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Step 1: Download the Enrollment Package
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| |  | You may need to download Adobe Reader in order to view the documents
Download Here: Adobe Reader |
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Call Toll-Free: 866-331-1348To request an application be mailed to you. |
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Step 2: Complete the Enrollment Application Form
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 | Fill out the application and attach the eligibility documentation:- Last month’s check stubs
- Latest Federal tax return
- Written prescriptions (Rx) from your doctor
- Completed NC MedAssist Application
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Step 3: Fax or Mail in your Enrollment Package
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 | Fax to: 704-536-9865 |
 | Mail to:- NC MedAssist
- 5516 Central Avenue
- Charlotte, NC 28212
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Eligibility Requirements
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| | Be a North Carolina resident Cannot have Medicare, Medicaid or any other prescription drug insurance Income must be at or under 200% of the Federal Poverty Level |
# of People Living in Your House | Annual Income | Monthly Income | 1 | $ 21,660/yr or less | $ 1,805.00 or less | 2 | $ 29,140/yr or less | $ 2,428.33 or less | 3 | $ 36,620/yr or less | $ 3,051.67 or less | 4 | $ 44,100/yr or less | $ 3,675.00 or less | 5 | $ 51,580/yr or less | $ 4,298.33 or less | 6 | $ 59,060/yr or less | $ 4,921.67 or less | 7 | $ 66,540/yr or less | $ 5.545.00 or less | 8 | $ 74,020/yr or less | $ 6,168.33 or less | *For family units of more than 8 members, add $ 3,740 to Annual Income |
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