Medical Benefits

Regular health care
Maternity care
  • Pregnancy care and care management services
  • Childbirth education classes
  • OB/GYN and hospital services
  • One medically necessary postpartum home visit for newborn care and assessment following discharge, but no later than 60 days after delivery
  • Care management services for high-risk pregnancies during pregnancy and for two months after delivery
Hospital care
  • Inpatient care
  • Outpatient care
  • Labs, X-rays and other tests
Home health services
  • Must be medically necessary and arranged by AmeriHealth Caritas North Carolina
  • Time-limited skilled nursing services
  • Specialized therapies (including physical therapy, speech-language pathology and occupational therapy)
  • Home health aide services (for help with activities such as bathing, dressing, preparing meals and housekeeping)
  • Medical supplies
Personal care services (adults only)
  • Must be medically necessary and arranged by AmeriHealth Caritas North Carolina
  • Help with common activities of daily living (including eating, dressing and bathing) for individuals with disabilities and ongoing health conditions
Hospice care
  • Hospice care will be arranged by AmeriHealth Caritas North Carolina if medically necessary.
  • Hospice helps patients and their families with the special needs that come during the final stages of illness and after death.
  • Hospice provides medical, supportive and palliative care to terminally ill individuals and their families or caregivers.
  • You can get these services in your home, in a hospital or in a nursing home.
Vision care
  • Services provided by ophthalmologists and optometrists (including routine eye exams and medically necessary lenses)
  • Specialist referrals for eye diseases or defects
  • Prescription drugs
  • Some medicines sold without a prescription (also called "over-the-counter"), like allergy medicines
  • Insulin and other diabetic supplies (like syringes, test strips, lancets and pen needles)
  • Smoking cessation agents, including over-the-counter products
  • Enteral formula (balanced nutrition designed for the tube-feeding of children)
  • Emergency contraception
  • Medical and surgical supplies
Pharmacy Lock-in Program
  • The NC Medicaid Pharmacy Lock-In Program was established as mandated by legislation to restrict beneficiaries whose utilization of targeted medications with a significant potential for abuse and misuse (opioids and benzodiazepines) is documented as being excessive.
  • Beneficiaries are "Locked-In" to one prescriber and one pharmacy for a two-year period in order to monitor and reduce unnecessary or inappropriate utilization of these targeted medications.
  • This program is intended to prevent Medicaid beneficiaries from obtaining multiple prescriptions for and excessive quantities of these targeted medications through multiple visits to physicians and pharmacies.
Emergency care
  • Emergency care services are procedures, treatments or services needed to evaluate or stabilize an emergency.
  • After you have received emergency care, you may need other care to help make sure you remain in stable condition.
  • Depending on the need, you may be treated in the emergency department, in an inpatient hospital room or in another setting.
  • Read more about our emergency and urgent care services.
Specialty care
  • Respiratory care services
  • Podiatry services
  • Chiropractic services
  • Cardiac care services
  • Surgical services
Nursing home services
  • Must be ordered by a physician and authorized by AmeriHealth Caritas North Carolina
  • Includes short-term, or rehabilitation, stays and long-term care for up to 90 days
  • If you need nursing care for more than 90 days, you may need to enroll in a different health plan. Talk with your PCP or call Member Services at 1-855-375-8811 (TTY 1-866-209-6421) if you have questions.
  • Covered nursing home services include medical supervision, 24-hour nursing care, assistance with daily living, physical therapy, occupational therapy and speech-language pathology.
  • Nursing home services must come from a nursing home that is in AmeriHealth Caritas North Carolina's provider network. If you choose a nursing home outside of AmeriHealth Caritas North Carolina's network, and the services you need are available from a provider in the plan's network, you may have to transfer to another plan. Call Member Services at 1-855-375-8811 (TTY 1-866-209-6421) for help with questions about nursing home providers and plan networks.
  • Talk with your PCP or call Member Services at 1-855-375-8811 (TTY 1-866-209-6421) for help finding a nursing home in our network.
Family planning
You do not need a referral from your PCP for family planning services. Family planning services include:
  • Birth control
  • Birth control devices such as IUDs, implantable contraceptive devices and others that are available with a prescription
  • Emergency contraception
  • Sterilization services
  • HIV and sexually transmitted infection (STI) testing, treatment and counseling
  • Screenings for cancer and other related conditions
Other covered services
  • Durable medical equipment, prosthetics or orthotics
  • Hearing aid products and services
  • Telemedicine
  • Extra support to manage your health
  • Home infusion therapy
  • Rural Health Clinic (RHC) services
  • Federally Qualified Health Center (FQHC) services
  • Free clinic services

You must get the services above from the providers who are in AmeriHealth Caritas North Carolina's network. Services must be medically necessary, and provided, coordinated or referred by your primary care provider (PCP) unless otherwise noted. Talk with your PCP or call Member Services at 1-855-375-8811 (TTY 1-866-209-6421) if you have questions or need help.

For some benefits, you have to be a certain age or have a certain need for the service.

In addition to the benefits above, view detailed information for our: