Most people will get the same Medicaid services in a new way – through health plans. You will be able to choose the health plan that is best for you. You will also choose a primary care provider (PCP).
North Carolina’s Medicaid program changed to Medicaid Managed Care on July 1, 2021. This means that most Medicaid beneficiaries will receive their benefits through health plans (similar to private insurance) for the first time instead of directly from the state. A health plan provides a network of doctors, hospitals, and other providers who work together to provide the care you need.
Most Medicare recipients will have to enroll in a specific plan in order to receive their benefits. You should have received information from Medicare about enrolling in a plan in March of 2021. If you did not enroll in a plan by May 21, 2021, you were automatically enrolled in one.
Appalachian Regional Healthcare System (ARHS) will be “in-network” for the AmeriHealth plan, and possibly others. All health plans offer the same basic Medicaid services. Each health plan has its own network of providers. You can sign up for a new plan and select a new primary care provider that is “in-network” for ARHS, or for any reason, within 90 days of your initial enrollment date or until September 30.
What you need to do
- Choose a primary care provider (PCP): To keep your doctor, clinic or other health care provider as your PCP, find out which health plans they work with. You can also choose a new PCP.
- Choose a health plan: A health plan is a group of doctors, hospitals and other providers. They work together to give you the health care you need. ARHS will be in-network with AmeriHealth. Learn more: ncmedicaidplans.gov/find/viewhealthplans
- Enroll in one of these ways:
- Go to ncmedicaidplans.gov
- Use the NC Medicaid Managed Care mobile app
- Call us toll free at 1-833-870-5500 (TTY: 1-833-870-5588)
- When you receive an enrollment form, fill it out and mail or fax it back
Contact NC Medicaid directly with questions about eligibility, coverage, or enrolling in a plan. Visit ncmedicaidplans.gov or call 1-833-870-5500 Monday through Saturday between 7 a.m. and 5 p.m.
If you are staying with the traditional Medicaid plan and have questions, contact your Medicaid Case Manager at the following locations and numbers:
- Watauga DSS 828-265-8100
- Ashe DSS 336-846-5719
- Avery DSS 828-733-823