Tips for choosing a health plan

If you are choosing a health plan for the first time:

To keep your primary care provider (PCP), choose a health plan your PCP is in. Use these questions to help you choose the best health plan for you:

• Do you want to keep your current provider? Or do you want a new one?
• Does the health plan have the providers, hospitals and specialists you use? To find out, go to Find a provider.
• Does anyone in your family have special health needs?
• What added services does the health plan have? To view each health plan’s added services, go to View health plans.

If you want to change the health plan you chose or that we chose for you, here are some things to think about:

If you must enroll in a health plan, you can change your health plan up to 90 days after the start date shown on your health plan enrollment letter. After that, you can change your health plan:

• At your Medicaid recertification date
• If you are required to change health plans
• If you have a special or “with cause” reason, such as:
  • You moved out of your health plan’s service area
  • You have a family member in a different health plan
  • You cannot get all the related services you need from providers in your health plan, and there is a risk to getting the services separately
  • A different health plan may be better for your complex medical conditions
  • Your Long-Term Services and Supports (LTSS) provider is not in your health plan
  • Your health plan does not cover a service you need for moral or religious reasons
  • Other reasons (poor quality of care, lack of access to covered services, lack of access to providers experienced in dealing with your health care needs)

You can change your health plan at any time for these reasons:

• You need services to address a mental health disorder, substance use disorder, intellectual/ developmental disability, (I/DD) or traumatic brain injury (TBI)
• You are a federally recognized tribal member or qualify for services through Indian Health Service (IHS)

If you want to keep the health plan you chose or that we chose for you, you don’t have to do anything.

To learn more about benefits and coverage, contact the health plan. You can find health plan contact information at Contacts and links.

If you need help, call us at 1-833-870-5500 (TTY: 711 or RelayNC.com). The call is toll free. Or use the chat tool to chat with us online.