Show All Answers

1. What is NC Medicaid Managed Care?

NC Medicaid Managed Care helps you get the most out of your Medicaid benefits. Instead of one
Medicaid 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 tests
and 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 health
care providers. Each plan has its own network of qualified doctors and health care providers. To
keep your doctor, clinic or other provider, find out which plans they work with. Then choose one
of those plans.

2. What is NC Medicaid Direct?

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, mental
illness, traumatic brain injury and substance use disorder. To learn more about NC Medicaid Direct,
call 1-888-245-0179.

3. Is Medicaid eligibility changing?

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 at
ncdhhs.gov/localdss.

4. What is a primary care provider (PCP)?

Your PCP is your family doctor, clinic or health care provider. Your PCP will help you with your
health care needs. They will also coordinate your care with other health providers.

5. What is a health plan?

A health plan is a group of doctors, hospitals and other providers. They work together to give you
the health care you need.

6. Do I have to choose a health plan?

It depends. Most people in NC Medicaid must choose a health plan. Some people can choose to
stay 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? at
ncmedicaidplans.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.

7. Will I lose any services when I enroll?

No. You will not lose any services. Health plans may also offer added services.

8. What do I need to do?

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

9. What is the deadline to enroll?

The deadline for all counties to enroll is December 13, 2019.

10. What happens after I enroll?

After you enroll, your health plan will mail you information and new Medicaid card. You will use this
Medicaid 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.

11. Can I change my health plan after I enroll?

Yes. In the first 90 days, you can change your health plan for any reason. After that, unless you have a
special reason, you cannot change your health plan until your Medicaid recertification date. Reasons
are listed on the Health Plan Change Request form. For a copy of the form, go to Member resources
at 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 chat
with us online.

12. When can I call to get help?

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 and
October 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 the
website. If you do not speak English, our call center is still available to help you with a language
assistance service. You can also use the chat feature on the website to get answers to your questions.

13. Can I keep my current primary care provider (PCP)?

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.

14. Why can I only visit certain doctors?

Your health plan works with a provider network. A network is a group of doctors, hospitals and
other 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 certain
services, like physical therapy.

15. What if I have a scheduled visit with a doctor who is not in my health plan’s network?

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.

16. What if I have a chronic health condition, standing appointments or an upcoming surgery/procedure?

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 for
the health plans at ncmedicaidplans.gov/choose/compareplans.