Healthy Blue Benefits

As a Healthy Blue member, you get all of your Medicaid benefits and services, including:

• Primary care provider (PCP) visits
• Immunizations and wellness visits
• EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) services for members under 21
• Maternity care
• Hospital care
• Lab and X-ray services
• Home health and personal care services
• Hospice care
• Emergency and urgent care
• Specialty care
• Behavioral health services (mental health and substance abuse services)

Check your member handbook for a full list of benefits. All services must be medically necessary.

We can help you with issues beyond your medical care. The Healthy Opportunities Pilot* (HOP) program covers certain nonmedical aids for high-risk members. These services help with housing, safety, food, and transportation.

The services may be available under Healthy Blue based on where you live and other factors, such as if you have a physical or behavioral health condition.

Learn more about the Healthy Opportunities program 

*Healthy Opportunities Pilots Service Stop (Effective July 1, 2025) Due to a lack of funding currently available in the North Carolina General Assembly’s Senate or House budget bills, the state is stopping 1) all new service authorizations and 2) existing service delivery for all Healthy Opportunities Pilots services until further notice. This means that services provided under the Healthy Opportunities Pilots program will no longer be available after this date, including for individuals currently receiving service.

 Healthy Opportunities Rights and Responsibilities

Your benefits include routine eye exams and eyeglasses, if needed.

Find an eye doctor 

Sometimes, life leads to stress, and stress can lead to depression and anxiety. Stress can lead to marriage, family and/or parenting problems, too. It can also lead to alcohol and drug use.

If you or a family member is having these kinds of problems, we can help. Call Healthy Blue Member Services at 844-594-5070 (TTY 711).

Your benefits include medically needed services, such as:

• Inpatient behavioral health services
• Outpatient behavioral health services
• Partial hospitalization
• Substance use treatment
• Crisis services

You can also get the name of a behavioral health specialist. You don’t need a referral from your primary care provider (PCP) to get these services or to visit a behavioral health specialist in your plan.

If you think a behavioral health specialist does not meet your needs, talk to your PCP. They can help you find a different kind of specialist.

There are some treatments and services your PCP or behavioral health specialist must ask Healthy Blue to approve before you can get them. Your doctor will be able to tell you what they are.

If you have questions about referrals and when you need one, contact Member Services at 844-594-5070 (TTY 711) Monday through Saturday, 7 a.m. to 6 p.m. Eastern time. If you feel like you’re in crisis, please call our Behavioral Health Crisis Line at 844-594-5076.

Your benefits include a wide range of prescriptions and over the counter (OTC) medicines. We can even deliver your medicines to your home. We work with CarelonRx to provide these benefits.

Visit the pharmacy page to find a pharmacy near you and check if your medicine is covered.

Healthy Rewards is a no-cost optional program for eligible Healthy Blue members. It pays you for completing healthy activities like:

• Yearly well-child and childhood dental visits.
• Prenatal and postpartum visits for pregnant members.
• Screenings for diabetes management.

To redeem your Healthy Rewards, visit the Benefit Reward Hub. To learn about other value-added benefits, visit the Extra Benefits page.

Managing your health care alone can be hard, especially if you are dealing with many health problems at the same time. If you need extra support to get and stay healthy, we can help. As a member of Healthy Blue, you may have a care manager on your health care team. A care manager is a specially trained health professional who works with you and your doctors to make sure you get the right care when and where you need it.

Learn more about care management 

This guide can help you know when to set up doctor visits and important screenings for you and your children. Ask your doctor which exams, tests, and vaccines are right for you, when you need them, and how often.

 Preventive Health Guidelines (English)

 Preventive Health Guidelines (Spanish)

You can get no-cost rides to and from your appointments. Visit the Transportation page to learn more about setting up a ride.

Go to the Transportation page 

If you have a certain health condition or disability, you may need help with day-to-day activities, like eating, bathing, or doing household chores. You can get the help you need through Long Term Services and Supports (LTSS). LTSS includes services like home health and personal care services. You may get LTSS in your home, community or in a nursing home.

If you need LTSS, you may have a care manager on your care team. A care manager is a specially trained health professional who works with you and your doctors and other providers of your choice to make sure you get the right care when and where you need it.

If you are leaving a nursing home and are worried about your living situation, we can help. Our Housing Specialist can connect you to housing options as needed. Call Member Services at 844-594-5070 (TTY 711) to learn more.

If you have questions about using LTSS benefits, talk with your PCP, a member of your care team or call Member Services at 844-594-5070 (TTY 711).