Carolina Complete Health Coverage & Help

Carolina Complete Health (CCH) is a Medicaid managed care health insurance plan in North Carolina. As a provider-led partnership of Centene and the NC Medical Society, CCH serves over 370,000 Medicaid members in the state. This plan offers comprehensive health coverage and member support, guiding eligible individuals through enrollment and care. In this guide, we’ll explain what Carolina Complete Health covers, how to apply, and where to get help. Whether you’re interested in Carolina Complete Health login, finding doctors, using your ID card, or understanding Medicaid benefits, this article provides the answers.

What Is Carolina Complete Health?

Carolina Complete Health (CCH) is a Medicaid-managed health plan in North Carolina. It was created as a unique joint venture between Centene Corporation and the North Carolina Medical Society, designed and governed by local physicians. CCH offers the Standard and Tailored Medicaid plans (since July 2024) to eligible state residents, including children, pregnant women, families, older adults, and individuals with disabilities. By choosing CCH, members gain access to a network of providers and value-added services that address social and health needs.

This plan emphasizes preventive care and community support. It includes programs to improve education, fight food insecurity, and support maternal health. Overall, Carolina Complete Health Coverage & Help means a comprehensive care network for Medicaid participants, coupled with extra assistance programs to keep you healthy. The plan is part of Centene’s local approach in NC, with staff and offices in cities like Raleigh, Charlotte, and Greensboro.

Coverage and Benefits

Carolina Complete Health offers extensive Medicaid benefits for routine medical care, preventive services, and more. Members enjoy coverage for a wide range of services and items, including:

• Primary and Preventive Care: Regular office visits with your Primary Care Provider (PCP), routine check-ups and well-child visits, vision and hearing exams, and immunizations for all ages. CCH covers essential preventive screenings like annual check-ups, blood pressure and cholesterol screenings, mammograms, colonoscopies, well-baby care, and developmental screenings.
• Specialty and Hospital Care: Referrals to specialists (cardiologists, obstetricians, etc.), hospital inpatient and outpatient care, surgery, X-rays and lab tests. For example, if you need respiratory therapy, podiatry, or cardiac care, those services are included under your plan. Emergency room care is also covered for true emergencies.
• Dental and Vision: Routine dental exams and cleanings for adults and children, plus medically necessary dental procedures. Eye care is covered by ophthalmologists and optometrists, with referrals for diseases like glaucoma or cataracts. Regular vision screenings and medically necessary eyeglasses or lenses are included.
• Behavioral Health: Mental health counseling and substance abuse treatment services. All members can access therapy or counseling for conditions like depression or anxiety, as well as rehabilitation programs. Behavioral health support is part of the standard coverage.
• Prescription Drugs (Pharmacy): Most prescription medications and many over-the-counter (OTC) drugs prescribed by your Carolina Complete provider are covered. This includes diabetic supplies, vaccines, and smoking cessation aids. Note that some medications require prior authorization and may have quantity limits. You can request the Preferred Drug List or search the formulary online.

In short, Carolina Complete Health’s Medicaid plan covers routine primary care, preventive screenings (like cancer and diabetes tests), specialist visits, hospital services, mental health, and more. Members pay little or nothing for most covered services.

Figure: A Carolina Complete Health doctor reviews a patient’s chart in a clinic (illustrating Carolina Complete Health doctors).

Example: According to CCH’s benefits overview, members can get annual check-ups, blood tests, cancer screenings (mammograms, cervical screens, etc.), diabetes counseling, flu shots, and well-child visits all covered. These preventive services help catch health issues early. If you ever need specialty care – say a heart condition or surgery – those are covered too, under your PCP’s referral. Pharmacy coverage means your prescriptions, from antibiotics to chronic medication, are largely paid by the plan.

Finding Providers and Doctors

One of the strengths of Carolina Complete Health is its network of providers. Carolina Complete Health doctors refers to the primary care providers (PCPs) and specialists that accept this plan. To find an in-network doctor:

• Online Directory: Use the official Find a Provider tool on the CCH website or mobile app. Enter your location to see a list of nearby PCPs, specialists, dentists, or pharmacies that accept Carolina Complete Health.
• Provider Directories: Carolina Complete Health maintains provider directories by county. You can request a printed directory at no charge by calling Member Services at 1-833-552-3876 (TTY 711). This directory lists PCPs, specialists, clinics, hospitals, and pharmacies.
• Primary Care Provider (PCP): When you join CCH, you should choose a PCP who will coordinate your care. If you want to change your PCP later, call Member Services or update it through the member portal.
• Telemedicine and Urgent Care: For non-emergency issues, CCH covers virtual visits (telemedicine) and has in-network urgent care centers. The Member Handbook outlines where to go for care depending on the situation.

CCH’s network is large and growing. The official site notes they’re “adding new providers every day” and emphasize a strong provider network. If you’re not sure who to pick, contact Member Services for a recommendation. Remember: to get coverage, services should be provided by a CCH-approved doctor or through an emergency.

Pharmacy and Prescription Coverage

Carolina Complete Health includes robust pharmacy benefits. Most prescription drugs and many over-the-counter medicines (when prescribed) are covered under the plan. Key points about CCH pharmacy coverage:

• Prescription Drugs: Almost all generic and brand-name medications that CCH covers can be obtained at in-network pharmacies. There is a Preferred Drug List (formulary) that CCH updates regularly; this list is provided to members and providers.
• Prior Authorization: Some medications require prior authorization. There may also be age limits or quantity limits on certain drugs (for example, high-cost or specialty medications). Always check with your doctor or call Member Services if you encounter a denial.
• How to Get Your Meds: At the pharmacy, present the prescription from your Carolina Complete Health provider and your Carolina Complete Health ID card. The ID card proves your coverage. If you can’t find a pharmacy in the network, the CCH website’s Provider/Pharmacy finder can locate nearby options.
• Contact for Help: If you have questions about drug coverage or need help finding a pharmacy, you can call Carolina Complete Health at 1-833-552-3876 (TTY 711). That number connects you to Member Services and the 24/7 Nurse Advice Line.

Figure: Patients in a clinic waiting room consulting with a healthcare provider (depicting the Carolina Complete Health provider network).

In summary, prescriptions are mostly covered. You may have nominal copays or limits per Medicaid rules (read your Member Handbook or check Member Materials on the CCH site). The pharmacy page confirms that “Carolina Complete Health covers most prescription medications and over-the-counter drugs when prescribed by a Carolina Complete Health provider”. You can use any in-network pharmacy or even arrange delivery through mail-order if needed.

The Carolina Complete Health Member Card

When you enroll in Carolina Complete Health, you receive an ID card similar to a health insurance card. This card must be presented whenever you get care or fill prescriptions. The card includes your name, ID number, PCP name, and plan details. To highlight its use:

• Show Your Card for Services: Whenever you visit a doctor, clinic, or pharmacy, present your Carolina Complete Health ID card. This proves you have CCH coverage.
• Lost Card? If you lose your card, you can request a new one: log into the member portal (see below) and print a copy, or call Member Services at 1-833-552-3876 to have a card mailed to you.
• Pharmacy Pickup: To get medicine, you’ll show your prescription and your ID card at the pharmacy. The pharmacy staff will process the claim using your card information.

The official site reminds members: “At the pharmacy, you will need to give… your Carolina Complete Health prescriber and your Carolina Complete Health ID Card”. In other words, always carry your card. It’s your key to accessing doctors, tests, and prescriptions under Carolina Complete Health coverage.

Carolina Complete Health Login (Member Portal)

CCH provides an online Member Portal for managing your account. Through the portal, members can:

• View Benefits and Claims: See what services have been covered and check claim details.
• Print an ID Card: You can download or print a replacement ID card if needed.
• Update Info: Change your address or contact info.
• Find Providers: Access the online directory or find nearby doctors.

To access the portal, visit the Carolina Complete Health website and click Member Portal Login (often at the top menu). If you haven’t created an account yet, you can sign up with your CCH ID and personal details. The site encourages members: “Create your own online account today! It’s free and easy! You will have access to your health care information. View claims, get a new ID card, update your information, and more!”.

Having portal access makes managing your health coverage simpler. For example, after seeing a doctor, you can log in to confirm the visit was recorded. Or if you’re going on vacation, you can check your plan details anytime. For any login issues, CCH’s Member Services at 1-833-552-3876 can assist you.

Applying for Carolina Complete Health (Medicaid Enrollment)

How to Apply: Carolina Complete Health is available to those enrolled in North Carolina Medicaid. You don’t apply directly to CCH; instead, you apply to Medicaid and choose CCH as your plan. The state provides several ways to enroll:

1. Online: Go to the NC Medicaid Managed Care website (NCMedicaidPlans.gov) and complete the enrollment form.
2. By Phone: Call the NC Medicaid enrollment line at 1-833-870-5500 (TTY 711), Monday–Saturday 7 a.m.–5 p.m..
3. By Mail/Fax: If you received a paper enrollment form, fill it out and mail it to NC Medicaid, PO Box 613, Morrisville, NC 27560, or fax it to 1-833-898-9655.
4. Mobile App: Download the free NC Medicaid Managed Care app from the Apple App Store or Google Play and apply on your smartphone.

Once you apply, an independent enrollment specialist can help you choose a plan. Carolina Complete Health is one of several Medicaid plans in NC. If you want to enroll in CCH, simply select it as your provider when prompted. If you need assistance, you can also call the Medicaid enrollment specialists at 1-833-870-5500 for guidance.

Eligibility: North Carolina Medicaid covers a broad range of people. The state expanded Medicaid in 2023 to include adults 19–64 up to 138% of the Federal Poverty Level. In general, you may qualify for coverage (and thus for CCH) if you are one of the following:

• Children and families (with income limits)
• Pregnant women
• Elderly (age 65+) or individuals with disabilities (often with very low income thresholds)
• Expansion adults (19–64) up to about 138% of the poverty level.

The NC DHHS site explains, “North Carolina Medicaid programs may offer coverage for children, pregnant women, and families with children, the elderly, adults with disabilities, and children with disabilities.”. Once eligible, you can enroll and select Carolina Complete Health.

Coverage Begins: After enrollment, it may take a few weeks for your Medicaid coverage to become active. Once it does, CCH will send you a welcome packet and an ID card. You can also immediately create a member portal login to begin using your benefits.

Member Services and Contact Information

Carolina Complete Health provides robust support to its members. If you have questions or need help, you can reach out:

• Member Services Phone: Call 1-833-552-3876 (TTY 711). This line is available Monday–Saturday, 7 a.m. to 6 p.m. ET. Representatives can help with benefits questions, finding a doctor, changing your PCP, getting an ID card, and more.
• 24/7 Nurse Advice Line: Also at 1-833-552-3876 (TTY 711), any time of day. Registered nurses are available 24/7 for medical advice or questions about symptoms and when to seek care.
• Online Contact: Visit the Contact Us page on the CCH website. There’s a form for general inquiries, but note they recommend secure messaging through the member portal for PHI.
• Office Locations: CCH has offices in Charlotte and Durham (by appointment only). If you need in-person help or a printed form, you can visit or schedule with Member Services.

For quick reference, CCH’s site states: “Contact us at 1-833-552-3876 (TTY: 711)” for any inquiries. Store this number with your ID card. Whether you have a billing question or need a ride to a doctor’s appointment, Member Services can point you in the right direction.

Carolina Complete Health also works with the NC Medicaid Ombudsman for member concerns. If you ever face a grievance or need independent help understanding your rights, you can call the NC Medicaid Managed Care Ombudsman at 1-877-201-3750 or visit ncmedicaidombudsman.org.

Carolina Complete Health Reviews and Member Feedback

Carolina Complete Health often receives positive feedback for its comprehensive coverage and community programs. Many members appreciate the “value-added services” – programs like baby showers, nutrition support, and free fitness programs that CCH offers to keep families healthy (see the Value-Added Services section on the website). Social media posts and member surveys highlight that the provider network is large and local, making it easy to find a doctor.

However, like any plan, experiences vary. Some members say customer service is very helpful, while others suggest improvements in things like call wait times or provider listings. It’s always a good idea to read recent reviews or ask other beneficiaries in your community about their experience. (Note: online reviews may refer to employee satisfaction, such as a Glassdoor score of 3.9 for CCH, but member reviews focus on things like care access and help resources.)

Tip: The best way to gauge a health plan is by asking neighbors or community groups about Carolina Complete Health. Clinics and social service agencies in NC are usually familiar with the different Medicaid plans and can share insights.

Key FAQs about Carolina Complete Health

• Q: Who can enroll in Carolina Complete Health coverage?
  A: Carolina Complete Health is available to North Carolina Medicaid members. Eligibility for Medicaid (and thus CCH) includes children, pregnant women, parents, elderly adults, people with disabilities, and expanded Medicaid adults (19–64) up to ~138% of the federal poverty level. If you qualify for Medicaid in NC, you can choose CCH as your health plan.
• Q: How do I apply for Carolina Complete Health?
  A: You apply by enrolling in NC Medicaid and selecting Carolina Complete Health as your plan. You can apply online at NCMedicaidPlans.gov/enroll, by phone at 1-833-870-5500, by mail/fax with a form, or via the free Medicaid managed care mobile app. Once you complete Medicaid enrollment, you can pick CCH. If you need help, call 1-833-870-5500 (TTY 711) to speak with a Medicaid specialist.
• Q: What services does Carolina Complete Health cover?
  A: CCH covers a full range of Medicaid services. This includes preventive care (annual check-ups, vaccines, cancer screenings, well-child visits) and primary care; specialist care, hospital stays, and emergency services; mental health and substance use care; dental and vision services (routine exams and medically necessary treatment); and a comprehensive pharmacy benefit (prescription drugs and OTC meds). In short, most medically necessary care is covered, subject to standard Medicaid rules (like doctor referrals and prior authorizations).
• Q: How can I find a doctor in the Carolina Complete network?
  A: Use the CCH Find a Provider tool on their website or app. Enter your zip code to search by specialty. You can also request a paper Provider Directory for your county by calling 1-833-552-3876. The directory lists all in-network PCPs, specialists, urgent care clinics, and pharmacies. If you need help, Member Services can assist you in finding a doctor.
• Q: What is the Carolina Complete Health member portal (login)?
  A: The member portal is an online account for CCH members. Once you log in (from the CCH website’s “Member Portal Login”), you can see your coverage details, print a new ID card, view claims, and update your contact information. The portal is free to use. As the website notes: “You will have access to your health care information. View claims, get a new ID card, update your information, and more!”.
• Q: How do I contact Carolina Complete Health for help?
  A: Call 1-833-552-3876 (TTY 711) for Member Services or the 24/7 Nurse Advice Line. There is no separate provider phone; this is the main number for both administrative questions and medical guidance. You can also email or send a secure message through the member portal. The Contact Us page on the CCH site has an online form, but note that email is not fully secure for protected info.

Conclusion

Carolina Complete Health Coverage & Help provides a full-service Medicaid health plan for North Carolinians in need of medical coverage. By combining a wide range of covered services (from doctor visits and hospital care to prescriptions and wellness programs) with extra member support, CCH aims to keep you healthy and informed.

If you qualify for NC Medicaid, consider applying and choosing Carolina Complete Health as your plan. Enroll online or by phone, then log in to the member portal to start managing your benefits. Remember to choose a doctor, keep your ID card handy, and use the toll-free number (1-833-552-3876) if you need assistance.

We hope this guide to Carolina Complete Health has been helpful. Share this article with friends or family who are looking into Medicaid plans. If you have experience with Carolina Complete Health, leave a comment below to let others know how it worked for you. Your input can help someone get coverage and care!