Cigna Medicare Advantage Notice

As of midnight on December 31, 2024, WakeMed is out-of-network with Cigna’s Medicare Advantage plans: Cigna Courage Medicare (HMO), Cigna Preferred Medicare (HMO), Cigna Preferred Plus Medicare (HMO), Cigna Preferred Savings Medicare (HMO), Cigna Preferred Select Medicare (HMO), Cigna TotalCare (HMO D-SNP), Cigna TotalCare Plus (HMO D-SNP) and Cigna True Choice Medicare (PPO).

As you may be aware, Cigna’s Medicare Advantage plans are being acquired by Health Care Services Corporation (HCSC). Since this acquisition was announced, WakeMed has been working diligently to determine what this transition will mean for our patients. Unfortunately, Cigna has, to date, been unable to provide the assurances needed by WakeMed to allow the provider contract to be assigned to HCSC. WakeMed has requested reasonable written assurances that would protect your coverage and the care we are able to provide. Additionally, Cigna Medicare is not following the Centers for Medicaid & Medicare Services (CMS) guidelines for approving hospital admissions from the emergency department, which is causing a financial impact to patients.

Take Action to Maintain Access to WakeMed

If you are currently enrolled in an individual Cigna Medicare advantage plan, you may change your enrollment to a different Medicare Advantage plan, or to original Medicare (with or without a Part D plan), during the Medicare Advantage Open Enrollment Period. This special open enrollment period takes place each year from January 1 through March 31.

You can only use this period if you already have an individual Medicare Advantage plan (group plan members are not eligible). To learn more, visit the Special Enrollment Periods page on the Medicare website or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

Individual plan members may also qualify for a Special Enrollment Period (group retiree plan members are not eligible). Members who qualify will have two months to switch to another plan. Information about this process is also available on the Special Enrollment Periods page on the Medicare website.

WakeMed is currently in network with the following Medicare Advantage plans: 

• AARP Medicare Advantage by UnitedHealthcare HMO, POS, PPO
• Alignment Health HMO, POS, PPO
• Blue Medicare HMO, POS, PPO (in-state and out-of-state)
• Experience Health HMO
• FirstMedicare Direct SmartHMO (Wake County residents only)
• Healthy Blue + Medicare Dual Eligible Special Needs Plan
• Liberty Medicare Advantage HMO
• PruittHealth Premier HMO (North Carolina and South Carolina PruittHealth Premier enrollees only)
• 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 Medicare HMO, PPO (North Carolina residents only)

Cigna Medicare Advantage Patients

WakeMed values the opportunity to be your partner in health and a part of your health care team.

Please note that after December 31, 2024, you can still receive emergency care at WakeMed. If you have scheduled services at a WakeMed provider on or after January 1, 2025, please contact Cigna Medicare to determine if they will issue a prior authorization to allow your care to be delivered on an out-of-network basis. Your out-of-pocket costs may be higher for care obtained on an out-of-network basis.

A summary of impacts to the various Cigna Medicare Advantage plans is below:

• Wake County Retirees: For Wake County retirees with the Cigna Group Medicare Advantage PPO, benefit coverage does not change when a member receives treatment from an out-of-network provider. You may continue to receive care at WakeMed at no additional costs, however, all out-of-network services must receive prior authorization from Cigna Medicare. To initiate this process, please contact Cigna using the information on the back of your ID card. 
• Cigna MAP PPO Members: Cigna PPO plans offer some out-of-network benefits. Patients with these plans can continue to seek non-emergency care from a WakeMed facility, outpatient clinic or at a specialty WakeMed Physician Practice; however, patients may see an increase in out-of-pocket costs for out-of-network care for which you will be responsible. A deposit will be required in most instances. In addition, for many services, pre-authorization will be required and that must be obtained prior to care delivery. 
• Cigna MAP HMO Members: The Cigna HMO plans do not have any out-of-network benefits. As a result, these patients will be fully responsible for the cost of their care if they choose WakeMed. We understand these patients may seek care with Cigna participating providers to be covered. 

Cigna may also cover certain conditions for which you are already receiving care and certain chronic conditions through continuity of care provisions. Additionally, under the No Surprises Act, you may be able to receive care at WakeMed at the in-network benefit level with prior authorization from Cigna. The same holds true for certain plans where there is no difference between in- and out-of-network benefits (e.g. the Wake County retiree plan).

 If you have questions related to your insurance plan, you may contact WakeMed Customer Service at 919-350-8359. We also encourage you to call Cigna with any concerns you may have using the member contact information on the reverse side of your Cigna Medicare identification card.

We will provide additional updates as needed if the situation is resolved. Thank you for choosing WakeMed.