Accepted Health Insurance Plans

Duke Health contracts with most major health insurance carriers and transplant networks. Please call your insurance company and ask if you have access to health care services at Duke Health locations, and what (if any) co-payments, co-insurances, and deductibles will be your responsibility. 

The Duke Consultation and Referral Center (855-855-6484) can also review the list of Duke Health accepted insurance plans with you. 

This list covers insurance plans accepted by Duke Health in 2018. It is not all-inclusive, is updated periodically, and may be subject to change. 

Buying Health Insurance on HealthCare.gov?

If you are shopping for a health plan on the Health Insurance Marketplace (HealthCare.gov), please visit planforduke.com to learn what plans cover Duke Health hospitals and doctors and are available in your county in 2019.

Accepted Health Insurance Plans

Aetna 

  • Aetna Choice POS, Aetna Choice POS II
  • Aetna Elect Choice HMO, Aetna Open Access Elect Choice
  • Aetna Health Network Only, Aetna Health Network Option
  • Aetna HMO
  • Aetna Limited Benefit Insurance PPO
  • Aetna Managed Choice POS
  • Aetna Medicare HMO Open Access
  • Aetna Medicare Plan (HMO, PPO)
  • Aetna Medicare Premier Plan (PPO)
  • Aetna Medicare Prime Plan (HMO, PPO)
  • Aetna Open Access HMO, Open Access Aetna Select, Aetna Open Access Select, Aetna Open Access Managed Choice
  • Aetna Open Choice PPO
  • Aetna PCP Coordinated POS Plan
  • Aetna Quality Point of Service (QPOS)
  • Aetna Select HMO
  • Aetna Traditional Choice
  • Aetna Voluntary Indemnity Group Plan
  • Aetna Whole Health – Duke WakeMed WKCC

Blue Cross Blue Shield of North Carolina

  • Blue Advantage
  • Blue Local with Duke Health and WakeMed*
  • Blue Medicare (HMO, PPO)**
  • Blue Options (123, PPO, HSA)
  • Blue Select

*BCBSNC will no longer offer Blue Local with Duke Health & WakeMed in 2019. Action may be needed on your part. Visit planforduke.com to learn more.
**Duke HomeCare and Hospice does not participate with the plan.

CIGNA

  • Cigna Choice Plus
  • Cigna Open Access
  • Cigna Open Access Plus

Coventry Healthcare

  • Coventry Advantra Freedom (PPO)
  • Coventry Advantra Gold (HMO)
  • Dual Option of AWH or PPO

Duke Group Plans

  • Duke Basic
  • Duke Select

First Health

Gateway Health Alliance

Gateway Health Plan

  • Gateway Health Medicare Assured Prime (HMO)
  • Gateway Health Medicare Assured Choice (HMO)

Halifax Physician-Hospital Organization

Healthgram

Humana

  • Humana Choice (PPO)
  • Humana ChoiceCare (PPO)
  • Humana Gold Choice (PFFS)
  • Humana Gold Plus (HMO)

MedCost

Medicare

  • First Medicare Direct*
  • Medicare Part A
  • Medicare Part B

*This is for Wake County only.

MultiPlan / Private Healthcare Systems

NC Medicaid

  • NC Medicaid*

*Not all Duke locations and doctors participate in this plan. Please contact the location you will be visiting to determine what is accepted.

OneNet PPO

Optima Health

  • FAMIS
  • Optima Family Care (Medicaid HMO in VA)
  • Optima Individual & Family (On & Off Exchange Plans)
  • Optima Plus (PPO)
  • Optima Vantage (HMO)

TRICARE

  • TRICARE Extra*
  • TRICARE for Life*
  • TRICARE Prime*
  • TRICARE Prime Remote*
  • TRICARE Standard*

*Duke Primary Care does not participate with the plan.

United Healthcare

  • AARP Medicare Complete (HMO, PPO)*
  • AARP Medicare Complete Essential (HMO)*
  • All Savers Alternate Funding
  • All Savers Fully Insured
  • State Employee Health Plan (for retirees)
  • United Healthcare (HMO, PPO, POS)
  • United Healthcare Charter/Charter Balance/Charter Plus
  • United Healthcare Choice/Choice Plus
  • United Healthcare Core/Core Essential
  • United Healthcare Navigate/Navigate Plus/Navigate Balanced
  • United Healthcare of the River Valley
  • United Healthcare Option PPO
  • United Healthcare Options PPO with Harvard Pilgrim
  • United Healthcare Passport Connect Choice/Choice Plus
  • United Healthcare Passport Connect Options PPO
  • United Healthcare Select/Select Plus
  • United Medical Resources (UMR)

*Keep in mind that not all of these plans are offered in each county. In addition, Duke Homecare and Hospice does not participate in the Blue Medicare plan. Choose the plan in your county that includes Duke Health physicians, clinics and hospitals as part of its network. Some Duke providers may be in network for AARP / United Healthcare products and the Humana Medicare Advantage HMO product, however, Duke hospitals and Duke Primary Care providers are not in-network. If you are seeing a Duke provider who is in-network for these plans, and need care at Duke Hospital, Duke Regional Hospital or Duke Raleigh Hospital you will be charged for out-of-network services. If you are a retired North Carolina state employee, United Healthcare and Humana's Medicare Advantage plans do cover Duke doctors and hospitals.

Health Insurance Marketplace Products (HealthCare.gov)

As you prepare to make decisions about your health insurance coverage for 2019, we encourage you to select a product that allows you continued access to the world-renowned care you’ve come to expect from Duke Health. Certain plans offered in the Health Insurance Marketplace (HealthCare.gov) do not allow you to see a Duke Health doctor or visit a Duke clinic or hospital without a significant out of pocket expense.

Duke Health IS participating in the following Marketplace plans in 2019. Enrollment in any of these plans will allow you to continue your access to Duke Health. These health insurance plans, which are available on HealthCare.gov, differ by county. Check planforduke.com for the plans that are available in your county.

  • Ambetter NC
  • BCBSNC Blue Advantage
  • ​BCBSNC Blue Select 

Duke Health is NOT participating in the following Marketplace plans. Selection of one of these plans will result in significantly higher out of pocket costs to you to receive services from Duke Health doctors and hospitals.

  • BCBSNC Blue Value
  • BCBSNC Blue Local with Carolinas HealthCare System
  • Cigna Connect