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Duke Health offers a range of medical insurance plans, including Duke Select, Duke Basic, Blue Care, Duke Options, and Duke USA. Each plan has different coverage options, such as pharmacy and behavioural health benefits, and pre-existing conditions are covered for all services. Duke Health also participates with Medicare and some Medicare Advantage plans, as well as contracting with most major insurance carriers and transplant networks. When comparing Duke's medical plans, it is important to consider out-of-pocket expenses and premiums, as well as specific coverage details.
| Characteristics | Values |
|---|---|
| Number of Plans | 5 |
| Plan Names | Duke Select, Duke Basic, Blue Care, Duke Options, Duke USA |
| Coverage | Pharmacy, behavioral health, pre-existing conditions, nutritional counseling, infertility benefits, SaveOnSP prescription medications |
| Geographic Limitations | Yes |
| Primary Care | Yes |
| Specialty Care | Yes |
| Transplant Services | Yes |
| Mental Health Services | Yes |
| Home Health Services | No |
| Medicare | Yes |
| Medicare Advantage | Yes |
| Supplemental Insurance | Yes |
| Out-of-Pocket Expenses | Yes |
| Premiums | Yes |
| Balance Billed Charges | Yes |
| Tobacco Surcharge | $50 per month |
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What You'll Learn
Cost of out-of-pocket expenses
When comparing Duke's medical insurance plans, it is important to consider the cost of out-of-pocket expenses. Out-of-pocket expenses refer to the amount you pay for medical services that are not covered by your insurance plan. These expenses can include copayments, deductibles, and coinsurance. It is worth noting that Duke charges an extra $50 per month for employees covered under a Duke medical insurance plan who smoke or use other forms of tobacco. This surcharge does not apply to dependents who use tobacco.
When reviewing Duke's medical plans, it is advisable to compare the out-of-pocket costs with those of other insurance plans to determine the most cost-effective option for your needs. This comparison will help you understand the financial burden you may face if you require medical services. It is also important to consider the specific coverage offered by each plan, as some services may not be included in all plans. For example, mental health services may not be covered by your insurance plan, resulting in higher out-of-pocket expenses if you require such treatment.
Additionally, it is worth noting that Duke Health contracts with major health insurance carriers and transplant networks. This means that the cost of out-of-pocket expenses for Duke employees may vary depending on their specific insurance plan and provider. It is recommended to contact your insurance company directly to understand your responsibilities regarding co-payments, co-insurances, and deductibles. This will help you anticipate any potential out-of-pocket costs associated with your specific plan.
Furthermore, when considering out-of-pocket expenses, it is important to review the network of healthcare providers associated with your insurance plan. If you receive treatment from an out-of-network provider, you may incur higher out-of-pocket costs. For example, if you choose Blue Cross Blue Shield of North Carolina Blue Value and want to see a Duke provider, you will pay significantly higher out-of-pocket expenses because Duke is considered an "out-of-network provider" for that particular plan. Therefore, selecting a plan that considers Duke "in-network," such as Blue Local, Coventry One, or United Healthcare Compass, can help prevent unexpected expenses.
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Primary and specialty care
Duke Health contracts with most major health insurance carriers and transplant networks. It is important to note that not all services are covered, and there may be geographic limitations to the care provided.
Duke Health accepts insurance plans from various providers, including CIGNA Healthcare of NC, Aetna, and United Healthcare. However, it is always advisable to contact your insurance company to confirm your access to healthcare services at Duke Health locations and understand any co-payments, co-insurances, or deductibles that may be your responsibility.
Duke offers five different medical plans to meet the needs of its employees and their families. These plans include Duke Select, Duke Basic, Blue Care, Duke Options, and Duke USA. Each plan has unique features, such as specific provider networks or coverage for pre-existing conditions.
When comparing Duke's medical plans, it is crucial to consider the cost of out-of-pocket expenses and premiums. Additionally, factors such as pharmacy and behavioral health benefits, coverage for pre-existing conditions, and nutritional counseling visits should be taken into account.
Duke also provides supplemental health insurance for eligible employees and their families traveling internationally on Duke business, known as Cigna Medical Benefits Abroad (MBA). This coverage supplements the regular health insurance plan and includes unexpected injuries and illnesses during travel.
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Geographic limitations
When considering Duke medical insurance, it is important to be aware of potential geographic limitations. These limitations can impact your access to healthcare services and providers, so understanding them is essential for making informed decisions about your care.
Firstly, Duke Health contracts with various major health insurance carriers and transplant networks, but the specific plans accepted by Duke Health may vary over time. It is recommended that individuals contact their insurance company directly to confirm their access to healthcare services at Duke Health locations and understand any associated costs. This proactive step ensures that patients are aware of any potential limitations before seeking treatment.
Additionally, Duke offers several medical plans, such as Duke Select and Duke Basic, which utilize a unique healthcare provider network. These plans encourage enrollees to carefully review the provider listing, as out-of-network care is typically limited to emergency or urgent situations. This distinction is crucial, as utilizing out-of-network providers can result in higher out-of-pocket expenses.
Furthermore, for individuals residing outside of North Carolina, there are specific responsibilities to ensure prior authorization for medical services. This process involves evaluating the medical necessity and cost of care before receiving authorization from the insurance provider. While the physician often initiates this process, the ultimate responsibility lies with the patient to ensure proper authorization is obtained.
Lastly, Duke provides supplemental health insurance for eligible employees travelling internationally on Duke business. This coverage, known as Cigna Medical Benefits Abroad (MBA), supplements the regular Duke insurance plan or the employee's other health insurance. It covers unexpected injuries and illnesses during travel, including up to seven days of personal travel when attached to a covered business trip. This provision addresses the unique needs of those travelling abroad, ensuring they have access to medical care beyond their primary geographic location.
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Supplemental health insurance
Duke Health contracts with most major health insurance carriers and transplant networks. It also participates with Medicare and many of the Medicare Advantage plans offered in the North Carolina market. Duke's medical plans cover both pharmacy and behavioural health benefits, and all plans cover pre-existing conditions for covered services.
When comparing Duke's medical plans, it is important to compare the cost of out-of-pocket expenses as well as premiums. It is also worth noting that Duke charges employees covered under a Duke medical insurance plan who smoke or use other forms of tobacco an extra $50 a month.
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Medicare and Medicare Advantage
Duke Health works with most major health insurance carriers and transplant networks. It also participates with Medicare and many of the Medicare Advantage plans offered in the North Carolina market, but not all of them.
Medicare Advantage plans have become increasingly popular, with 54% of eligible Medicare beneficiaries enrolled in an MA plan in 2024. The average enrollee has 43 plans to choose from, and about three-quarters of these plans have no additional premiums. Most Medicare Advantage plans have set copay amounts for physician visits, and they have an annual cap on out-of-pocket expenses.
When comparing Duke's medical plans, it is important to compare the cost of out-of-pocket expenses as well as premiums. Duke's medical plans cover both pharmacy and behavioral health benefits, and all of them will cover pre-existing conditions for covered services.
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Frequently asked questions
Duke offers five different medical plans to meet the needs of its employees and their families. These include Duke Select, Duke Basic, Blue Care, Duke Options, and Duke USA.
Each medical plan covers both pharmacy and behavioural health benefits. All plans will cover pre-existing conditions for covered services and comply with the Patient Protection and Affordable Care Act. Nutritional counselling visits provided as treatment for a behavioural health diagnosis are no longer subject to a six-visit limit.
Duke Health contracts with most major health insurance carriers and transplant networks. It is important to check with your insurance company to see if you have access to healthcare services at Duke Health locations and what co-payments, co-insurances, and deductibles are your responsibility.
Out-of-network care is only covered for emergency or urgent care and is limited to 20 visits and 20 days for behavioural health or substance use disorder when out-of-network.
Yes, Duke offers supplemental health insurance for eligible employees and their families travelling internationally on Duke business. It also offers Cigna Medical Benefits Abroad (MBA), which covers unexpected injuries and illnesses while travelling.
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