Accepted Insurance Plans

To meet the widest range of healthcare needs in the region, Northwestern Medicine hospitals participate in a variety of insurance plans and is considered an "in-network" provider for a large number of insurers. Being in-network means that insurance companies have made special contracting arrangements to provide a higher level of payment coverage for their customers who receive care at a Northwestern Medicine facility. If Northwestern Medicine hospitals are part of your insurance network, it could reduce your out-of-pocket health care expenses.

View these comprehensive reference charts of accepted insurance plans. If you have specific questions about your coverage, please contact your insurance company directly.

Medicare Patient Announcement

Medicare is issuing new ID cards for all Medicare patients. Patients who arrive for services after 12/31/2019 must have their new Medicare card/ID. If already issued, patients may bring their new Medicare card to their next appointment prior to 12/31/2019.

Note: Most of the physicians providing care at Northwestern Medicine hospitals are independent and may accept different insurance plans than those accepted at a care location. Please contact your physician’s office directly for information about accepted plans. Patients receiving behavioral health services should contact the office directly for information related to in-network insurance plans.

Commercial Insurance is a type of insurance coverage that pays for medical and surgical expenses that are incurred by the insured. Health insurance is often included in benefit packages through employers. Northwestern Medicine participates with a wide variety of commercial insurance plans to meet the needs of the patient community.

Plan legend
Northwestern Medicine Commerical Insurance Plan Legend
Y Participating
N Not Participating
# Contact your insurance company
## Services for Delnor physicians only
Y* Tier 2
**N Only from contracted IPA's, Referrals required for Specialty Services
^ Patients must have a referral for services
^^ Specialist services only
^^^ Workers Comp Only
NMH Northwestern Memorial Hospital
NLFH Northwestern Lake Forest Hospital
NMG Northwestern Medical Group
CDH Northwestern Medical Central DuPage Hospital
Delnor Northwestern Medicine Delnor Hospital
RMG Northwestern Medicine Regional Medical Group (Formerly Cadence Medical Group and formerly Kishwaukee Physician Group)
KH Northwestern Medicine Kishwaukee Hospital
VW Northwestern Medicine Valley West Community Hospital
Centegra Centegra Health System
KPG Now part of Regional Medical Group (RMG)

Northwestern Medicine Commerical Insurance Plans
2019 Commercial Plans  NMH NLFH NMG CDH Delnor RMG KH VW Centegra
Aetna Choice POS Y Y Y Y Y Y Y Y Y
Aetna Choice POS II Y Y Y Y Y Y Y Y Y
Aetna Elect Choice Y Y Y Y Y Y Y Y Y
Aetna EPO Y Y Y Y Y Y Y Y Y
Aetna Health Network Only Y Y Y Y Y Y Y Y Y
Aetna Health Network Option Y Y Y Y Y Y Y Y Y
Aetna HMO Y Y Y Y Y Y Y Y Y
Aetna Illinois Preferred Plan Y Y Y Y Y Y Y Y Y
Aetna Limited Benefits Insurance Plan (PPO) Y Y Y Y Y Y Y Y Y
Aetna Managed Choice POS Y Y Y Y Y Y Y Y Y
Aetna NAP Y Y Y Y Y Y Y Y Y
Aetna Open Access Elect Choice Y Y Y Y Y Y Y Y Y
Aetna Open Access HMO Y Y Y Y Y Y Y Y Y
Aetna Open Access Managed Choice Y Y Y Y Y Y Y Y Y
Aetna Open Choice PPO (including, but not limited to Aetna Signature Administrators® and Open Choice) Y Y Y Y Y Y Y Y Y
Aetna Performance Network Y Y Y Y* Y Y Y* Y* Y
Aetna Premier Care Network Y Y Y# Y# Y Y# Y# Y# Y
Aetna Premier Care Network Plus Y Y Y# Y# Y Y# Y# Y# Y
Aetna QPOS Y Y Y Y Y Y Y Y Y
Aetna Savings Plus Y Y Y Y* Y Y## Y* Y* Y
Aetna Select Y Y Y Y Y Y Y Y Y
Aetna Student Health Y Y Y Y Y Y Y Y Y
Aetna Traditional Choice Y Y Y Y Y Y Y Y Y
Aetna Voluntary Group Medical Plan (Indemnity Plan) Y Y Y Y Y Y Y Y Y
Beechstreet (Viant) Y Y Y Y Y Y N N Y
Blue Cross Blue Shield - Blue Advantage HMO N** N N** Y Y Y Y^ Y^ Y
Blue Cross Blue Shield - Blue Choice Y Y Y Y Y Y Y Y Y
Blue Cross Blue Shield - Blue Choice Options Y* Y* Y* Y* Y* Y* Y^ Y^ Y
Blue Cross Blue Shield - Flexibile Network Y Y Y Y Y Y Y Y Y
Blue Cross Blue Shield - HMOI (Medical Group/IPA Information in Legend below) Y^ Y^ Y^ Y Y Y Y^ Y^ Y ^
Blue Cross Blue Shield - PPO Y Y Y Y Y Y Y Y Y
Cigna - Open Access Y Y Y Y Y Y Y Y Y
Cigna - Open Access Plus Y Y Y Y Y Y Y Y Y
Cigna - Choice Fund Open Access Plus Y Y Y Y Y Y Y Y Y
Cigna - ChoiceCare PPO Y Y Y Y Y Y Y Y Y
Cigna - EPO Y Y Y Y Y Y Y Y Y
Cigna - Global Health Benefits Y Y Y Y Y Y Y Y Y
Cigna - GWH POS Open Access Plus Y Y Y Y Y Y Y Y Y
Cigna - HMO (or POS) Y Y Y Y Y Y Y Y Y
Cigna - HMO (or POS) Open Access Y Y Y Y Y Y Y Y Y
Cigna - Local Plus Y Y Y Y Y Y Y Y Y
Cigna - Network Open Access Y Y Y Y Y Y Y Y Y
Cigna - Network POS Y Y Y Y Y Y Y Y Y
Cigna - One Health HMO eff 4/1/19 Y Y Y Y Y Y Y Y Y
Cigna - POS Y Y Y Y Y Y Y Y Y
Cigna - PPO Y Y Y Y Y Y Y Y Y
Cigna - Shared Administration PPO and OAP Y Y Y Y Y Y Y Y Y
Coventry Health Care - First Health HMO, PPO and POS Y Y Y Y Y Y Y N Y
Coventry Health Care - National HMO, PPO and POS Y Y Y Y Y Y Y N Y
CoventryOne Y Y Y Y Y Y Y N Y
Coventry Health Care of Illinois HMO, PPO and POS ( HMO requires a referral) Y Y Y Y Y Y Y N Y
Global Excel - PPO Y Y Y Y Y Y Y Y Y
Galaxy Health Network PPO Y Y Y Y Y Y Y Y Y
HealthLink PPO and HMO Y Y Y Y Y Y Y Y Y
HFN - EPO (HFN20) Y Y Y Y Y Y Y Y Y
HFN - PPO (HFN10) Y Y Y Y Y Y Y Y Y
Humana - Choice POS Y Y Y Y Y Y Y Y Y
Humana - ChoiceCare PPO Y Y Y Y Y Y Y Y Y
Humana - EPO Y Y Y Y Y N Y Y Y
Humana - HMO Premier Y Y Y^ Y Y Y^ Y Y Y
Humana - HMO Select Y Y Y^^ Y Y Y^^ Y Y Y
Humana - Illinois Platinum HMO Y Y Y^^ Y Y Y^^ Y Y Y
Humana - National  Preferred POS - Open Access Y Y Y Y Y Y Y Y Y
Humana - National POS Y Y Y Y Y Y Y Y Y
Humana - PPO Y Y Y Y Y Y Y Y Y
Humana - Preferred PPO Y Y Y Y Y Y Y Y Y
Interplan (Chandler/Preferred Plan/ HealthSmart) Preferred Plan Only Preferred Plan Only Preferred Plan Only Y Y Y Preferred Plan Only Preferred Plan Only Y
LifeSynch N N N Y Y Y N N Y
Magellan N N N Y Y N N N N
MultiPlan/PHCS Y Y Y Y Y Y Y Y Y
Northern Illinois Health Plan PPO N N N N N N N N Y
Prime Health Services PPO N N N N N Y N N Y
The Alliance N N N N N N Y Y Y
Three Rivers Provider Network PPO N N N N N Y N N Y
United Healthcare - All Savers Y Y Y Y Y Y Y Y Y
United Healthcare - Catalyst Y# Y# Y# Y# Y# Y# Y# Y# Y#
United Healthcare - Charter N N N N N N N N N
United Healthcare - Choice Y Y Y Y Y Y Y Y Y
United Healthcare - Choice Plus Y Y Y Y Y Y Y Y Y
United Healthcare - Core Y Y Y Y Y Y Y Y Y
United Healthcare - HMO Y^ Y^ Y^ Y^ Y^ Y^ Y^ Y^ Y^
United Healthcare - HMO Plus Y Y^ Y Y^ Y^ Y^ Y^ Y^ Y^
United Healthcare - Navigate Y Y Y Y Y Y Y Y Y
United Healthcare - Open Access Y^ Y^ Y^ Y^ Y^ Y^ Y^ Y^ Y^
United Healthcare - Options PPO Y Y Y Y Y Y Y Y Y
United Healthcare - Select Plus Y Y Y Y Y Y Y Y Y
United Healthcare - Select Y Y Y Y Y Y Y Y Y
United Healthcare Affiliates - Particpate through UHC PPO Y Y Y Y Y Y Y Y Y


Medical Group/IPA Site HMO Illinois Blue Advantage HMO
Site 471 (Northwestern Centegra & CHWN) X X
Site 475 (NMPN Central DuPage) X X
Site 477 (NMPN Delnor) X X
Site 487 (NMPN Lake Forest) X
Site 489 (NMH) X
Site 493 (NMPN DeKalb) X X

Health exchanges or health insurance marketplaces were established in accordance with the Affordable Care Act ("Obamacare") of 2010. These marketplaces provide a set of government-regulated and standardized healthcare plans where individuals may purchase health insurance policies, some of which include federal subsidies.

As one of the leading healthcare systems serving greater Chicago, we are dedicated to putting patients first and providing you and your family with exceptional care. Rapidly evolving changes with individual plans on the insurance exchange may impact the primary care physician selection included in your coverage.

At this time, Blue Precision HMOSM is the only insurance option on the healthcare exchange that includes Northwestern Medicine. If you wish to continue to receive healthcare services from Northwestern Medicine, you will need to select Blue Precision HMOSM during your open enrollment period. However, please be aware of the following:

  • Under Blue Precision HMOSM at Northwestern Medicine, you are required to have an assigned primary care physician (PCP).
    • The current medical group/IPAs to select for Northwestern Medicine are: 475, 477, 493

PCPs credentialed at Northwestern Medicine Central DuPage Hospital, Northwestern Medicine Delnor Hospital and Northwestern Medicine Kishwaukee Hospital are available as options.

If you have questions about a physician's hospital affiliation, please call 312.926.7440.

To sign up for one of these PCPs or to change your PCP, please refer to your enrollment materials for instructions or call 708.240.5145.

For instructions on how to enroll in this plan please call 312.926.7440.

If the available PCP or this insurance product are not the right for you, please review additional options on www.healthcare.gov to find a physician that is in the desired location.

Thank you again for choosing Northwestern Medicine as your preferred healthcare provider.

Are there any other insurance options on the exchange that provide access Northwestern Medicine?

No, Blue Precision HMOSM is the only exchange product that includes Northwestern Medicine.

If I do choose Blue Precision HMOSM, what kind of access will I have across the system?

In consultation with your primary care physician (PCP), you may have access to services at all Northwestern Medicine sites when clinically appropriate.

Specialty care downtown, on the Streeterville campus, and at Northwestern Medicine Lake Forest Hospital will be available with Northwestern Medical Group specialists, when clinically appropriate. The only exception to this is infertility care and some transplant services, which are managed by the HMO through a separate network of physicians and facilities.

What is the difference between a referral and a pre-authorized referral?

A referral is a form of communication between your PCP and the specialist or facility they are referring you to. In the referral, your PCP indicates your diagnosis, pertinent history, and what they are requesting of the specialist physician or facility. Such examples would be referral to a specialist for care of diabetes, or in the case of a facility, referral for a chest x-ray.

A Pre-authorized referral is a referral that has to be reviewed and approved before the service can be delivered. These are usually done to insure that your benefits of the health plan appropriately cover the service, or when requesting services outside of the NM system. We do this so that you do not end up with inappropriate bills from providers.

In most scenarios, NM does not require referrals to be pre-authorized when done within the NM system, and the number of services that do require a pre-authorized referral is fairly limited.

But I don't know which PCP I should select?

You do not have to pick a PCP at the time of enrollment, but you do need to pick a medical group/IPA. If you select Medical Group/IPA 475, 477 or 493, one of the PCPs available will be assigned to you at a location that is as close as possible to the home address registered when you selected Blue Precision HMOSM.

Can all of my family members access the same care at NM through this HMO plan?

Yes, there are Northwestern Medicine Internal Medicine, Family Medicine, Pediatricians and OB/GYN PCPs available in Medical Groups/IPAs 475, 477 and 493.

 

Plan legend
Northwestern Medicine Exchange Insurance Plan Legend
Y Participating
N Not Participating
+ Patients must select Site 475, 477 and 493 participating NMPN primary care physician, patients can be referred to NMPN contracted specialists across Northwestern Medicine.
# Patients of Sites 475, 477 and 493 can be referred to specialists based on appropriate medical need across Northwestern Medicine.
* Patients of Sites 475, 477 and 493 can be referred to facilities across Northwestern Medicine based on appropriate medical need.
** Blue Precision HMO site 471 only (includes Bronze, Silver, Gold products)
^ Requires referral from PCP/Referring Specialist.
NMH Northwestern Memorial Hospital
NLFH Northwestern Lake Forest Hospital
NMG Northwestern Medical Group
CDH Northwestern Medical Central DuPage Hospital
Delnor Northwestern Medicine Delnor Hospital
RMG Northwestern Medicine Regional Medical Group (Formerly Cadence Medical Group and formerly Kishwaukee Physician Group)
KH Northwestern Medicine Kishwaukee Hospital
VW Northwestern Medicine Valley West Community Hospital
Centegra Centegra Health System
KPG Now part of Regional Medical Group (RMG)

Northwestern Medicine Exchange Insurance Plans
NORTHWESTERN MEDICINE: ILLINOIS INSURANCE EXCHANGE PLANS 2019
Metal Level Insurer Name Exchange
Plan Type
NMH NLFH NMG CDH Delnor RMG KH VW Centegra
Blue Cross Blue Shield of Illinois
Bronze Blue Cross and Blue Shield of Illinois Blue Precision Bronze HMO 205 HMO Y* Y* Y# Y* Y* Y# Y+ Y# Y**
Silver Blue Cross and Blue Shield of Illinois Blue Precision Silver HMO 206 HMO Y* Y* Y# Y* Y* Y# Y+ Y# Y**
Gold Blue Cross and Blue Shield of Illinois Blue Precision Gold HMO 207 HMO Y* Y* Y# Y* Y* Y# Y+ Y# Y**
Medical Group/IPA Site Blue Precision HMOSM
Site 471 (CHWN/Northwestern Centegra) X
Site 475 (NMPN Central DuPage) X
Site 477 (NMPN Delnor) X
Site 493 (NMPN DeKalb) X

Government plans are a wide range of plans that include a variety of Medicare and/or Medicaid plans. Northwestern Medicine participates in traditional Medicare and Medicaid as well as Family Health Plans (FHP), Integrated Care Plans (ICP) and Medicare-Medicaid Alignment Initiative (MMAI). FHP, ICP and MMAI plans are often available to individuals who were previously eligible for traditional Medicaid but are now accessing Managed Medicaid plans through expansion of the Affordable Care Act or “Obamacare.”

In addition, Northwestern Medicine participates with TriCare Military Services. For active duty military personnel and their families, this is administered by a plan for the Department of Defense.

Plan legend
Northwestern Medicine Government Health Insurance Plan Legend
Y Participating
N Not Participating
# This includes select NMG Providers, verify at time of scheduling
^ Patients must have a referral for services
^^ Patients must have a referral if seeking services from a physician outside of Northwestern
* Referrals required for specialty care, NO primary care is covered.
NMH Northwestern Memorial Hospital
NLFH Northwestern Lake Forest Hospital
NMG Northwestern Medical Group
CDH Northwestern Medical Central DuPage Hospital
Delnor Northwestern Medicine Delnor Hospital
RMG Northwestern Medicine Regional Medical Group (formerly Cadence Medical Group and formerly Kishwaukee Physician Group)
KH Northwestern Medicine Kishwaukee Hospital
VW Northwestern Medicine Valley West Community Hospital
Centegra Centegra Health System
KPG Now part of Regional Medical Group (RMG)

Northwestern Medicine Government Health Insurance Plans 2019
2019 Governmental Plan Plan Type NMH NLFH NMG CDH Delnor RMG KH VW Centegra
Governmental Advantage Plans
Medicare Traditional Medicare Y Y Y Y Y Y Y Y Y
Medicaid Traditional Medicaid Y Y Y Y Y Y Y Y Y
Medicare Advantage Plans
Aetna - HMO Medicare Advantage Y Y Y Y Y Y Y Y Y
Aetna - PPO Medicare Advantage Y Y Y Y Y Y Y Y Y
Aetna-Open Access HMO Medicare Advantage Y Y Y Y Y Y Y Y Y
Blue Cross Blue Shield - PPO Medicare Advantage Y Y Y Y Y Y N N Y
Blue Cross Blue Shield - HMO Medicare Advantage Y Y Y Y Y Y Y Y N
Health Alliance Medicare Advantage Y* Y* Y* Y Y Y Y Y Y
Humana HMO Gold Plus Medicare Advantage N N N Y Y N Y Y Y
Humana PFFS Medicare Advantage N N N Y Y Y Y Y Y
Humana PPO Medicare Advantage N N N Y Y Y Y Y Y
Illinicare Medicare Advantage N N N N N N N N N
Meridian Medicare Advantage N N N Y Y Y Y Y Y
United HealthCare Medicare Complete Access Medicare Advantage N* N* N* N* N* N* N* N* N*
United HealthCare Medicare Complete Advocate HealthCare Medicare Advantage N*** N*** N*** N*** N*** N*** N*** N N
United HealthCare Medicare Complete Plan 1 Medicare Advantage Y^^ Y^^ Y^^ Y^^ Y^^ Y^^ Y^^ Y^^ Y^^
United HealthCare Medicare Complete Plan 2 Medicare Advantage Y^^ Y^^ Y^^ Y^^ Y^^ Y^^ Y^^ Y^^ Y^^
United HealthCare Medicare Advantage PPO Medicare Advantage Y Y Y Y Y Y Y Y Y
United HealthCare Medicare Advantage Medicare Advantage Y Y Y Y Y Y Y Y Y
Please Note: Cigna HealthSpring is no longer in-network with any NM location eff. 7/31/19
Medicare/Medicaid Alignment Innitiative Agreements (MMAI)
Aetna Better Health MMAI N N N Y Y Y N N N
Blue Cross Blue Shield MMAI Y Y Y Y Y Y Y Y Y
Humana MMAI N N N N N N N N Y
Illinicare MMAI N N N N N N N N N
Meridian Complete MMAI N N N N N Y N N Y
Medicaid Managed Care Programs/HealthChoice Illinois
Blue Cross Blue Shield MMCP Y Y Y Y Y Y Y N Y
Illinicare MMCP N N N N N N N N N
CountyCare MMCP Y Y Y Y Y Y Y Y Y
Meridian  MMCP Y Y Y Y Y Y Y Y Y
Medical Group/IPA Site Medicare Advantage HMO
Site 757 (Northwestern Medicine) X