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Blue Cross Blue Shield of NC
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Gateway Health Plan
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FAQs about health plans and open enrollment

Below are some frequently asked questions about health insurance options available in 2017.

Which insurance plans on (“The Exchange”) include Duke Health?

In the Triangle area, Duke is considered in-network for Blue Local with Duke Health and WakeMed from Blue Cross Blue Shield of North Carolina. Outside of the Triangle, Duke is considered in-network for Blue Select and Blue Advantage, depending on what county you live in. Policies are available 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 you enrolled in Coventry One or United Healthcare Compass for 2016, you need to enroll in a plan for 2017 that includes Duke Health (Blue Local, Blue Advantage or Blue Select) to ensure you can continue to see your Duke doctor.

What are the benefits of choosing a plan on that includes Duke?

The Blue Local, Blue Select and Blue Advantage plans from Blue Cross Blue Shield of North Carolina give you access to a breadth of services offered by Duke Health as well as access to local providers and hospitals. Check with the insurance provider to see which local providers are considered in-network.

What if I pick a health plan that does not consider Duke Health in-network but I want to see a Duke doctor?

If Duke is considered an “out-of-network provider” in your plan, you may have to pay significantly higher out-of-pocket expenses to see a Duke doctor or use a Duke hospital or clinic. To have more control over the cost of your care at Duke, be sure to choose the Blue Local with Duke Health and Wake Med plan from Blue Cross Blue Shield of North Carolina (in the Triangle) or Blue Select or Blue Advantage (outside the Triangle).

What if I selected a plan that doesn’t include my Duke doctors?

If you have already chosen a plan but now are concerned your access to Duke Health may be limited, you must change your plan before January 31, 2017 by visiting In the Triangle area Duke is ONLY participating in Blue Local with Duke Health and WakeMed from Blue Cross Blue Shield of North Carolina. Outside of the Triangle, Duke is considered in-network for Blue Select and Blue Advantage in most North Carolina counties. No insurance plan changes can be made between January 31, 2017 and the next 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.

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 Duke's information. The information we supply will let you know if the insurance plan you are choosing considers Duke to be an in-network provider.

Where can I go for help to determine which plan is best for me?

There are a few resources to help you choose the right plan for you and answer any questions you may have:

  • to ensure your Duke doctor is covered in your health plan and to help you determine which plans include Duke Health.
  • can connect you with local application assisters and healthcare navigators to help walk you through the process. Just enter your zip code to find available appointments near you.
  • is your best resource to evaluate which plans are available in your area, and the cost of each plan. They also provide information to help determine your health insurance-related expenses and how they change depending on the plan that you choose.
What Medicare Advantage plans include Duke Health?*

Blue Medicare/BCBSNC
Coventry Healthcare – Advantra
Gateway Health Plan
Humana Medicare PPO

*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 plans do cover Duke doctors and hospitals.
If I live closer to community hospital options, why do I need a plan with Duke in the coverage?

Serious illness or accidents can occur without notice and can require more advanced care than what your community hospital offers. For the ultimate peace of mind, you’ll want to keep your local providers plus have access to specialists at a larger health system like Duke.

Where should I go in an emergency for immediate care?

If a medical emergency arises, call 911 or go to the closest hospital to you. In the case of emergency care, your insurance company is required to have the same benefits and same patient cost-sharing no matter what emergency room you go to. In other words, you can expect the same co-pays and deductibles as you would for in-network care.

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