Open Enrollment 2024

Commercial Insurance

• Aetna (including Aetna Connected)  The NC State Employee Health Plan is moving to Aetna on 1/1/25. WakeMed participates in both plans – Basic PPO Plan and Enhanced PPO Plan. WakeMed does not participate in the State’s Clear Pricing Project.
• Ambetter
• American Health Alliance
• Assurant Health
• Atlantic Integrated Health/Beacon Company
• Beech Street
• Blue Cross Blue Shield - (excluding Blue Home, Blue Local and Blue Value)
• Cigna Health Care (including Cigna Connect, excluding Cigna Surefit)
• Coventry National
• Coventry Preferred PPO
• Duke Select / Duke Basic (For limited services. Contact Aetna Member Services to confirm participation.)
• Evolutions Healthcare Systems *Out of Network for WakeMed Physician Practices
• First Health PPO
• Great-West Healthcare
• Humana ChoiceCare Network
• MEDCOST
• Multiplan, Inc.
• 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)

Medicare 

• Medicare Part A & B

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

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)
• Cigna Medicare HMO, PPO (contract scheduled to expire on 12/31/24)
• 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
• 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)

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.

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

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

Medicaid Tailored Plans

North Carolina launched the Behavioral Health and Intellectual/Developmental Disabilities Tailored Plan on July 1, 2024. Tailored Plans cover specific Medicaid enrollees who are currently members of NC Medicaid Direct. 

• Alliance Health Tailored Plan (includes only WakeMed Raleigh facility, WakeBrook facility and limited WakeMed Physician Practice locations) 

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 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.