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Countless North Carolina Medicaid beneficiaries have transitioned into an NC Medicaid Managed Care Plan. One option is Blue Cross and Blue Shield of North Carolina’s Healthy Blue of North Carolina plan, exclusively for the state’s eligible Medicaid members. As of June 2023, 2,360,473 North Carolinians are enrolled in the program. To prevent shouldering the debt of unexpected medical expenses, many North Carolinians extend their Medicaid coverage to include a more comprehensive range of benefits and services by way of private health insurance.
Here, you’ll learn how you and your loved ones can access affordable healthcare through NC Medicaid. You can receive the treatment you need and extend your AHCA coverage for a well-rounded health insurance plan.
Eligible candidates for NC Medicaid’s health plans are residents who meet income and household size requirements.
The state of North Carolina, together with the federal government, jointly funds NC Medicaid Managed Care, which was previously called Medicaid. So, what is Healthy Blue offering for those currently signing up for this health insurance plan? For a North Carolina resident who meets Medicaid's eligibility and income requirements, choosing this particular plan offers free or low-cost healthcare that includes excellent access to doctor's visits, prescriptions, dental care, and much more.
Is Healthy Blue Medicaid? Technically, yes it is, and North Carolina’s Medicaid members have access to this medical insurance plan.
However, the first piece of information to note is the change that took place with the North Carolina Medicaid expansion in 2021. At this point, Medicaid plans changed in the state of North Carolina. Instead, they formed five separate NC Medicaid Managed Care Plans as follows:
When you join the program, you receive an NC Medicaid Managed Care card with essential information as the one shown above, such as:
After receiving approval, you should receive this card in the mail. Typically, it arrives shortly after the Medicaid welcome packet.
You have the following enrollment options for joining an NC Medicaid Managed Care Plan:
The two quickest ways to enroll are online with the app or a computer and your NCID account. If you already have your North Carolina Identity Management account active, you can apply online at NCID.nc.gov. Alternatively, download the NC Medicaid Managed Care mobile app and start your enrollment via your smartphone.
If you're wondering how to apply for Healthy Blue the old-fashioned way, you can also call the application department at 1-833-870-5500 (toll-free) or (TTY: 711 or RelayNC.com). You also have the option to fax your enrollment form to 1-833-898-9655 or mail it to the following address:
NC Medicaid
PO Box 613
Morrisville NC 27560
Explore your enrollment options at https://ncmedicaidplans.gov/en/enroll.
North Carolina Medicaid eligibility requirements include being a North Carolina resident (either as a documented non-U.S. citizen or U.S. citizen). If you meet the income and household size requirements, you must also fit one of the following categories:
Those who are eligible for the newly switched NC Medicaid Managed Care program will choose one of the five plans for their needs. All plans are statewide, except Carolina Complete Health, Inc., which is only available in some North Carolina counties.
A single person has a maximum income requirement of less than half a household size of five’s requirement. Check your household size and income limit at https://www.benefits.gov/benefit/1390.
You will get your NC Medicaid Managed Care card shortly after applying and choosing a plan. If you select Healthy Blue, you'll receive a card in the mail with your Medicaid ID number and PCP information. You can begin the enrollment process at https://ncmedicaidplans.gov/en/enroll.
If you lose your Medicaid card, you can call 844-594-5070 (TTY: 711). You may still access some of your NC Medicaid Managed Care services while you're waiting for your new card to come in. Visit healthybluenc.com for help.
What is Healthy Blue coverage offering? Now that you know how to apply for it, understanding what Healthy Blue covers can help you decide whether your NC Medicaid Managed Care plan will meet your needs. You can enjoy excellent benefits through your medical plan, including the ones covered below:
With NC Healthy Blue and North Carolina Medicaid, you can receive high-quality dental care services to maintain and improve your oral health. These include treating injuries, impairments, and diseases through oral exams, screenings, cleanings, and more.
Like with Medicaid programs across other states, children with Medicaid in North Carolina often receive more comprehensive dental care benefits. The local dental services may offer fluoride application, sealants, x-rays, cleanings, exams, and other treatments to safeguard oral health.
For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in North Carolina is advisable.
Each plan under NC Medicaid Managed Care has its own pharmacy benefits manager. The PBM for Healthy Blue is IngenioRx. Why not take a look at NC Medicaid's Preferred Drug List to see the coverage available for the prescriptions you need?
In North Carolina, you can get help paying for prescription drugs and other medications with the following programs:
You can also get assistance for over-the-counter medicines, insulin for diabetes, emergency contraception, surgical and medical supplies, and medications to help you quit smoking. There is a plan to prevent members from overusing or incorrectly using pain medications, too.
Will you have copays for your prescriptions? It depends on the specifics of your plan. The typical copayment for Medicaid prescriptions in North Carolina is minimal, but those who are pregnant, under 21, receiving hospice care, or in other qualifying groups will have zero copayments.
You can send a message to Healthy Blue if you have benefit questions. You can also call Member Services Monday through Saturday at 844-594-5070 (TTY 711).
The Medicaid program as a whole provides comprehensive treatment options and services for numerous needs. For example, you can access everything from family planning and maternity care to dental and orthodontic services. Still, many Medicaid North Carolina plans provide extended healthcare services to those who need mental health services, care for intellectual disabilities, and substance abuse disorder treatments. Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work either temporarily or permanently, and to help with the cost of medical needs.
You can contact your plan provider to learn specific details about your coverage and benefits.
You will receive out-of-state care if you are experiencing a life-threatening medical emergency, such as injuries to various body parts and organs. Pregnant women who cannot transfer to a North Carolina hospital due to a threat to their life or the baby can also receive medical care where they are.
However, just like Medicaid coverage across other states, North Carolina’s Medicaid does not cover healthcare services outside of state lines. If you are waiting for coverage approval or moving to North Carolina and looking for coverage, you may also need to receive reimbursements or retroactive care. Saving your records and any medical expenses can help support your case and with future coverage.
Note that retroactive coverage for North Carolina Medicaid is for up to three months before the month you applied.
If you are traveling outside of North Carolina for leisure, invest in proper travelers insurance.
There are no specific Medicaid coverage details for students in North Carolina, but public schools can use Medicaid funds to provide care to students. These instances may include the need to access physical and occupational therapy, nursing services, audiology support, or speech-language pathology services. Healthy Blue also provides rideshare gift cards for college students to attend local events, obtain groceries, and more.
For seniors who need long-term care and support, there will be assistance through the NC Medicaid plan. From providing care for day-to-day activities to arranging a move to a long-term care facility, seniors can find the support they need from their insurance coverage as follows:
All seniors who have a limited income should receive Medicaid for their needs. If you’d like more information on eligibility, call (888) 245-0179. Then, use the ePASS portal with your NCID to enact enrollment and find information.
Besides providing care for students and seniors, North Carolina Medicaid also offers services for American Indians or Native Americans and members of the military or veterans. State services for these groups are also available to make accessing and paying for necessary medical services easier. Browse the kinds of benefits these groups can obtain for their healthcare needs below.
Individuals or federally recognized tribe members can choose how they receive Medicaid services if they qualify for the Indian Health Service (IHS). Enrolling in a Standard Plan typically means becoming a Healthy Blue member. Depending on their medical needs, they also have the choices of the EBCI Tribal Option, Tailored Plans, or NC Medicaid Direct.
If you are a Native American and have questions about your eligibility, why not contact your local Department of Social Services (DDS)? Find locations in your area by visiting ncdhhs.gov/localdds. Those seeking insurance typically must share their name, tribe information, and how they are enrolled or affiliated with a specific tribe to verify their citizenship.
No specific plan covers veteran or military members only, and these groups will generally receive Medicaid coverage on one of the standard plans. However, health services and other benefits are available for members of the military, veterans, and their families through the following:
Are you wondering about coverage for specific services? If you are part of this group, you can reach out to your plan provider (Healthy Blue, WellCare, etc.) to determine your benefits. If you’re unsure of your coverage, always ask before booking anything!
Since you have a better understanding of what Healthy Blue covers and what general Medicaid coverage in North Carolina looks like, it's good to remember the services your plan won't cover. Coverage items vary based on which of the five Medicaid plans you have, so speak with your provider about the most up-to-date coverage information.
Additionally, note the following common items that Medicaid in North Carolina does not offer coverage for:
It is also important to note that NC Medicaid doesn’t put forth funds towards the cost of a funeral. Considering the rising cost of burial and related fees, ensure that your family is secured with comprehensive funeral insurance.
Besides offering normal visits with your PCP, labs and testing, and specialist referrals, North Carolina Medicaid provides many other healthcare services as part of your coverage.
Consider these primary categories with specific benefits to you as a Medicaid member:
| Dental | |
|---|---|
| X-Rays and exams | North Carolina’s Medicaid deems these services as medically necessary for adult and child members. They may also provide tooth restoration, cleanings, and more. You can get yearly exams and X-rays every five years. |
| Wisdom teeth | Tooth extractions for wisdom teeth may fall under Medicaid coverage if it is necessary for your oral health. |
| Vision | |
|---|---|
| Eye Exams | Medicaid members can receive routine eye exams from optometrists and ophthalmologists in North Carolina to assess their optic health. |
| Glasses | You can obtain eyeglasses, lenses, and optic frames or contact lenses from your provider in North Carolina. |
| Laser Eye Surgery | North Carolina Medicaid plans do not often cover laser eye surgery if other treatment options are available. They may make an exception if your specialist deems it medically necessary, but this is rare. |
| Surgery | |
|---|---|
| Rhinoplasty | Medicaid will cover rhinoplasty surgery only if it falls under specific criteria, such as being medically necessary for a member's quality of life or health. This might include blocked nasal passages, trauma, or similar challenges. |
| Breast Augmentation | Breast augmentation procedures are cosmetic services, which do not fall under what Medicaid covers. Therefore, if you are seeking this treatment, you'll need to pay out-of-pocket or attempt to receive permission for medical reasons. |
| Hospital | |
|---|---|
| Hospital stays | North Carolina will cover hospital services for Medicaid members, including admission, outpatient care, inpatient care, labs, and related services. When treatment remains in the state of North Carolina, Medicaid will offer coverage. |
| Ambulance transportation | When you require emergency medical services and need transportation via ambulance, Medicaid will bring you to a nearby medical facility. The provider should operate in North Carolina and have their proper licenses. |
| Giving birth | You can receive medical care for the delivery of your baby but also access prenatal and postpartum care. You can obtain healthcare services for you and your child for several months after delivery, including a medically necessary home visit. |
Medicaid in North Carolina allows its members to seek out mental health services for their needs. They can book individual, group, or family therapy services from a provider that accepts Medicaid or their specific plan. These services can also include assessments and psychological testing.
Behavioral health counseling is part of your Medicaid coverage. You may also obtain medication management services as they relate to your mental health and general well-being. Talking to your PCP or Medicaid plan provider (like Healthy Blue) can help you book these services.
| Sexual Health | |
|---|---|
| Gynecologist visits | You can book OB/GYN appointments with a provider that accepts Medicaid or Healthy Blue. Assistance for family planning and birth control also falls under this type of care so that you can work with your primary care doctor or specialist. |
| Erectile Dysfunction | Medicaid doesn't cover erectile dysfunction drugs or treatments. However, men can obtain family planning healthcare services for their needs, including screenings, reproductive healthcare, and more, to take control of their health. |
| Birth Control | With birth control services, North Carolina’s Medicaid aims to help Medicaid make smart family planning choices. They offer birth control for eligible men and women, with options that include the pill, IUDs, injectable drugs, implant devices, and emergency contraceptives. Medicaid members can also receive ultrasounds to check for IUD complications but not for routine IUD checkups. Keep in mind that for diaphragms, Medicaid may cover the fitting but typically won’t pay for the actual device. Be sure to ask your service provider for details before agreeing to anything. |
| Fertility Treatment | Although North Carolina Medicaid helps with family planning and services for pregnant women, they will not cover fertility or infertility treatments. Reproductive health services are available, as are various resources. However, fertility is not a part of that. |
| Specialist Services | |
|---|---|
| Dermatology | Skincare health assessments to treat diseases and problems typically fall under Medicaid. You can look for a dermatologist who accepts Medicaid or obtain a referral through your primary care provider. Cosmetic services like chemical peels do not fall under medically necessary dermatology services. |
| Physiotherapy | You could receive care for your chronic pain, sports injuries, or other medically necessary physiotherapy services. |
| Massage Therapy | Medicaid may cover massage therapy, depending on your plan. Healthy Blue often does not cover it. |
| Podiatry and Foot Care | Medically necessary footcare services include corn and callus cutting and removal, hygienic care that relates to vascular care or diabetes, and nail treatments like cutting, clipping, debriding, or trimming. |
| Allergy Testing | Medicaid covers necessary allergy tests for eligible members but not all types of tests. |
| Sleep Physician Services and CPAP Machines | Members with sleep apnea and those seeking sleep services can obtain a CPAP machine with approval if they meet the criteria. |
North Carolina’s Medicaid options offer great coverage. Still, obtaining private or third-party coverage can strengthen your current coverage by adding an extra layer of protection. Not only can you receive care from medical providers and specialists outside of your network, but you can also get help paying for treatments, access medical services out of the state, and explore alternative medical treatments. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.
Other benefits of acquiring third-party or private insurance include the following:
A service like Insurdinary can help you compare potential coverage options and find the best fit. The right care lets you spend less and receive incredible services, and that’s the kind of matchmaking Insurdinary’s team does best.
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:
