Already have a health insurance policy you purchased through the Health Insurance Marketplace®?
That’s great! Remember that you will have to update your coverage or re-enroll each year at HealthCare.gov. If you have questions or need free assistance managing your policy, NC Navigator is always here to help.
Already have Medicaid and need additional plan information?
If you need help understanding your Medicaid plan or you’re having issues using it, reach out to the NC Medicaid Ombudsman. They can be reached by calling 1-877-201-3750.
The NC Medicaid Enrollment Broker is available to help Medicaid eligible beneficiaries select a Medicaid Managed Care Plan or find a Primary Care Provider. They can be reached at 1-833-870-5500.
If you feel you’ve been wrongly denied Medicaid services or you’re having issues with your plan’s billing, reach out to Legal Aid NC’s Medicaid Appeals Technical Team (MATT). You can apply online or dial 1 (866) 219-5262
For most Medicaid beneficiaries, your prescriptions and doctor visits currently have a copay of $4. Even if you can’t pay that $4 right away, the doctor or the pharmacy still has to help you. They can’t say no just because you don’t have the money right then.
Having issues getting prescriptions? Show this to your pharmacy for help.
Questions about paying premiums or general inquiries with the plan you purchased on the Marketplace?
Refer to your Marketplace health insurance company’s contact information below.
Ambetter – (833) 863-1310
AmeriHealth Caritas – (833) 613-2262
Blue Cross Blue Shield – (800) 324-4973
CareSource – (833) 230-2099
Cigna – (866) 494-2111
Oscar – (855) 672-2788
United – (800) 980-5213
WellCare – (833) 925-2861
Have an issue with your insurance company?
The North Carolina Department of Insurance can help with the following:
- File a written complaint if you are not happy with an action taken by your insurance company
- Report an insurance agent or broker if you were enrolled in a plan without your knowledge or consent
- Understand your rights and responsibilities regarding health insurance coverage
- File a medical appeal with your insurance company
- Request an external review if your claim was denied
Click the button below to request assistance or to file a complaint electronically. You can also visit their website or call their toll-free number (1-855-408-1212) for more information.
Have Medicare-related questions?
The NC Navigator Consortium is unable to assist with any inquiries related to Medicare. If you have questions about Medicare, including Medicaid supplemental plans for Medicare beneficiaries, contact the North Carolina Senior Health Insurance Information Program (SHIIP) at their website, or by calling 1-855-408-1212
Glossary of Health Coverage Terms
- Coinsurance: A method of cost-sharing in health insurance plans in which the plan member is required to pay a defined percentage of their medical costs after the deductible has been met.
- Copayment: A fixed dollar amount paid by an individual at the time of receiving a covered health care service from a participating provider. The required fee varies by the service provided and by the health plan.
- Deductible: A feature of health plans in which consumers are responsible for health care costs up to a specified dollar amount. After the deductible has been paid, the health insurance plan begins to pay for health care services.
- Health Maintenance Organization (HMO) Plan: An HMO plan includes a network of providers. No coverage is available for non-emergency out of network care.
- Health Savings Account (HSA): An HSA is a tax-exempt savings account that can be used to pay for current or future qualified medical expenses. Only certain high-deductible plans are paired with an HSA.
- Metal Levels: Insurance plans in the marketplace are graded based on actuarial value (what percentage of expenses the plan will cover). Bronze plans have a 60% actuarial value. Silver plans have a 70% actuarial value. Gold plans have a 80% actuarial value. Platinum plans have a 90% actuarial value. The higher the “metal” level, the higher the premium costs, but the lower the out-of-pocket costs.
- Out-of-pocket limit: A yearly cap on the amount of money individuals are required to pay out-of-pocket for healthcare costs, excluding the premium cost and non-covered services.
- Point of Service (POS) Plan: A POS plan includes a network of providers. If the insured goes to a network provider, he or she will pay less out of pocket than at a non-network provider. POS plans may require the insured to choose a primary care provider who must make referrals to specialists or for non-emergency use of the hospital.
- Preferred Provider Organization (PPO) Plan: A PPO plan includes a network of providers. If the insured goes to a network provider, he or she will pay less our of pocket than at a non-network provider. May have a broader provider network than a POS plan.
- Premium: The amount paid, often on a monthly basis, for health insurance. The cost of the premium may be shared between employers or government purchasers and individuals.
- Premium tax credits, or subsidies: A fixed amount of money or a designated percentage of the premium cost that is provided to help people purchase health coverage. Premium subsidies are usually provided on a sliding scale based on an individual’s or family’s income.
The project described was supported by Funding Opportunity number CMS-NAV-24-001 from the Centers for Medicare and Medicaid Services.
The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.