Same hospital system, two different answers. WakeMed’s Raleigh hospitals returned to UnitedHealthcare’s network on October 15 for people with employer-sponsored plans. They remain out of network for people in UnitedHealthcare’s Medicare Advantage plans, who have until December 7 to switch.
What the October 15 contract changed
WakeMed and UnitedHealthcare signed a new multi-year contract for employer-sponsored commercial plans, effective October 15, WakeMed says on its negotiations page. Members of those plans regained in-network access to WakeMed’s acute and rehabilitation hospitals, its HealthPlex locations, specialty physicians and home health.
The health system says it resumed scheduling and providing care on an in-network basis that day. Its page also acknowledges that “the past eleven months have been incredibly challenging” for patients, and says the agreement lets more of them return to care teams they know.
The deal has limits even among younger members. WakeMed says UnitedHealthcare’s individual Marketplace plans are not covered by this agreement. Patients on those plans should check coverage before scheduling anything that is not an emergency.
Where Medicare Advantage stands
For Medicare Advantage, nothing changed. UnitedHealthcare’s WakeMed page says the hospitals, specialists, HealthPlex locations and home health will remain out of network for people in its Medicare Advantage plans. UnitedHealthcare lists the affected categories as individual plans, dual-eligible special needs plans and group retiree plans.
Some WakeMed services never left. The health system says its employed primary care physicians, its ambulatory surgery centers and its free-standing PET imaging center remain in network for commercial, Medicare Advantage and group retiree members. A member can keep a WakeMed family doctor and still be unable to use the hospital.
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That split matters in practice. A Medicare Advantage member could see a WakeMed primary care doctor in network, then be referred to a WakeMed specialist or sent for surgery at a WakeMed hospital and land outside the network. The referral question is worth asking before any appointment is booked.
Two other groups of UnitedHealthcare members are unaffected. UnitedHealthcare says Medicare Supplement members, who hold Medigap policies, were never affected and can use WakeMed with no change. WakeMed says the same of the UnitedHealthcare Community Plan of North Carolina, the Medicaid plan, whose contract it says “was never impacted.”
The group retiree exception
One group of Medicare Advantage members has a possible cushion. WakeMed says that for group retiree PPO plans with the same cost sharing in and out of network, care at WakeMed does not trigger a higher copay, deductible or coinsurance solely because WakeMed is out of network.
The health system still tells those members to confirm coverage and any authorization requirements before scheduling non-emergency services. Other Medicare Advantage members are told to review their benefits and confirm coverage for the specific WakeMed provider or service.
Emergencies are a separate rule. Both organizations say a medical emergency should go to the nearest emergency department. UnitedHealthcare says emergency care is covered at the in-network benefit level whether or not the hospital is in its network.
Switching by December 7
Medicare Open Enrollment runs from October 15 through December 7, 2026, the Centers for Medicare & Medicaid Services says in its September 28 announcement. CMS says people who want to keep their current coverage generally do not need to re-enroll, which for a WakeMed patient means the default keeps the problem in place.
UnitedHealthcare names the hospitals it points Medicare Advantage members toward in the region: UNC Rex Hospital, UNC Medical Center, UNC Health Johnston, Duke Raleigh Hospital, Duke Regional Hospital, Duke University Medical Center and Wilson Medical Center. A replacement plan has to include whichever of these a member actually uses, or WakeMed itself.
The national numbers CMS published are mild. The agency projects about 5,532 Medicare Advantage plans for 2027 and a weighted average monthly premium of $12.00, down from $14.37. It adds that about eight in 10 members can stay in their current plan at the same or a lower premium, but a plan that suits the budget still has to include the hospital.
CMS Administrator Dr. Mehmet Oz urged beneficiaries to use the period to review their coverage and compare options. The agency also points people with limited income to Medicare Savings Programs and Extra Help, noting that anyone enrolled in a Savings Program automatically qualifies for Extra Help.
Members can compare 2027 plans in the Medicare Plan Finder, or by calling 1-800-MEDICARE, which CMS says is open around the clock. The Maryland Insurance Administration, in its guidance for plans that are ending, describes a later window from December 8 through February 28, though it is written for plan terminations rather than network disputes.
The plan websites carry the details. WakeMed directs Medicare Advantage members to myuhcmedicare.com and group retiree members to retiree.uhc.com, and says the two organizations were updating network information and administrative processes ahead of October 15.
WakeMed takes questions about the agreement at 919-350-8359. UnitedHealthcare members should call the number on the health plan ID card. The employer-plan deal is done, and the Medicare question is whether a plan chosen by December 7 puts WakeMed back in reach.
Does the Medicare plan you pick cover WakeMed?
A Raleigh Medicare Advantage member who assumes the October 15 deal covers them can be wrong at the front desk. The employer-plan contract did not change Medicare Advantage, and a plan chosen after December 7 leaves a much shorter window to fix it.
The 2027 Medicare Open Enrollment Decision Kit gives a member a provider call script for confirming a hospital and doctor, a cost calculator spreadsheet that compares plans on cost, drugs and doctors, and the Open Enrollment calendar. It also covers Medigap guaranteed-issue rights for people who leave Medicare Advantage, with a call script.
Get the hospital-network call script and plan cost calculator kit →
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This article was produced with AI assistance and edited for accuracy against the sources linked above.
David M. Keller is a finance writer based in Columbus, Ohio, covering personal finance and consumer-focused economic topics. He earned his degree in journalism from Ohio University and began his career reporting on local business and economic trends for a regional media outlet. Since then, he has contributed to a variety of online publications, focusing on clear, practical coverage of topics such as cost of living, debt, and everyday financial decision-making.
