For a physician referral


526 Moye Blvd
Greenville, NC 27834

For a physician referral


526 Moye Blvd
Greenville, NC 27834

Medicare Advantage Plans

Hospitals and clinics associated with University Health System of Eastern North Carolina do not participate in any Medicare Advantage Private Fee For Service (PFFS) plans because of marketing efforts that continue to mislead seniors. The following is just a sampling of the plans that we do not participate in:

  • Humana Gold Choice
  • Pyramid - Today's Options
  • Sterling Option
  • Unicare - Save Well
  • Unicare SecurityChoice
  • WellCare
  • Secure Horizons
  • Advantra/Coventry- Freedom
  • America's 1st Choice Insurance Company of NC - Patriot & Presidential Plans
  • Health Net Pearl Option
  • HealthMarkets - The Care Assured Value and Premier Plans

Heritage and Pitt County Memorial Hospital have agreed to participate in and accept Southeast Community Care, a Medicare Advantage HMO plan offered by Arcadian Health Plan of NC. Rollout to the rest of the regional hospitals will be based upon the success and administration of the program.

If you are confused or feel pressured to make a decision about your Medicare options, please click here for assistance from the Seniors Health Insurance Information Program, which is a branch of the NC Department of Insurance.

Frequently Asked Questions About Medicare Advantage PFFS Plans

Do you have Medicare Part A and Medicare Part B?

To join a Medicare Advantage plan, you must have both Medicare Part A and Medicare Part B. If you do not have both, you may not join any Medicare Advantage plan.

If you join a Medicare Advantage plan, you no longer have Original Medicare and will not use your red, white and blue card when you see a doctor or go to the hospital. You would need to use the card provided by the Medicare Advantage plan. The Medicare Advantage plan will pay (if the doctor or hospital accepts the plan) for your covered medical services. Medicare will not pay, because you have chosen a different plan.

What is a Medicare Advantage PFFS Plan?

It is a health plan offered by a private insurance company under contract with Medicare. It must provide all medically necessary health care services covered by Medicare Part A and Part B. It is not a Medicare Supplement/Medigap policy.

If I join a PFFS Plan, will I have to check with my doctors and hospital before each visit to see if they still accept it?

Yes, you will need to check with your doctors and hospital each time you plan to visit them. A doctor and hospital can change their minds at any time and not accept the coverage any longer.

Does the PFFS plan include Medicare prescription drug coverage, or do you have to get your Medicare prescription drug coverage separately?

Some PFFS plans include the Medicare prescription drug coverage, but many do not. If the plan does include the Medicare prescription drug coverage, you will need to make sure it covers your medications. If it doesn't cover your prescriptions, it may not be the best choice for you.

Do I have to pay any premium for the PFFS plan?

You will continue to pay the Medicare Part B premium, and you might also have to pay an additional monthly premium charged by the PFFS plan.

Does the PFFS Plan work the same as a Medicare Supplement/Medigap policy?

No. A Medicare Supplement/Medigap policy is a private insurance policy that will work only with Original Medicare and will help pay your share (coinsurance, copayments, or deductibles) of the costs of Medicare-covered services.

A Medicare Advantage plan is coverage for Medicare Part A and Medicare Part B services but provided through a private insurance company under contract with the Medicare program. The Medicare Advantage plan, not Medicare, decides what you have to pay for copayments, coinsurance and deductibles.

Will my Medicare Supplement/Medigap policy work with the PFFS plan?

No. If you select to join a PFFS plan (or any other type of a Medicare Advantage plan), the Medicare Supplement/Medigap policy will not coordinate with these plans. Medicare Supplement/Medigap coverage only works with Original Medicare.

What else should I know before joining a PFFS plan?

It is important to understand what your copayments or coinsurance will be under the PFFSplan. Every plan is different. You need to look at and understand how much you will have to pay each time you go for a doctor visit, a hospital stay, outpatient hospital visit, etc.