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North Carolina health plans

Looking for low-cost or no-cost health insurance? We offer Medicaid plans. We also offer dual health plans for people with both Medicaid and Medicare.

For general information about the plans in your state, visit North Carolina's Medicaid and Exchange homepage.

Staying up-to-date with COVID-19 vaccines and health check-ups will keep everyone safer and healthier as they get ready for spring and summer fun—family celebrations, BBQs, graduations, vacations, and gatherings that we’ve missed the last two years. Help stop the spread by:

  • Staying up-to-date on your COVID-19 vaccinations: receive an initial dose, second dose AND booster.
  • Helping loved ones get vaccinated: kids 5-11 & teens 12-17 can receive a Pfizer-BioNTech vaccine.
  • Scheduling wellness visits when you are due for a check-up. Prevention is the best health care!

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4  results  for North Carolina

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UnitedHealthcare Dual Complete® (HMO-POS D-SNP)

H5253-041-000

Monthly premium: $0.00*

* Your costs may be as low as $0, depending on your level of Medicaid eligibility.

This dual health plan is for people who qualify for both Medicaid and Medicare Parts A & B (Original Medicare).

This is a Health Maintenance Organization (HMO) plan. With an HMO plan, you must use network providers to get your medical care and services.

Alamance, Buncombe, Caswell, Catawba, Chatham, Cumberland, Davidson, Davie, Durham, Forsyth, Guilford, Henderson, Mecklenburg, Orange, Person, Randolph, Rockingham, Rowan, Stokes, Wake, Wilkes, and Yadkin.

Benefits & Features

  • OTC+Healthy Food

    $220 a month on a prepaid card for OTC and covered groceries in-store or online

  • Dental coverage

    Up to $3500 for covered types of preventive and comprehensive dental

  • Routine vision care

    $0 copay on yearly routine eye exam and $300 eyewear allowance

Enroll in Plan (Opens modal window) View Plan Details Check Eligibility (Opens modal window)

Have questions?    8 a.m. – 8 p.m. local time, 7 days a week    1-844-812-5967    TTY 711

UnitedHealthcare Dual Complete® RP (Regional PPO D-SNP)

R1548-001-000

Monthly premium: $0.00*

* Your costs may be as low as $0, depending on your level of Medicaid eligibility. 

This dual health plan is for people who qualify for both Medicaid and Medicare Parts A & B (Original Medicare).

This is a Preferred Provider Organization (PPO) plan. You have access to a local network of doctors and hospitals. Plus, you can see any provider outside the network nationwide that participates in Medicare and accepts the plan. You may pay a higher copay or coinsurance when you see an out-of-network provider.

This plan is available in all counties.

Benefits & Features

  • OTC+Healthy Food

    $175 a month on a prepaid card for OTC and covered groceries in-store or online

  • Dental coverage

    Up to $2500 for covered types of preventive and comprehensive dental

  • Prescription drug coverage

    $0 copay on covered generic and brand-name prescriptions including home delivery

Enroll in Plan (Opens modal window) View Plan Details Check Eligibility (Opens modal window)

Have questions?    8 a.m. – 8 p.m. local time, 7 days a week    1-844-812-5967    TTY 711

UnitedHealthcare Community Plan Medicaid

UnitedHealthcare Community Plan of North Carolina provides Medicaid coverage to children, pregnant women, families and adults. You can choose your own doctor, and get many extras that other plans don’t offer.

This plan is available in all counties.

Benefits & Features

  • Choice of Doctor

    Use Doctor Lookup tool to see if your doctor is in our network or to find a new one.

  • Medicines

    Fill your prescriptions at local pharmacies.

  • Transportation

    We pay for rides to and from medical visits.

View Plan Details

Have questions?    Monday - Friday 8am – 5pm ET Excluding State Holidays 1-800-349-1855    TTY 711

 

Individual and Family Plans

UnitedHealthcare is offering individual and family plans in North Carolina that are designed to provide the best possible coverage at an affordable price. 

We have plan choices in all three metal levels, bronze, silver and gold, offering a variety of benefits. And all of our plans come with reliable, friendly guidance from our experienced team.  

Alexander, Bladen, Brunswick, Buncombe, Burke, Caldwell, Catawba, Columbus, Cumberland, Davidson, Davie, Duplin, Forsyth, Franklin, Guilford, Harnett, Haywood, Henderson, Hoke, Iredell, Jackson, Johnston, McDowell, Mecklenburg, New Hanover, Orange, Pender, Randolph, Richmond, Robeson, Rockingham, Rutherford, Sampson, Scotland, Stokes, Surry, Transylvania, Wake, and Yadkin.

Benefits & Features

  • $0 virtual care

    With most plans, you get $0^ virtual visits with a doctor who's specially trained to provide online urgent, specialty and primary care. 

  • Prescriptions as low as $3

    Pay a $3^ copay on Tier 1 generic drugs at Walgreens. Plus, get member-exclusive discounts, like 20% off Walgreens-brand health and wellness products.

  • Digital fitness classes at no additional cost

    Get access to a premium library with thousands of live and on-demand digital fitness classes included in your plan. 

Visit UHCExchange.com (Opens in a New Tab)

Have Questions? 1-888-610-9045 TTY 711

Individual and Family Plans Disclaimer
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Medical plan coverage offered by: UnitedHealthcare of Arizona, Inc.; Rocky Mountain Health Maintenance Organization, Incorporated in CO; UnitedHealthcare of Florida, Inc.; UnitedHealthcare of Georgia, Inc.; UnitedHealthcare of Illinois, Inc.; UnitedHealthcare Insurance Company in LA, TN and AL; Optimum Choice, Inc. in VA and MD; UnitedHealthcare Community Plan, Inc. in MI; UnitedHealthcare of North Carolina, Inc.; UnitedHealthcare of Oklahoma, Inc.; UnitedHealthcare of Texas, Inc.; and UnitedHealthcare of Oregon, Inc. in WA. Administrative Services provided by United HealthCare Services, Inc. or their affiliates.

^Some plans may require copayments, deductibles and/or coinsurance for these benefits. Plans in metal tiers varies and are subject to plan deductibles, copayments, and coinsurance. This policy has exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, review your plan documents, call or write your insurance agent or the company, whichever is applicable. By responding to this offer, you agree that a representative may contact you.

Virtual visits conducted by telephone or video chat with a doctor are not an insurance product, health care provider or a health plan. Unless otherwise required, benefits are available only when services are delivered through a Designated Virtual Network Provider. Virtual visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times, or in all locations, or for all members. Check your benefit plan to determine if these services are available. The Designated Virtual Visit Provider's reduced rate for a virtual visit is subject to change at any time. Virtual primary care visits are unavailable for members under the age of 18.

Discount valid until 12/31/22. Discount valid only for in-store purchases of eligible Walgreens brand health and wellness products by current members.

Available to members of applicable health plans who register for an account with Peloton. Credit to All-Access Membership limited to 1 per family. Must be 18+ years of age and covered under applicable UnitedHealthcare health plan. Subject to state legal and regulatory availability. Peloton equipment not required. UnitedHealthcare members that own a Peloton Bike or Tread can receive equivalent value ($155) to be credited to an All-Access Membership. Peloton offers its services directly to consumers pursuant to an agreement between Peloton and the consumer. The information provided under this program is for general informational purposes only and is not intended to be nor should be construed as medical advice. You should consult with an appropriate health care professional before beginning any exercise program and/or to determine what may be right for you.

Enrollees are eligible to earn a $25 gift card for certain retail participants upon completion of a wellness visit with the enrollee's primary care physician. Limited to one gift card per enrollee. Restrictions apply, see amazon.com/gc-legal. Walgreens is not a sponsor of this promotion. Fulfillment of Walgreens Gift Cards will be done through National Gift Card. The program's rewards provider should be contacted by gift card recipients with any questions. Gift cards are subject to all terms and conditions printed on the back of the gift cards and are subject to change at Walgreens' discretion. Walgreens is not liable for any alleged or actual claims related to this offer. The Walgreens name and logo are registered trademarks of the Walgreen Company. National Gift Card is solely responsible for the fulfillment and value of Walgreens Gift Cards awarded through this program. Please contact National Gift Card regarding any questions related to Walgreens Gift Cards. UnitedHealthcare is not affiliated with Walmart Stores, Inc., or any of its affiliates. The services, products or activities of UnitedHealthcare, are neither endorsed nor sponsored by Walmart Stores, Inc., or any of its affiliates. See https://www.walmart.com/help/article/gift-card-terms-and-conditions/90f9e217278146898946c1d786bedea3 for complete gift card terms and conditions.

Last Updated: 04.11.2022 at 11:26 AM CDT

Disclaimer information
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Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

UnitedHealthcare Dual Complete plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call 1-800-905-8671 TTY 711 for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Nurseline disclaimer

This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your doctor's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan)

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) information, please contact our Member Services at 1-844-445-8328 (TTY 711) from 7 a.m. to 8 p.m. Monday through Friday (voice mail available 24 hours a day/7 days a week) for help at no cost to you.

Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio (plan Medicare-Medicaid), comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al 1-844-445-8328 (TTY 711) de lunes a viernes de 7 a.m. a 8 p.m. (correo de voz disponible las 24 horas del día, los 7 días de la semana).

UnitedHealthcare Connected® (Medicare-Medicaid Plan)

UnitedHealthcare Connected® (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected® for One Care (Medicare-Medicaid Plan)

UnitedHealthcare Connected® for One Care (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees. UnitedHealthcare Connected® for One Care (Medicare-Medicaid Plan) es un plan de salud que tiene un contrato tanto con Medicare como con el programa MassHealth (Medicaid) para proporcionar los beneficios de ambos programas a sus miembros.

ATTENTION: If you speak an alternative language, language assistance services, free of charge, are available to you. Call the Member Engagement Center 1-866-633-4454, TTY 711, 8 am - 8 pm, local time, 7 days a week. The call is free.

ATENCIÓN: Si habla español, tiene a su disposición servicios de asistencia gratuitos en su idioma. Llame al Centro de participación de miembros/a Servicio al Cliente al 1-866-633-4454, TTY 711, de 8 am a 8 pm, hora local, los 7 días de la semana. La llamada es gratuita.

ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele Sant Angajman Manm/Sèvis Manm nan 1-866-633-4454, TTY 711, 8 am - 8 pm, lè lokal, 7 jou sou sèt. Apèl la gratis.

[សម្គាល់៖ ប្រសិនបើលោកអ្នកនិយាយភាសាខ្មែរ លោកអ្នកអាចរកបានសេវាកម្មជំនួយផ្នែកភាសាដោយឥតគិតថ្លៃបាន។ ទូរសព្ទទៅ​មជ្ឈមណ្ឌល​ចូលរួម​ជាមួយ​សមាជិក/សេវាកម្ម​សមាជិក  1-866-633-4454, TTY 711, 8 ព្រឹក - 8 យប់ ម៉ោងក្នុងមូលដ្ឋាន 7 ថ្ងៃ​ក្នុង​មួយ​សប្ដាហ៍។ ការហៅទូរស័ព្ទគឺឥតគិតថ្ល។

[ເຊີນຊາບ: ຖ້າທ່ານເວົ້າ ພາສາລາວ, ພວກເຮົາມີບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາໂດຍບໍ່ຕ້ອງເສຍຄ່າໃດໆໃຫ້ແກ່ທ່ານ. ໂທ​ຫາ​ສູນ​ຕິດ​ຕໍ່​ພົວ​ພັນ​ສະ​ມາ​ຊິກ/ຝ່າຍ​ບໍ​ລິ​ການ​ສະ​ມາ​ຊິກ 1-866-633-4454, TTY 711, 8 ໂມງ​ເຊົ້າ - 8 ໂມງ​ແລງ, ຕາມ​ເວ​ລາ​ທ້ອງ​ຖິ່ນ, 7 ວັນ​ຕໍ່​ອາ​ທິດ. ການ​ໂທ​ແມ່ນ​ບໍ່​ເສຍ​ຄ່າ.

ATENÇÃO: Se fala português, é-lhe disponibilizado um serviço gratuito de assistência linguística. Telefone para o Centro de Conexão dos Associados/Serviços de Atendimento a Associados 1-866-633-4454, TTY 711, 8h00 - 20h00, hora local, 7 dias por semana. A chamada é gratuita.

ВНИМАНИЕ! Если Вы говорите по-русски, можете бесплатно воспользоваться помощью переводчика. Звоните в центр взаимодействия с участниками/отдел обслуживания участников по номеру телефона 1-866-633-4454, TTY 711, 8:00 - 20:00 по местному времени, без праздничных и выходных. Звонок бесплатный.

LƯU Ý: Nếu quý vị nói tiếng Việt, chúng tôi có dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho quý vị. Xin gọi cho Trung tâm Tham gia Hội viên/Dịch vụ Hội viên 1-866-633-4454, TTY 711, 8 am - 8 pm, giờ địa phương, 7 ngày trong tuần. Cuộc gọi này là miễn phí.

[注意：如果您说中文，您可以获得免费语言帮助服务。致电会员服务中心/会员服务 <1-866-633-4454>，听障专线（TTY）711，当地时间<上午 8 点 - 晚上 8 点>，每周 <7> 天。该通话是免费的。

UnitedHealthcare Connected benefit disclaimer 

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected Member Services or read the UnitedHealthcare Connected Member Handbook. Benefits and/or copayments may change on January 1 of each year.

You can get this document for free in other formats, such as large print, braille, or audio. Call 1-866-441-0395, TTY 711, 8 am - 8 pm., local time, Monday - Friday (voicemail available 24 hours a day/7 days a week). The call is free. You can call Member Engagement Center and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

Language Line is available for all in-network providers. 

Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al 1-877-542-9236, TTY 711, de 8am. a 8pm, hora local, de lunes a viernes (correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro. Los servicios Language Line están disponibles para todos los proveedores dentro de la red.

Potential for contract termination

How to end your membership in our plan

As long as you are still eligible for Medicare and MassHealth, you can leave UnitedHealthcare Connected for One Care without losing your Medicare and MassHealth benefits. If you are over age 65 and you decide to leave One Care, you will not be able to enroll in a One Care plan later. If you think you want to end your membership in our plan, there are a few ways you can get more information about what will happen, and how you can still get Medicare and MassHealth services.

  • Call MassHealth Customer Service at 1-800-841-2900, Monday – Friday, 8 am – 5 pm, TTY users (people who are deaf, hard of hearing, or speech disabled) may call 1-800-497-4648. 
  • Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users (people who have difficulty hearing or speaking) may call 1-877-486-2048. 
  • Contact a SHINE counselor at 1-800-243-4636. TTY users (people who are deaf, hard of hearing, or speech disabled) may call 1-800-439-2370.

If you decide to end your membership, call MassHealth or Medicare and tell them you want to leave UnitedHealthcare Connected for One Care. 

  • Call MassHealth Customer Service at 1-800-841-2900, Monday – Friday, 8 am – 5 pm TTY users (people who are deaf, hard of hearing, or speech disabled) may call 1-800-497-4648; OR 
  • Send MassHealth an Enrollment Decision Form. You can get the form at www.mass.gov/one-care or by calling plan contact information if you need us to mail you one; OR 
  • At times when MassHealth Customer Service is closed, call Medicare at 1-800-MEDICARE (1- 800-633-4227), 24 hours a day, 7 days a week. TTY users (people who have difficulty hearing or speaking) should call 1-877-486-2048. When you call 1-800-MEDICARE, you can also enroll in another Medicare health or drug plan. More information on getting your Medicare services when you leave our plan is in the chart on page 188 in your Member Handbook/Evidence of Coverage. 

Your coverage with UnitedHealthcare Connected for One Care will end on the last day of the month that we get your request.

Other situations when your membership ends

These are the cases when MassHealth or Medicare must end your membership in our plan: 

  • If there is a break in your Medicare Part A and Part B coverage. 
  • If you are no longer eligible for MassHealth. Our plan is for people who are eligible for both Medicare and MassHealth. 
  • If you join a MassHealth Home and Community Based Services (HCBS) Waiver program 
  • If you move out of our service area. 
  • If you move into an Intermediate Care Facility operated by the Massachusetts Department of Developmental Services. 
  • If you go to jail or prison for a criminal offense. 
  • If you are not a United States citizen or are not lawfully present in the United States. – You must be a United States citizen or lawfully present in the United States to be a member of our plan. – The Centers for Medicare & Medicaid Services will notify us if you aren’t eligible to remain a member on this basis. – We must disenroll you if you don’t meet this requirement. 
  • If you have or get other comprehensive insurance for prescription drugs or medical care. UnitedHealthcare Connected for One Care MEMBER HANDBOOK 191 Chapter 10: Ending your membership in UnitedHealthcare Connected for One Care If you have questions, please call UnitedHealthcare Connected for One Care at 1-866-633-4454, TTY 711, 8 am – 8 pm local time, 7 days a week. The call is free. For more information, visit www.UHCCommunityPlan.com. 
  • If you let someone else use your Member ID Card to get care. 
  • If your membership ends for this reason, Medicare may ask the Inspector General to investigate your case, and MassHealth may ask the Bureau of Special Investigations to investigate your case. 

We can also ask you to leave our plan if you continuously behave in a way that is so disruptive that we cannot provide care for you or other members of our plan. We can only make you leave if we get permission from Medicare and MassHealth first.

UnitedHealthcare Connected® benefit disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

You can get this document for free in other formats, such as large print, braille, or audio. Call 1-877-542-9236, TTY 711, 8 a.m. - 8 p.m., local time, Monday - Friday (voicemail available 24 hours a day/7 days a week). The call is free.

You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

Language Line is available for all in-network providers.

Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al 1-877-542-9236, TTY 711, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.

Los servicios Language Line están disponibles para todos los proveedores dentro de la red.

UnitedHealthcare Senior Care Options (HMO SNP) Plan

UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

Availability of non-english disclaimer

ATTENTION: If you speak an alternative language, language assistance services, free of charge, are available to you. Call 1-800-905-8671 TTY 711.

ATENCIÓN: Si habla Español, hay servicios de asistencia lingüística disponibles para usted y que no tienen cargo. Llame al 1-800-905-8671 TTY 711.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system.

Formularies

The formulary, pharmacy network and provider network may change at any time. You will receive notice when necessary.

NCQA

UnitedHealthcare Connected® has a Model of Care approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until 2017 based on a review of UnitedHealthcare Connected’s Model of Care.

Important provider information

The Choice is Yours

We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsement of a particular physician or health care professional's suitability for your needs.

The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

Out-of-network/non- contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

American Disabilities Act notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Referrals

Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

Paper directory requests

Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

Inaccurate information

To report incorrect information, email provider_directory_invalid_issues@uhc.com. This email box is for members to report potential inaccuracies for demographic (address, phone, etc.) information in the online or paper directories. Reporting issues via this mail box will result in an outreach to the provider’s office to verify all directory demographic data, which can take approximately 30 days. Individuals can also report potential inaccuracies via phone. UnitedHealthcare Members should call the number on the back of their ID card, and non-UnitedHealthcare members can call 888-638-6613 TTY 711.

Declaration of Disaster or Emergency

If you’re affected by a disaster or emergency declaration by the President or a Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non- contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.

This site contains documents in PDF format. PDF (Portable Document Format) files can be viewed with Adobe® Reader®. If you don't already have this viewer on your computer, download it free from the Adobe website.

Last Updated: 04.11.2022 at 11:26 AM CDT

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