Aetna Medicare Advantage Notice

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

As of 12:01 am on February 1, 2025, WakeMed will be out-of-network with Aetna’s Medicare Advantage plans: Aetna Medicare Value Plus (HMO); Aetna Medicare Value (HMO-POS); Aetna Medicare Primary (HMO); Aetna Medicare Eagle (PPO); Aetna Medicare Premier (PPO).

For several months WakeMed has been attempting to resolve issues with Aetna Medicare not following the Centers for Medicaid & Medicare Services (CMS) guidelines for approving hospital admissions from the emergency department and denying readmissions of terminally and chronically ill patients, which is causing a financial impact to patients.

Aetna Medicare Advantage Patients

Please note that after January 31, 2025, you can still receive emergency care at WakeMed. If you have scheduled services at a WakeMed provider on or after Monday, February 3, 2025, please contact Aetna Medicare to determine if they will issue 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.

Aetna Medicare may also cover certain conditions for which you are already receiving care and certain chronic conditions through continuity of care provisions. The same holds true for certain plans where there is no difference between in- and out-of-network benefits. Lastly, you may be eligible to change your plan from Aetna Medicare to another Medicare Advantage insurance plan that WakeMed is participating with. Those plans are listed on our website.

You may also receive a letter from Aetna explaining the fact that WakeMed’s Medicare contract is ending February 1, 2025. We will continue working to resolve this issue and are hopeful that an agreement can be reached in the very near future. We will provide additional updates as needed if the situation is resolved.

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