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Frequently Asked Questions

 

Carolina Complete Health is a provider-led Medicaid Managed Care health plan, providing coverage to pregnant women, families with children, the elderly, adults with disabilities, and children with disabilities in Regions 3, 4, and 5. View the Carolina Complete Health coverage map.

An MCO is an insurance company that contracts with providers and medical facilities to provide health care services to its members.

Carolina Complete Health’s Benefits include provider/doctor visits, hospital coverage, preventive services, prescription drug coverage, and more.  A more comprehensive listing of Benefits is included in the Member Handbook that is posted on this website. Carolina Complete Health also offers members Value Added Services.

In addition to meeting certain income levels, applicants must meet specific eligibility requirements to receive Medicaid coverage. Eligibility for programs and services is determined by the Department of Health and Human Services (DHHS). For more information on North Carolina Medicaid eligibility, please contact the DHHS Contact Center at 1-800-662-7030.

No. There is no cost to enroll in Carolina Complete Health. Some members may pay minimal copayments for provider/doctor visits, emergency room care, and prescriptions.

You can apply for services in several ways.

By Phone:

DHHS Contact Center at 1-800-662-7030

Online:

Apply online at the North Carolina DHHS Services Portal.

Mail:

Download Paper Application (PDF) and mail in.

No. Your Medicare services and providers/doctors will stay the same. It’s the responsibility of your Medicaid MCO to coordinate your services with your Medicare Primary Care Provider/Doctor.

Ask your providers/doctors if they are contracted with Carolina Complete Health. You can check the Find a Provider tool on our website to view our online Doctor/Provider Directory or consult our Provider Directory. If you have questions about our doctors, contact Carolina Complete Health Member Services at 1-833-552-3876 (TTY: 711).

Yes. You can change your Primary Care Provider/Doctor at any time.

Your Primary Care Provider/Doctor must request a referral for you to see a specialist. If you would like additional information, you may contact Carolina Complete Health Member Services at 1-833-552-3876 (TTY: 711).

The “Community Benefit” is the name given to a set of services that help to keep people in their homes and communities. Some of these services include adult day health, respite care, and personal care services.