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Explore the Enhanced CHF Heart Care Silver $0 Rx Options plan.
Learn about coverage and benefits that support your heart health.
Plan Details
The Ambetter of North Carolina Inc. Enhanced CHF Heart Care Silver plan includes essential health benefits, along with added services that may help members manage ongoing health needs.
This plan offers enhanced benefits that may be especially helpful for managing conditions like Congestive Heart Failure (CHF), these features are available to all members enrolled in the plan.
Plan features include:
- $0 copays for certain medications used to treat heart failure
- $0 copays for select mental health medications
- $0 copays for nicotine replacement therapy* to support smoking cessation
- $0 copays for 6 visits with your cardiologist per year, cholesterol lab testing, and EKGs done at your cardiologist visit
- $0 copays for 12 visits per year of cardiac education and nutritional counseling
- Care management to guide your care and support your health goals
View the 2027 $0 Rx Benefit for Enhanced CHF Heart Plans document for medications and supplies available at a $0 copay** with this plan.
For a full list of covered medications and coverage details, see the 2027 Formulary/Prescription Drug List or log into your Online Member Account.
Tools and Support for Heart Health
Members have access to an online heart health education center with easy‑to‑understand articles, videos, and tools. Health Hub helps you learn what changes to look for and offers practical tips for healthy food choices and staying active. Explore Health Hub.
Health Hub also includes a digital health assistant that can help members learn more about heart health. Connect with your digital health assistant.
Now in your member account and mobile app!
Ambetter Health plans include My Health Connect—a new way to do more than just manage your coverage. Earn rewards***, explore discounts, and get personalized support for your mind and body, all in one place. Log in to your Online Member Account or mobile app today to explore this new feature.
After you enroll, you may be assigned a Primary Care Provider (PCP). Your PCP is your main health care professional and should be your first choice for:
- Routine check-ups
- Non-emergency medical care such as colds and fevers
- Managing health conditions like allergies and asthma
- Prescriptions
- Lab tests
- Imaging services like x-rays, ultrasounds or CT scans
You can view or change your PCP in your Online Member Account.
The Enhanced CHF Heart Care Silver plan offers Care Management services to support you in your health journey. Care Managers can work closely with you and your doctors to create a care plan based on your needs.
Our Care Managers are registered nurses or social workers who can:
- Work with your providers to support your health goals
- Help coordinate your care
- Connect you with additional resources
Want extra support with your care? Visit our Care Management page to see how a Care Manager can help you reach your health goals and get the care you need.
Apart from specialized care, your plan offers balanced care for your whole health:
- Preventive care benefits, such as annual wellness exams and vaccinations, at no extra cost to you
- Psychotherapy and counseling
- Inpatient care
- and more!
Where To Go for Care
When it comes to getting care, Ambetter Health members have options.
Health Insurance 101
Know these health insurance terms to make the most out of your Enhanced CHF Heart Care Silver plan.
A health insurance network is a group of doctors, hospitals, clinics, and other healthcare providers. These providers are part of your plan. Members in the Enhanced CHF Heart Care Silver plan have access to doctors in the Premier Network
- In-network (INN) providers partner with your health plan. When you use their services, your plan typically covers a larger portion of costs, and you pay less.
- Out-of-network (OON) providers are not part of your network. If you see a doctor who is out of your network, you may have to pay more. Some plans may cover a smaller portion of the cost, but many do not cover out-of-network services at all. That is why it is best to stay in-network.
Your Primary Care Provider (PCP) is your main point of contact for care. This can be a doctor, a physician assistant, or a nurse practitioner.
See your PCP for wellness and sick visits, checkups, vaccinations, or for mental wellness. Your PCP can assess your symptoms, give you initial treatment, help you with your medication and refer you to a specialist when it is necessary.
As an Enhanced CHF Heart Care Silver plan member, you may be assigned a PCP. You can view or change your PCP in your Online Member Account.
Why is it good to have a PCP?
- Your PCP gets to know you and your medical history. This helps you get care that's right for you.
- Your PCP handles your preventive care. Regular checkups, screenings and vaccinations can help prevent health issues.
- If you have diabetes, asthma or another chronic condition, your PCP keeps track of it and helps you get consistent care.
A Premium is a fixed fee you will pay each month for your health insurance plan.
A copay (or copayment) is a set fee you pay for a doctor visit or prescription. You typically pay it during your visit.
Copays are common for these medical services:
- Doctor or specialist visit
- Urgent care visit
- Emergency room (ER) visit
- Prescriptions
Not all health plans have copays. Usually, plans with a high deductible do not have copays for doctor visits or prescription drugs. You can find your copay information on your Member ID Card.
A deductible is the money you need to pay for the covered services you are using before your plan starts to pay. Before you reach your deductible, you are responsible for the full costs of your care. Deductibles reset every year.
Most health plans have a deductible, but the amounts can vary. A plan with a higher monthly premium often has a lower deductible. Lower monthly payments generally mean a higher deductible.
Your deductible may also depend on where you go for care. Typically, you pay less when you get care from a doctor who is in your network.
Coinsurance is a type of cost-sharing. Usually, coinsurance begins once you pay your deductible. Coinsurance is as a percentage that you need to pay for covered services. It is a smaller portion of the full cost, and your insurance covers the rest.
This is the maximum amount of money you can pay for covered services in a year. Once you reach this limit, your plan typically covers the full cost of covered services for the rest of the year.
Frequently Asked Questions
A PCP is your Primary Care Provider. It is where you go for checkups, vaccinations or if you have fever or cold. Your PCP also cares about your ongoing issues like allergies, diabetes or asthma.
Go to the Find a Provider tool and select the PREMIER network. Use the search to find an in-network provider of your choice.
Check your plan's formulary to find out the exact brand names and quantities of the medications and supplies covered by your plan.
You can access urgent care virtually or in person without a referral.
For a virtual visit:
- Go to your Online Member Account and select “Virtual 24/7 Care”**** on the right side of the homepage to schedule your visit.
For an in-person visit:
- Find a nearby urgent care clinic using the Find a Provider tool. Choose the PREMIER network and search for “Urgent Care.”
No. As an Enhanced CHF Heart Care Silver plan member, you can choose to see any in-network specialist. Your plan will cover this visit. To find a doctor in your network, use the Find a Provider tool. Be sure to select your state, plan year and the PREMIER network before searching.
Most out-of-network services are not covered by your plan. You will have to pay in full for any out-of-network visits. The only exception is if you have a PPO plan. To choose a doctor in your network, use the Find a Provider tool. Be sure to select your state, plan year and the PREMIER network before searching.
*This benefit isincluded with all plans.
**The benefits, rates and costs listed in these advertisements are illustrative and are based on a specific household size, specific age, smoker status, and in a specific coverage area in North Carolina. A person should not send money to the issuer of the health benefit plan in response to the advertisement. A person cannot obtain coverage under the health benefit plan until the person completes an application for coverage. This policy has exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. This policy has provisions relating to renewability, cancellability, and termination, and may include provisions for modification of benefits, losses covered or premiums because of age or for other reasons. For costs and complete details of the coverage, call or write your insurance producer or the company, whichever is applicable. Additional information is available in the Evidence of Coverage.
***Healthcare-related costs will vary by member and the plan in which you are enrolled. Funds expire immediately upon termination of insurance coverage. My Health Pays® rewards can be used for pharmacy cost share at Hy-Vee* and Walmart and at a mail order pharmacy (currently Express Scripts). *Hy-Vee is currently available in select states. Find a store at www.hy-vee.com/stores. Rewards cannot be used to purchase alcohol, tobacco, firearms products, lottery tickets, gift cards, or for cash. Restrictions apply. Members must qualify for and complete all activities to receive $500 or more. Visit My.AmbetterHealth.com for more details.
****Cost sharing may apply when using Virtual 24/7 Care. Ambetter Health does not provide medical care. Medical care is provided by individual providers which are independent contractors and not agents of Ambetter Health.
Ambetter of North Carolina Inc. is underwritten by Ambetter of North Carolina Inc. which is a Qualified Health Plan issuer in the North Carolina Health Insurance Marketplace. This is a solicitation for insurance. ©2026 Ambetter of North Carolina Inc., AmbetterHealth.com/en/nc. If you, or someone you’re helping, have questions about Ambetter of North Carolina Inc., and are not proficient in English, you have the right to get help and information in your language at no cost and in a timely manner. If you, or someone you’re helping, have an auditory and/or visual condition that impedes communication, you have the right to receive auxiliary aids and services at no cost and in a timely manner. To receive translation or auxiliary services, please contact Member Services at 1-833-863-1310 (Relay 711). For more information on your right to receive an Ambetter of North Carolina Inc. plan free of discrimination, or your right to receive language, auditory and/or visual assistance services, please visit AmbetterHealth.com and scroll to the bottom of the page.