Original Medicare & Medicare Advantage Plans

Group Retiree Plan Members

Many Group Medicare Advantage (PPO) plans are exempt from out-of-network penalties. This means you will pay the same out-of-pocket costs for covered services provided by WakeMed providers and hospitals, even if we are out of network with your plan administrator (HealthSpring, Humana and UnitedHealthcare, etc.).

Using these out-of-network benefits – at no additional cost to you, the employer or your plan administrator – may still require pre-authorization from your plan administrator. Contact your insurance company directly to determine the benefits associated with your plan. As a licensed Medicare participating health system, WakeMed accepts 100% of the CMS-allowed payment as our payment in full. That means the only costs we will bill you for are the out-of-pocket costs defined by your plan.

Members of Medicare Advantage employer sponsored group retiree PPO plans that do have an out-of-network penalties also have PPO benefits, which members are entitled to use. If you are not sure what your out-of-pocket costs are, please call your plan for the details.

Please note that WakeMed requires all out-of-network patients to complete the Patient Financial Responsibility form. Other financial terms may be applied, depending on your out-of-network benefits.

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

Medicare 

• Medicare Part A & B

Supplemental Medicare coverage is provided through private insurance companies.

Medicare Advantage 

• AARP Medicare Advantage by UnitedHealthcare HMO, POS, PPO
• Aetna Medicare HMO, POS, PPO
• Alignment Health HMO, POS, PPO
• Blue Medicare HMO, POS, PPO (in-state and out-of-state)
• ExperienceHealth HMO (excludes WakePET services)
• 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)
• Wellcare Medicare HMO, PPO (North Carolina residents only)

WakeMed is not participating with the following area Medicare Advantage plans: 

• Cigna Medicare HMO
• Humana Medicare HMO
• UnitedHealthcare HMO

For the above plans, many of their employer sponsored PPO retiree group plans have no out of network benefit penalty. Therefore these members can continue to receive services from WakeMed providers at no additional cost. Further, their PPO plans which do have a benefit differential are accepted at WakeMed. Being a licensed Medicare participating health system, WakeMed accepts CMS payment as payment in full, with no balance billing to the patient except for their plan determined copay, deductible, and coinsurance.