Benefits and services

Main Content

All health plans offer the same basic benefits and services.

Some services may only be available with prior authorization (pre-approval) or if medically necessary.

Some services may require a copay. Learn more about Copays.

Medical benefits and services include:

  • Ambulance services
  • Cardiac procedures
  • Certified pediatric and family nurse practitioner services
  • Chiropractic services
  • Clinic services
  • Dietary evaluation and counseling and medical lactation services
  • Durable medical equipment
  • Early and periodic screening, diagnostic and treatment services (EPSDT)
  • Family planning services
  • Federally qualified health center services
  • Freestanding birth center services (when licensed or otherwise recognized by the North Carolina Department of Health and Human Services)
  • Hearing aids
  • Home health services
  • Home infusion therapy
  • Hospice services
  • Inpatient hospital services
  • Inpatient psychiatric services for individuals under age 21
  • Laboratory and X-ray services
  • Limited inpatient and outpatient behavioral health services
  • Maternal support services
  • Non-emergency medical transportation (NEMT) to medical appointments
  • Nursing facility services
  • Obstetrics and gynecological services
  • Occupational therapy
  • Ophthalmological services
  • Optometry services
  • Outpatient hospital services
  • Personal care services
  • Pharmacy services
  • Physical therapy
  • Physician services
  • Podiatry services
  • Prescription drugs and medication management
  • Private duty nursing services
  • Prosthetics, orthotics and supplies
  • Respiratory care services
  • Rural health clinic services
  • Speech, hearing and language disorder services
  • Telehealth
  • Tobacco cessation counseling for pregnant women
  • Transplants and related services
  • Vision services

Behavioral health benefits and services include:

  • Ambulatory detoxification services
  • Diagnostic assessment services
  • Early and periodic screening, diagnostic and treatment services (EPSDT) for members under age 21
  • Facility-based crisis services for children and adolescents
  • Inpatient behavioral health services
  • Medically supervised alcohol and drug abuse treatment center detoxification crisis stabilization
  • Mobile crisis management services
  • Non-hospital medical detoxification services
  • Outpatient behavioral health emergency room services
  • Outpatient behavioral health services provided by direct-enrolled providers
  • Outpatient opioid treatment services
  • Partial hospitalization
  • Peer support services
  • Professional treatment services in a facility-based crisis program
  • Research-based intensive behavioral health treatment for autism spectrum disorder

Tailored Plan benefits and services include:

  • Innovations Waiver services
  • Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) services
  • State-funded (non-Medicaid) services
  • Traumatic Brain Injury (TBI) Waiver services
  • Transitions to Community Living (TCL) program services

Services covered outside of health plan networks

You can get these services from a provider outside of the health plan’s network, if the provider takes NC Medicaid:

  • Dental services
  • Services provided by Local Education Agencies that are included in your child's:
    • Individualized Education Program (IEP)
    • Individualized Family Service Plan (IFSP)
    • Section 504 Accommodation Plan (504 Plan)
    • Individual Health Plan (IHP)
    • Behavior Intervention Plan (BIP)
  • Services provided by Children’s Developmental Services Agencies (CDSAs) or providers contracted with CDSAs that are included in your child’s Individualized Family Service Plan (IFSP)
  • Services provided before NC Medicaid eligibility determination

You can get these services from a provider in the health plan’s network:

  • The fabrication of eyeglasses including complete eyeglasses, eyeglass lenses and eyeglass frames
    • A provider in the health plan's network will fit the NC Medicaid Direct eyeglasses and give them to you

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

Some health plans also offer added services. To learn more, go to View health plans.