Carelon Palliative Care Program effective January 1, 2026
Effective January 1, 2026, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) introduced palliative care services to eligible members facing serious illness through Carelon Palliative Care.
Member eligibility
This program applies to Commercial Fully Insured and Medicare Advantage plans. It does not apply to the Dual Eligible Special Needs Plan (D-SNP), Employer Group Waiver Plan (EGWP), Federal Employee Program (FEP) plan, and Administrative Services Only (ASO) plans.
Who Carelon Palliative Care serves
Carelon’s Palliative Care Program supports high-risk/high-cost chronic conditions at any stage of an illness, including:
- Advanced cancer (stage IV and certain stage III cancers)
- Advanced heart failure (class III-IV)
- Advanced COPD (stage III-IV)
- Advanced end-stage renal disease
- End-stage liver disease
- Advanced neurologic disease
- Advanced dementia
Benefits of palliative care
Carelon’s clinicians are skilled in helping patients manage their conditions and in providing relief from the symptoms, pain, and stress of a serious illness. They will serve members at home or virtually. Carelon’s non-hospice, community-based care focuses on:
- Physician-led interdisciplinary care team providing disease and symptom management
- 24/7/365 access to the palliative care team
- Patient disease and medicine education and review
- Reduced hospitalizations and ER visits
- Patient and family satisfaction
- Completion of advance care planning
Provider collaboration
For members who are enrolled in the program, Carelon will remain in communication with their providers, expanding the team serving the member and not replacing any form of care. Primary care providers will also receive clinical visit summaries to stay up to date on members’ Palliative Care assessments and to ensure continuity of care.
To refer your patients to the Palliative Care Program, call Carelon’s 24/7 Patient & Referral line at 844-232-0500. You can also get more information by visiting the “Provider” section at carelon.com.