North Carolina, Raleigh- There are a variety of health insurance options in North Carolina for both low- and middle-income individuals and families.
The best known is Medicaid, now known as NC Medicaid Direct. It is an option that provides critical coverage for low-income individuals and families, children, pregnant women, seniors, and people with disabilities.
However, as reported by sources from the Department of Health and Human Services to Enlace Latino NC, since 2021 most Medicaid beneficiaries began to receive the same services through a new modality called “NC Medicaid Managed Care.”
Basically, NC Medicaid Managed Care beneficiaries choose a health plan and receive care through that plan’s network of doctors.
Finally, there is also a health insurance program in North Carolina for low-income children whose parents are not eligible for Medicaid. This is the North Carolina Health Choice for Children, an option enabled for children of parents who have a high salary to qualify for Medicaid, but low to pay for private or employer-sponsored health insurance.
Below is general information about each of the health insurance programs available in North Carolina.
Public Health Insurance Programs Available in North Carolina
NC Medicaid Managed Care
In North Carolina, most people get their Medicaid services through NC Medicaid Managed Care. Through this program, beneficiaries have access to a network of providers, a 24-hour nurse line and can see their doctor as many times as they need without having to pay a monthly fee.
NC Medicaid Managed Care recipients must choose a primary health care provider, such as a family doctor or clinic. And then they can go to that provider for all of their medical needs. If you need care that is beyond that provider’s expertise, you will be referred to a specialist.
NC Medicaid Managed Care offers different health insurance options, including standard plans, custom plans, and traditional Medicaid.
NC Medicaid Direct
NC Medicaid Direct is traditional Medicaid. It is a program administered at the state level but with mixed funds, both federal and state. This program provides critical coverage for low-income individuals and families, children, pregnant women, seniors, and people with disabilities.
In North Carolina, this program is especially geared toward people who are not enrolled in any specific NC Medicaid Managed Care plan.
Coverage includes physical, pharmacy and care management services. In addition, it provides care for mental disorders, substance abuse, cognitive disabilities, and brain injuries.
North Carolina Health Choice for Children
North Carolina Health Choice for Children is a comprehensive health coverage program for children and adolescents ages 6 to 18 from low-income families. “If a parent is not eligible for Medicaid, but cannot afford private or employer-sponsored health insurance, their children may be eligible for NC Health Choice,” sources from the Department of Health and Human Services reported.
For certain families, choosing the North Carolina Health Choice for Children has an annual cost. If a family’s monthly income is above 159% of the federal poverty level, there is a registration fee of $50 per child or $100 for two or more.
However, if your family’s monthly income is at or below 159% of the poverty level, there is no enrollment fee.
The same goes for copayments, that is, the fixed amount of money that must be paid to providers for health care services. The amount of the copay depends on the income of each family.
Some NC Health Choice Benefits
Some of the benefits provided by NC Health Choice are:
- Case management and care coordination services
- Dental services – limited
- Durable medical equipment and disposable medical supplies
- Emergency services
- family planning services
- Palliative care
- home health care
- Immunizations (shots)
- hospitalization services
- Laboratory and radiology services
- Mental health services (inpatient and outpatient)
- Physician and clinic services (well and sick visits)
- Physiotherapy
- Occupational therapy (helps patients develop, regain, improve, and maintain skills needed for daily life and work)
- Therapy for people with speech, hearing and language disorders
- Prescription drugs
- Substance abuse services (inpatient and outpatient)
- surgical services
Instead, NC Health Choice does not cover long-term care services, services for recipients outside the United States, or pregnancy-related services.
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