North Carolina Medicaid covers more than 3 million residents through a managed care system where most enrollees choose a private health plan called a Prepaid Health Plan (PHP). In 2026, the five available standard plans are AmeriHealth Caritas NC, Carolina Complete Health (now merging into WellCare), Healthy Blue (Blue Cross NC), United Healthcare Community Plan, and WellCare of NC. Two of the most commonly chosen plans are AmeriHealth Caritas NC and Healthy Blue. This guide breaks down what each covers, who qualifies, and how to enroll or switch plans.
NC Medicaid Eligibility and Income Limits 2026
To qualify for standard NC Medicaid in 2026, you must be a North Carolina resident, a U.S. citizen or qualified immigrant, and meet income rules based on your household size and category.
North Carolina expanded Medicaid in December 2023, so adults between 19 and 64 who previously fell into a coverage gap can now qualify based on income alone.
Income Limits by Household Size (Adults, Medicaid Expansion, 2026)
| Household Size | Monthly Gross Income Limit | Annual Limit |
|---|
| 1 | $1,835 | $22,021 |
| 2 | $2,480 | $29,761 |
| 3 | $3,125 | $37,501 |
| 4 | $3,795 | $45,541 |
| 5 | $4,440 | $53,281 |
These limits represent 138% of the Federal Poverty Level (FPL) and apply to most non-elderly adults under the expansion. Children and pregnant women qualify at higher income thresholds.
Income Limits for Other Categories
| Category | Income Limit (% FPL) |
|---|
| Children under 19 | Up to 216% FPL |
| Pregnant women | Up to 196% FPL |
| Elderly (65+) and disabled (SSI-related) | Program-specific rules apply |
For long-term care Medicaid (nursing home coverage), different asset and income rules apply. Use our free benefits screener to find out which programs you may qualify for.
What Is NC Medicaid Managed Care?
When you are approved for standard Medicaid in North Carolina, you enroll in one of the state's Prepaid Health Plans rather than receiving services directly from the state. These plans are private insurers contracted by NCDHHS to coordinate and cover your care.
All five plans cover the same core Medicaid benefits, including:
- Primary care and specialist visits
- Emergency and urgent care
- Preventive screenings
- Mental health and substance use services
- Prescription drugs
- Dental services (for adults, limited)
- Vision
- Family planning
- Transportation to medical appointments
- Home health services
The differences between plans come down to provider network, pharmacy network, and extra value-added services (such as OTC allowances, fitness benefits, and telehealth).
AmeriHealth Caritas NC: Plan Overview
AmeriHealth Caritas North Carolina is a subsidiary of AmeriHealth Caritas, one of the largest Medicaid-focused managed care companies in the country. The plan has operated in North Carolina since the state launched its managed care program in 2021.
Key Features
- Strong care coordination programs for members with chronic conditions such as diabetes, heart disease, and asthma
- Dedicated care managers for high-need members
- Behavioral health integration within primary care
- Transportation benefits for non-emergency medical appointments
- 24/7 nurse line
- Member rewards for completing preventive care
How to Contact AmeriHealth Caritas NC
- Phone: 1-855-375-8811 (TTY: 1-866-209-6421)
- Website: amerihealthcaritasnc.com
- Hours: Monday through Friday, 8 AM to 5 PM ET
Healthy Blue NC: Plan Overview
Healthy Blue is the Medicaid product offered by Blue Cross and Blue Shield of North Carolina, the state's largest commercial insurer. Blue Cross NC's size gives Healthy Blue one of the broadest provider networks in the state, covering all 100 counties.
Key Features
- Large provider network due to BCBSNC's commercial presence statewide
- Integration with Blue Cross NC's care management infrastructure
- Broad telehealth options
- Extra benefits including OTC health supply allowances
- Healthy Blue + Medicare plan available for dual-eligible members (those who qualify for both Medicaid and Medicare)
- As of January 1, 2026, Blue Cross NC directly administers the Healthy Blue + Medicare (HMO-POS D-SNP) plan for dual-eligible members
How to Contact Healthy Blue NC
- Phone: 1-833-388-2833 (TTY: 711)
- Website: healthybluenc.com
- Hours: Monday through Friday, 8 AM to 6 PM ET
Plan Comparison: AmeriHealth Caritas vs. Healthy Blue
| Feature | AmeriHealth Caritas NC | Healthy Blue (BCBSNC) |
|---|
| Parent Company | AmeriHealth Caritas (Medicaid specialist) | Blue Cross and Blue Shield of NC |
| Provider Network | Statewide, Medicaid-focused | Statewide, large commercial base |
| Care Coordination | Specialized chronic care programs | Integrated with BCBSNC infrastructure |
| Telehealth | Available | Broad options |
| Extra Benefits | Member rewards, transportation | OTC allowance, fitness |
| Dual-Eligible Plan | Not applicable (standard Medicaid only) | Healthy Blue + Medicare (D-SNP) |
| Member Phone | 1-855-375-8811 | 1-833-388-2832 |
The best plan for you depends mainly on whether your current doctors and pharmacies are in-network. You can search both networks at ncmedicaidplans.gov before choosing.
All Five NC Medicaid Standard Plans at a Glance
| Plan | Operated By | Best For |
|---|
| AmeriHealth Caritas NC | AmeriHealth Caritas | Chronic disease management |
| Healthy Blue | Blue Cross and Blue Shield of NC | Broad provider network |
| United Healthcare Community Plan | UnitedHealth | Telehealth, disease management |
| WellCare of NC | Centene | Pharmacy benefits, member rewards |
| Carolina Complete Health | Centene (merging with WellCare, April 2026) | Community health center users |
Note: Carolina Complete Health merged with WellCare of NC in April 2026. Members were notified by mail and transitioned to WellCare's plan.
How to Apply for NC Medicaid
Step 1: Check Your Eligibility
Review the income limits above or use the NC benefits screener to estimate which programs you qualify for. For adults under 65, the main requirement is household income at or below 138% FPL.
Step 2: Apply Through NC ePASS or Your County DSS
You can apply for Medicaid in North Carolina through three channels:
- Online: Visit epass.nc.gov and create an account. Complete the online application, which covers Medicaid, SNAP, Work First, and other assistance programs.
- In person: Visit your county Department of Social Services (DSS) office. Find your local office at ncdhhs.gov/dss/local.
- By phone: Call NC Medicaid at 1-888-245-0179.
Step 3: Submit Required Documents
You will need to provide:
- Proof of identity (driver's license, state ID, or passport)
- Proof of North Carolina residency (utility bill, lease, or similar)
- Proof of income (pay stubs, employer letter, or tax return)
- Social Security numbers for all household members applying
- Immigration documents if applicable
Step 4: Wait for a Decision
Most applications are processed within 45 days. Disability-based applications can take up to 90 days. You will receive a notice by mail.
Step 5: Choose Your Health Plan
Once approved, you have 90 days to choose one of the five standard Prepaid Health Plans. If you do not choose within that window, the state will auto-assign you to a plan based on your location and prior provider relationships.
To choose or review plans, go to ncmedicaidplans.gov or call the NC Medicaid Enrollment Broker at 1-833-870-5500.
How to Switch Your NC Medicaid Plan
You can switch plans in several situations:
- First 90 days: You can switch freely during the first 90 days after enrollment, for any reason.
- Annual open enrollment: You can switch once per year during the annual open enrollment window.
- State-approved reasons: You can request a switch outside open enrollment for approved reasons, such as moving to a different county, your doctor leaving your plan's network, or quality-of-care concerns.
How to Submit a Plan Change
- Online: Log in at ncmedicaidplans.gov with your NCID and file a Standard Plan Change Request
- Phone: Call 1-833-870-5500 (TTY: 711)
- Mobile app: Download the free NC Medicaid Managed Care app from Google Play or the App Store
- Mail or fax: Download the Standard Plan Change Request Form from ncmedicaidplans.gov
Plan changes generally take effect on the first day of the following month after approval.
What NC Medicaid Does Not Cover Under Standard Plans
Standard Medicaid managed care plans cover most routine health services, but some services are handled separately:
- Long-term care (nursing home coverage) is not part of the standard PHP system
- Some behavioral health services are covered under Tailored Plans (for members with serious mental illness, intellectual and developmental disabilities, or substance use disorders)
- Dental coverage for adults is limited under standard plans
If you have complex behavioral health needs, ask your county DSS or call NC Medicaid to find out whether a Tailored Plan is available in your area.
Frequently Asked Questions
What is the difference between AmeriHealth Caritas NC and Healthy Blue?
AmeriHealth Caritas NC focuses specifically on Medicaid managed care and has specialized programs for members with chronic conditions. Healthy Blue is operated by Blue Cross and Blue Shield of NC and has a larger overall provider network because BCBSNC is the state's largest commercial insurer. The right choice depends on whether your current doctors participate in each plan's network. Check both at ncmedicaidplans.gov.
How do I find out if my doctor accepts AmeriHealth Caritas or Healthy Blue?
Go to ncmedicaidplans.gov and use the provider search tool. You can search by doctor name, specialty, or location for each plan. You can also call the plan directly: AmeriHealth Caritas at 1-855-375-8811 or Healthy Blue at 1-833-388-2832.
What happens if I do not choose a plan within 90 days?
The state will auto-assign you to one of the five plans based on your county and any prior provider relationships on record. You can still switch plans after being auto-assigned during the open enrollment period or for an approved reason.
Does NC Medicaid cover dental?
Standard Medicaid plans cover dental services for children. Adult dental coverage under NC Medicaid is limited for most enrollees but does include some preventive services. The Healthy Blue + Medicare plan offers $3,000 combined for preventive and comprehensive dental for dual-eligible members.
Can I have both Medicaid and Medicare in North Carolina?
Yes. If you qualify for both programs, you are "dual eligible" and may enroll in a Dual Special Needs Plan (D-SNP). Healthy Blue + Medicare (HMO-POS D-SNP) is one option available in North Carolina as of January 1, 2026. These plans coordinate both Medicare and Medicaid benefits in one plan.
What is the income limit for NC Medicaid as an adult in 2026?
For most non-elderly adults under the Medicaid expansion, the income limit is 138% of the Federal Poverty Level. In 2026 that equals approximately $1,835 per month for a single individual, or $3,795 per month for a family of four.
How long does it take to get approved for NC Medicaid?
Most standard applications are processed within 45 days. Disability-based Medicaid applications can take up to 90 days. Once approved, your coverage is typically retroactive to the first day of the month you applied.
Where can I apply for NC Medicaid?
You can apply online at epass.nc.gov, in person at your county DSS office, or by calling 1-888-245-0179. See our North Carolina benefits page for more local resources.
If you are unsure which programs you qualify for, run a free check with the Benefits USA screener. It covers Medicaid, SNAP, CHIP, and other assistance programs in North Carolina and all 50 states.
