UnitedHealthcare Community Plan Medicaid

Behavioral Health

Behavioral health is as important as physical health. That’s why we have coverage for both. Required care is 100% covered with no copay. This includes:

• Counseling
• Substance use treatment.
• Medications.

Call the Behavioral Health Crisis Line at 1-877-334-1141, at any time, 24 hours a day, 7 days a week. If you are in danger or need immediate medical attention call 911.

Breastfeeding Support

SimpliFed provides free virtual breastfeeding and baby feeding support to UnitedHealthcare Community Plan of North Carolina members, starting in pregnancy. Members have access to up to six visits with baby feeding experts who provide judgment-free care, no matter how you feed your baby.

For more information or to book an appointment, text UHCNC4MILK to 888-458-1364, visit www.simplifed.com/united-nc, or call 844-799-0538. 

Choice of Doctor

Each member can choose a primary care provider (PCP). Use the Doctor Lookup tool to see if your doctor is in our network.

The PCP is the main doctor for:

• Preventive care.
• Treatment if you are sick or injured.
• Referrals to specialists for certain conditions.

For members who don’t have a doctor or whose doctor is not in our network, we can help find a new one close by.  

Copays

Copays If You Have Medicaid

There are No Medicaid copays for the following people or services:

• Members under age 21
• Members who are pregnant
• Members receiving hospice care
• Federally recognized tribal members
• North Carolina Breast and Cervical Cancer Control Program (NC BCCCP) beneficiaries
• People living in an institution who get coverage for cost of care
• Children in foster care
• People living in an institution who are receiving coverage for cost of care
  
• Behavioral health services
• Intellectual/developmental disability (I/DD) services
• Traumatic brain injury (TBI) services

A provider cannot refuse to provide services if you cannot pay your copay at the time of service. If you have any questions about Medicaid copays, call Member Services at 1-800-349-1855, TTY 711..

Diabetic Support

If you have diabetes, we’ll help make life a little easier for you. You’ll get medicine, supplies and education to help you reach and stay your best. 

Our diabetes program also includes self-care training and classes focused on:

• Planning healthy meals.
• Managing stress.
• Living a healthy lifestyle. 

Disease Management

If you have chronic or high-risk illnesses, our disease management services are designed to support you.

We have special programs for:

• Congestive heart failure.
• Asthma.
• HIV.
• Chronic obstructive pulmonary disease (COPD).
• Coronary artery disease.

Durable Medical Equipment

Some members may need extra support to live safely at home.

Our plan covers medical equipment ordered by your doctor or case manager. This can include supplies like:

• Oxygen tanks.
• Hospital beds.
• Wheelchairs or walkers.

Health Education

Take free classes to help improve your health or to address a condition.

Our plan includes classes on diabetes, nutrition and more. You can even get a ride, if needed, to and from the class at no cost to you. 

BabyScripts

Build a healthy future for you and your baby and earn great rewards with BabyScripts. Our program will help you take the right steps to keep you and your baby healthy. Plus you can earn $20 just for signing up. 

We will help you:

• Choose a pregnancy provider and a pediatrician (child’s doctor).
• Schedule visits and exams and arrange rides to your visits.
• Earn rewards for going to visits throughout your pregnancy and baby’s first 15 months of life.
• Get supplies, including breast pumps for nursing moms.
• Connect with community resources such as Women, Infants and Children (WIC) services.

Healthy Rewards

An ounce of prevention can be worth a pound of cure. It can also be worth great rewards.

You can earn great gifts for your child by doing things like:

• Completing well-child exams.
• Getting lab tests.
• Recording your family’s health activities. 

Hearing Care

Trouble hearing can affect your everyday life in many ways.  Our plan includes services and support to help protect your hearing.

Our plan covers:

• Exams, therapy and tests.
• Hearing aids and batteries.

Hospitalization

This plan pays for all expenses related to a hospital stay, so you can rest and heal. 

Hospitalization coverage includes:

• Nursing care.
• Room and board.
• Supplies and equipment.
• Treatment and therapies.
• Diagnostic tests and exams.

And after you leave the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.

In-Home Care

After surgery or a serious illness, you may need extra help with day-to-day tasks like cleaning, cooking or dressing. You may even need an in-home medical visit to check on how well you are healing. With approval, our plan covers:

• An in-home medical visit.
• Medical equipment like hospital beds, walkers or wheelchairs.
• Disposable medical supplies.
• Help with personal care or housekeeping.

Lab and X-ray Services

Knowing what’s wrong and finding it early can make all the difference.  Our plan covers:

• Labs and testing.
• X-rays, scans and other imaging.

We’ll help you get the information needed to improve your health or be at your best. 

Language Help

You can get information in another language. Just ask. Then anything we write to you will only be in that language. This is provided at no cost to you.  

Medicines

And we make getting your child's medicine easy. We'll provide a list of covered drugs if you have questions about what prescriptions are covered.

You can fill the prescriptions at local pharmacies in the UnitedHealthcare Community Plan network.

Member Services

Sometimes you might need a little help understanding your health care options. We’ll answer your questions simply and completely.

We can also help you find:

• Home care providers.
• Specialists.
• Doctors.
• Pharmacies.
• Hospitals or other health facilities.
• Local resources.

Nurse Visit

Sometimes continued care is needed after leaving the hospital or urgent care. For example, after a serious illness, surgery or injury. In these cases, a nurse will make home visits to:

• Provide medical care.
• Answer any questions and concerns.

Nurse Hotline

Medical questions and situations can come at inconvenient times. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week.

Our nurses will: 

• Listen to symptoms.
• Help with self-care.
• Advise you about getting care at a doctor visit or an urgent care center.
• Help you know when to go to the emergency room.

Nutrition Coaching

Healthy eating goes a long way to helping you stay at your best. A nutritionist can meet with you to review your eating habits and food choices. 

You’ll come away with new ideas for:

• Making good choices for quick meals and snacks.
• Preparing healthy meals on a budget.

Obesity Care

Obesity is common and serious.  It can also lead to other health problems. To help our members be their best, our plan includes:

• Screening for obesity.
• Counseling for obesity.

Outpatient Services

Knowing what’s wrong and finding it early can make all the difference.  Our plan covers:

• Labs and testing.
• X-rays, scans and other imaging.

We’ll help you get the information needed to improve your health or be at your best. 

Personal Care

Sometimes the basics are hard to do yourself after an illness or injury. If needed, we provide someone to help with:

• Dressing.
• Bathing.
• Feeding. 

Prenatal Visits

A pregnancy is a journey that’s better with the help of friends, family and a pregnancy doctor, or OB/GYN.

All recommended prenatal clinical visits and tests are covered by our plan.

At these visits, the clinic will:

• Make sure both mom and baby are healthy.
• Explain what to expect at each stage of pregnancy.
• Answer questions.

Quitting Tobacco

Most people know the bad health effects of smoking. And they know they need to quit. We support our members while they quit, with coaches and supplies. The only thing they won’t get from us is a lecture.

Rehabilitation Care

After a serious illness, surgery or injury you may need extra nursing and therapy.  If needed, our plan covers short stays in a rehabilitation center where you can heal.  Included are:

• Nursing home services.
• 24-hour nursing care.
• Help with activities of daily living.

Physical, occupational and speech therapy.

Respite Care

Do you have family members or friends who care for you at home?

If so, we want to support their hard work too. That’s why we provide respite care to give your caregivers a rest. Respite care offers caregivers time away from their loved one who is ill or has special care needs.  

Shots and Vaccines

Routine shots help protect you from illness. So, our plan covers:

• Recommended shots and vaccines.
• Influenza shots. 

Social Services

Many communities offer additional benefits for children in this plan. Social Services helps members connect to these local programs and services, such as:

• WIC and financial support.
• School services.
• Respite care.
• Training and family phone line.

Speech Therapy

Speech therapy visits and exercises can help those who have difficulty speaking. At your doctor’s requests, we will cover up to 60 combined physical, occupational, speech and other therapy visits each year

Text4baby

Text4baby can help new and expecting mothers keep themselves and their babies healthy.

You’ll get text messages throughout your pregnancy and your baby’s first year. Each text contains health and safety tips for topics like:

• Prenatal care.
• Labor and delivery.
• Breastfeeding.
• Safe sleep.
• Nutrition.
• Car seat safety.

So you and your baby can make a great start on life.

Therapy Services

Physical, occupational and speech therapy can help you recover from a serious injury or illness, or simply reach your full potential. 

Our plan provides:

• Occupational therapy.
• Physical therapy.
• Speech therapy.

Unlimited Doctor Visits

There may be times when your or a family member’s health requires repeated visits to a primary care provider (PCP). Our plan does not limit the number the number of times you can see your PCP.  This way you get care need when you need it. And your doctor can see how your health is progressing.   

Urgent Care

You may have an injury or sudden illness that is not life-threatening but needs immediate attention. So our plan covers care at:

• Urgent care centers.
• Medical aid units.
• Other walk-in clinics.

Weight Control

Our plan encourages a healthy approach to eating and living. To help our members be their best, we cover:

• Screening for obesity.
• Support for healthy diet and exercise choices.

Wellhop for Mom & Baby

An online meeting and resource community for pregnant members. Wellhop brings pregnant women together and matches them with clinically trained facilitators in group video conversations for education and support. 

Well Visits

Well visits with your doctor are important for good health. These visits can catch health problems early, so they can be treated. Preventive services include:

• Checkups for adults and children.
• Well-baby care.
• Care for women expecting a baby.
• Routine shots and tests.
• Mammograms.

There are no copayments for preventive care.