Beginning in July, most people with Medicaid coverage will receive benefits through one of five health plans. These plans will have a network, which is the group of doctors, hospitals and other healthcare providers that you can see.
This change means most Medicaid patients will enroll in a new Medicaid plan between March 15, 2021 and May 14, 2021. When enrolling in a Medicaid health plan, patients will choose a primary care provider.
Here are three important things to know.
Check that your doctor is in-network with one of the NC Medicaid plans
All of the plans offer the same basic health care benefits and service. However, the doctors and hospitals included in each health plan may be different. The health plans also offer different non-healthcare related services.
“In-network” means that the healthcare provider or hospital will accept the plan.
What about emergencies? If you have a medical emergency, you should go to the closest hospital emergency room. It does not matter what health insurance plan you have, or if you can pay for emergency services.
How to enroll or change your NC Medicaid plan
Members who need to enroll in a plan will receive an enrollment packet in the mail.
Starting March 15, 2021, people who are eligible (qualify) can choose their health plan and their primary care provider (PCP) in the following ways:
Online: Go to NCMedicaidPlans.gov to enroll online using a computer.
Mobile App: Enroll from your smart phone (Android or iPhone). To get the app, search for NC Medicaid Managed Care on Google Play (Android) or on the App Store (iPhone).
Phone: Calling NC Medicaid toll free at 1-833-870-5500 (TTY: 1-833-870-5588)
Mail or fax: Fill out and send your enrollment form back (by mail or fax)
If you need to enroll in a plan and do not select one, the state will select a plan for you.
Certain Medicaid patients will not need to a pick a new plan
Tribal members and those living in Cherokee, Haywood, Graham, Jackson or Swain County or in a neighboring county of the 5-county region may choose to enroll in the Eastern Band of Cherokee Indians (EBCI) Tribal Option.
Those with behavioral health, substance use, intellectual and developmental disability (I/DD) or traumatic brain injury (TBI) support needs, may ask to stay in NC Medicaid Direct to keep getting services through your Local Management Entity-Managed Care Organization. Request to stay in Medicaid Direct here.