Benefits and services

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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. For questions about benefits and services, contact the health plan. For health plan contact information, go to Contacts and links.

Medical benefits and services include:

  • Allergies
  • Ambulance services
  • Anesthesia
  • Auditory implant external parts
  • Burn treatment and skin substitutes
  • 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
  • Inpatient hospital services
  • Inpatient psychiatric services for individuals under age 21
  • Laboratory and X-ray services
  • Limited inpatient and outpatient behavioral health services defined in required clinical coverage policy
  • Maternal support services
  • Non-emergent transportation to medical care
  • Nursing facility services
  • Obstetrics and gynecology
  • Occupational therapy
  • Ophthalmological services
  • Optometry services
  • Other diagnostic, screening, preventive and rehabilitative services
  • Outpatient hospital services
  • Personal care
  • Pharmacy services
  • Physical therapy
  • Physician services
  • Podiatry services
  • Prescription drugs and medication management
  • Private duty nursing services
  • Prosthetics, orthotics and supplies
  • Reconstructive surgery
  • Respiratory care services
  • Rural health clinic services
  • Services for individuals age 65 or older in an institution for mental disease (IMD)
  • Speech, hearing and language disorder services
  • Telemedicine
  • Tobacco cessation counseling for pregnant women
  • Transplants and related services
  • Ventricular assist device
  • 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 20
  • Facility‑based crisis services for children and adolescents
  • Inpatient behavioral health services
  • Medically supervised or 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
  • Professional treatment services in a facility‑based crisis program
  • Research‑based intensive behavioral health treatment

There are some services each plan does not provide.

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

  • Dental services
  • Services provided through the Program of All-Inclusive Care for the Elderly (PACE)
  • Services provided by local education agencies
  • Services provided by children’s developmental agencies that are included in your child’s Individualized Family Service Plan
  • Fabrication of eyeglasses, including complete eyeglasses, eyeglass lenses and ophthalmic frames

If you have questions, call us at 1-833-870-5500 (TTY: 1-833-870-5588). The call is free. Or use the chat tool to chat with us online.

Health plans may also offer added services. To compare plans, go to Compare plans.