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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.