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Know Which Insurance Plans on HealthCare.gov Include Duke Health

Updated October 12, 2016 / Published October 27, 2015
health plans that include Duke Medicine

Have questions about Duke’s participation in plans available in North Carolina on healthcare.gov during open enrollment season? We have answers. Learn which plans Duke is considered in network for, and when you need to contact your insurer or healthcare.gov for more information.

Which Insurance Plans Is Duke Considered "In-Network" on HealthCare.gov?

In the Triangle area, Duke is considered “in-network” for Blue Cross Blue Shield Blue Local with Duke Health and WakeMed. Outside of the Triangle area, Duke is considered “in-network” for Blue Advantage and Blue Select, depending on which county you live in. If you have questions about the types of plans, costs or access to non-Duke doctors or hospitals, you should contact the insurance company directly.

Check PlanForDuke.com to see which plans are available to you that cover Duke doctors, hospitals and clinics based on your county of residence. If you have questions about the types of plans, costs, or access to non-Duke doctors or hospitals, you should contact the insurance company directly.

If I Choose (Blue Local with Duke Health and WakeMed/Blue Select or Blue Advantage), What Providers Can I Go To?

These plans give you access to a breadth of services offered by Duke Health as well as access to local providers and hospitals. Check with your insurance provider to see which local providers are considered in-network.

What Happens if I Pick a Plan That Doesn't Include Duke but Want to See a Duke Provider?

Because Duke is considered an “out-of-network provider,” you will pay significantly higher out-of-pocket expenses to see a Duke provider or to use a Duke hospital or clinic if you choose a plan that does not consider Duke to be “in-network.”

What Happens if I Live in the Triangle and Want to Keep My Current Plan?

New plans take effect January 1, 2017. If you currently are enrolled in Blue Local with Duke Health and WakeMed, you will continue to have access to Duke providers as well as other providers in the area.

If you are enrolled in United Compass or Coventry One, you will no longer be covered as they are not offering insurance plans on the Healthcare Exchange in 2017.

If you do not pick an insurance plan that includes Duke Health, Duke will no longer be in your network of providers and hospitals. Please visit PlanForDuke.com to find a plan that includes Duke. Visit HealthCare.gov before January 31, 2017 to purchase the plan that includes Duke providers and hospitals in your network.

What Should I Do if I Selected a Plan That Doesn’t Include My Duke Providers?

If you have already chosen a plan and you are now concerned your access to Duke Health may be limited, you must change your plan before January 31, 2017 by visiting HealthCare.gov. Duke is participating in Blue Cross Blue Shield of North Carolina’s Blue Local with Duke Health and WakeMed in the Triangle area and Blue Select and Blue Advantage in most other NC counties. No changes can be made after January 31, 2017 until next year’s open enrollment period unless you have a qualifying life event.

If your care needs to be transitioned to another hospital or specialist, we will work with your covered provider to appropriately transition your care and medical records.

Why Is My Duke Doctor Listed as Participating On My Insurance Company’s Website, but the Duke Website Says He Doesn’t Accept the Plan?

The insurance website may not be as current as our information. The information we supply here and on PlanForDuke.com can let you know if the insurance plan you are choosing considers Duke to be an “in network” provider.

I Need to Know About Benefits Changes, Plan Designs, Levels and Costs.

Visit HealthCare.gov. This is your best resource for evaluating which plans are available in each area, and the cost of each plan.

Who Should I Contact With Questions Once I Am Enrolled in a Plan?

If you have questions about your benefits or the plan, please contact your insurance company.

If you have questions about your health once you are enrolled, or want to make an appointment, please contact your Duke provider.

Questions about benefits changes, plan designs, levels and costs should be referred to HealthCare.gov. This is the best resource for evaluating which plans are available in each area, and the cost of each plan. 

How Do I Determine What My Deductible Premium, Co-pay and Out-of-pocket Maximums Are?

HealthCare.gov contains several ways for you to determine your health insurance-related expenses, and how they change depending on the plan you choose.

I’m Still Confused! Where Can I Find More Help Choosing a Health Plan That Is Right for Me and My Family?

NCgetcovered.org can connect you with navigators and financial counselors who can walk you through the process. They can also be reached at 855-733-3711.

See a List of Insurance Plans Accepted at Duke

Accepted Health Insurance Plans
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