Insurance We Accept

Commercial Insurance

• Aetna (including Aetna Connect) 
• Ambetter
• American Health Alliance
• Assurant Health
• Atlantic Integrated Health/Beacon Company
• Beech Street
• Blue Cross Blue Shield - (excluding Blue Home, Blue Local, Blue Value, and Blue High Performance Network (HPN))
• Bright Health (Bright Health will not be an option on the Healthcare Marketplace/Exchange for 2023)
• Cigna Health Care (excluding Cigna Surefit)
• Coventry National
• Coventry Preferred PPO
• Duke Select / Duke Basic (for limited services)
• Evolutions Healthcare Systems *Out of Network for WakeMed Physician Practices
• First Health PPO
• Great-West Healthcare
• Humana ChoiceCare Network
• MEDCOST
• Multiplan, Inc.
• NC State Employee Health Plan (benefit levels may be lower for patients enrolled in the Clear Pricing Project)
• NPPN/Plan Vista *Out of Network for WakeMed Physician Practices
• OneNet PPO
• Paradigm Health Corporation *Out of Network for WakeMed Physician Practices
• Primary Physicians Care
• Private Healthcare Systems (PHCS)
• UnitedHealthcare (excluding Charter Benefit Plans, Doctors Plan Benefit Plans and Healthcare Marketplace/Exchange plans)
• WakeMed and WakeMed Physician Practices are out-of-network for Blue Cross Blue Shield Blue Home, Blue Local, Blue Value, and Blue High Performance Network (HPN).

Medicare 

• Medicare Part A & B

WakeMed is pleased to participate in the following Medicare & Medicare Advantage Plans.

Medicare Advantage 

• AARP Medicare Complete (HMO)
• Aetna Medicare Assure Plan (HMO D-SNP) 
• Aetna Medicare Value Plan (HMO) 
• Aetna Medicare Prime Plan (HMO)
• Aetna Medicare Essential Plan (PPO)
• Aetna Medicare Premier Plan (PPO)
• Alignment Health Platinum (HMO-POS)
• Alignment Health NC Duals (HMO D-SNP)
• Alignment Health Heart & Diabetes (HMO C-SNP)
• Alignment Health AVA (PPO)
• Blue Medicare HMO, POS, PPO (in-state and out-of-state)
• Cigna Medicare Advantage
• Experience Health (HMO)
• FirstMedicare Direct SmartHMO (Wake County residents only)
• Healthy Blue
• Humana Choice PPO**
• Humana Gold Choice (HMO)**
• Humana Gold Plus (HMO)**
• Liberty Advantage
• PruittHealth Premier
• United Healthcare Medicare (HMO, POS, PPO) – including AARP Medicare Complete and United HealthCare Dual Complete (excluding Medicare Select and Medicare Advantage private fee-for-service and medical savings account benefit plans)
• Wellcare MAP (HMO, PPO, PFFS, PDP)

**WakeMed hospitals and physicians are out of network with Humana Medicare PPO and HMO networks effective October 31, 2023. Learn More

NC Medicaid Renewal Process

North Carolina began the renewal process for Medicaid beneficiaries on April 1, 2023. Local Department of Social Services (DSS) offices will mail beneficiaries a letter if they need to complete a renewal form. To avoid any gaps in coverage, please make sure your local DSS has your current mailing address, phone number, email or other contact information. See the NC Department of Health & Human Services website for more information.

WakeMed is a participant in NC Medicaid & NC Health Choice.

On July 1, 2021, NC Medicaid transitioned to Medicaid Managed Care Health Plans.

As part of this transformation, the majority of Medicaid members are now in a Medicaid Managed Care plan.

Of the five Medicaid managed care plans in our region, WakeMed currently has a contract with the following:

• Amerihealth Caritas
• Carolina Complete Health
• WellCare Health Plans, Inc.
• UnitedHealthcare Community Plan

This means we are only in-network with these four plans.

What This Means for You

• Emergency services are covered regardless of your plan at any emergency department.
• You will be required to seek non-emergency care from specific doctors, hospitals and health care organizations that are in-network with your Medicaid managed care plan.
• WakeMed must get prior authorization to be paid for almost all services. If WakeMed is out of network, it is unlikely that we will receive authorization. This means you may not be able to receive non-emergency care from WakeMed hospitals and providers.
• While our hospitals and emergency departments are in-network with the four plans listed above, not all of our physician practices accept Medicaid. Please contact your health care provider’s office before scheduling an appointment to confirm your Medicaid plan is accepted.

We continue discussions with the other Medicaid managed care plan available in our area. If we sign an agreement and become an in network provider with this plan, we will post this information on our web site at www.wakemed.org/insurance.

Worker’s Comp

• Beech Street Corp/Capp Care
• Corvel Corporation
• Compcare Network (Key Risk Management Services)
• Multiplan, Inc.