct,call 1-888-245-0179.
No. Medicaid eligibility rules are not changing. If you have questions about your eligibility,contact your local Department of Social Services (DSS) office. Find contact information atncdhhs.gov/localdss.
Your PCP is your family doctor, clinic or health care provider. Your PCP will help you with yourhealth care needs. They will also coordinate your care with other health providers.
It depends. Most people in NC Medicaid must choose a health plan. Some people can choose tostay in NC Medicaid Direct. They will not need to choose a plan.
To find out if you must enroll, go to Who must enroll in NC Medicaid Managed Care? atncmedicaidplans.gov/learn/who-must-enroll-nc-medicaid-managed-care. If you still have questions,call us toll free at 1-833-870-5500 (TTY: 1-833-870-5588). Or use the chat tool to chat with us online.
No. You will not lose any services. Health plans may also offer added services.
1 Choose a primary care provider (PCP)
2 Choose a health plan – compare the plans and choose the best one for you
3 Enroll online, use the NC Medicaid Managed Care mobile app, call us toll free at 1-833-870-5500 (TTY: 1-833-870-5588) or fill out and mail or fax back the enrollment form sent to you
The deadline for all counties to enroll is December 13, 2019.
After you enroll, your health plan will mail you information and new Medicaid card. You will use thisMedicaid card to get health care services.
Health plan coverage for all counties will be available starting February 1, 2020.
Until your start date, get care and services the way you do now.
Yes. In the first 90 days, you can change your health plan for any reason. After that, unless you have aspecial reason, you cannot change your health plan until your Medicaid recertification date. Reasonsare listed on the Health Plan Change Request form. For a copy of the form, go to Member resourcesat ncmedicaidplans.gov/member-resources.
We will send you a letter telling you when you can choose a new health plan without a special reason.To learn more, call us toll free at 1-833-870-5500 (TTY: 1-833-870-5588). Or use the chat tool to chatwith us online.
We are open from 7 a.m. to 5 p.m., Monday through Saturday. Call us at 1-833-870-5500(TTY: 1-833-870-5588). During enrollment, from July 15th, 2019 through September 13th, 2019 andOctober 14th, 2019 through December 13th, 2019, we have extended hours from 7 a.m. to 8 p.m.,7 days a week. The call is free. You may need your Medicaid ID number when you call or go to thewebsite. If you do not speak English, our call center is still available to help you with a languageassistance service. You can also use the chat feature on the website to get answers to your questions.
Yes, if your PCP is in the health plan you choose. Here are four different ways you can find out which plans your PCP works with:
• Ask your PCP
• Call us toll free at 1-833-870-5500 (TTY: 1-833-870-5558)
• Go to Find a provider at ncmedicaidplans.gov/enroll/online/choose/find-provider
• Find a list of doctors and other specialists for each health plan on the free mobile app
You can choose your PCP when you enroll in a health plan. To choose the PCP you want after enrolling, call your health plan at the number on your Medicaid card. You can also view contact information for the health plans at ncmedicaidplans.gov/choose/compareplans.
Your health plan works with a provider network. A network is a group of doctors, hospitals andother health care providers who have an agreement with a health plan to give members medical care.Each health plan has a network of doctors for regular visits and specialists when you need certainservices, like physical therapy.
Call your health plan. For contact information, go to ncmedicaidplans.gov/choose/compareplans.You can also ask the doctor to join your health plan’s network.
If you have standing appointments, contact your chosen health plan to ask if they will still be covered.Call your health plan at the number on your Medicaid card. You can also view contact information forthe health plans at ncmedicaidplans.gov/choose/compareplans.