Know which insurance plans on healthcare.gov include Duke Medicine

WTVD logo
Friday, December 4, 2015

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 include Duke Medicine?

In the Triangle area, Duke is considered "in network" for Blue Cross Blue Shield Blue Local with Duke Medicine and WakeMed, Coventry One, and United Healthcare Compass. These products are available by county, so you must check in your specific county to see what your options are.

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.

What are the benefits of Blue Local with Duke Medicine and WakeMed, CoventryOne or United Healthcare Compass.

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

What happens if I pick Blue Cross Blue Shield of North Carolina Blue Value but end up wanting 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 use a Duke hospital or clinic. To prevent paying significant out of pocket expenses, choose a plan that considers Duke "in network" like Blue Local, Coventry One, or United Healthcare Compass.

If you live in the Triangle and have Blue Advantage or Blue Select.

If you currently are enrolled in Blue Advantage or Blue Select, and live in the Triangle, and you do not change your plan, you will be auto-enrolled into Blue Value on January 1, 2016. Duke will no longer be in your network of providers and hospitals.

Please visit planforduke.com to pick a plan that includes Duke. Visit healthcare.gov before January 31, 2016 to purchase the plan that includes Duke providers and hospitals in your network.

Blue Advantage and Blue Select plans are available in some but not all counties in North Carolina through healthcare.gov and through some people's employers. If you have questions about why a plan isn't available in your county, please contact Blue Cross Blue Shield of North Carolina directly.

What if my new plan doesn't include my Duke providers?

If you have already chosen a plan and you are now concerned your access to Duke Medicine may be limited, you must change your plan before January 31, 2016 by visiting healthcare.gov. Duke is participating in Blue Local with Duke Medicine and WakeMed, Coventry One, and United Compass in the Triangle area. No changes can be made after January 31, 2016 until next year's open enrollment period.

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.

I see a Duke doctor listed on my insurance website, but not on the Duke website. What's up?

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 once I'm enrolled in a plan?

Your insurance company is your best resource for questions about benefits, plan designs, levels and costs.

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

Can you help me understand terms like deductibles, premiums, and co-pays?

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!

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.

Click here to see a list of insurance plans accepted at Duke