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Optum (New Jersey) accepted insurance plans guide

Attention This page contains accepted insurance details for patients in New Jersey. Patients in New York, please visit our New York accepted insurance plans guide.

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Urgent Care

New Jersey insurance plans

Optum (New Jersey) accepts most major insurances, including:

Aetna

Aetna Whole Health Plans
Aetna Standard Plans
Aetna Open Access Plus Plans
Aetna HealthFund Plans
Savings Plus Plans
Aetna with Innovation Health Plans
National Advantage Program (NAP)
Aetna CVS Health Plans
Aetna Assure Premier Plus Plan
Medicare Advantage Individual and Group Plans

Non-participating: Aetna Better Health (Medicaid)

AmeriHealth

Local Value Network (including AmeriHealth Advantage & AmeriHealth Hospital Advantage) (Tier 2)
Regional Preferred Network
Value Plus Network

Centivo

Cigna

HMO
POS
PPO
EPO
Cigna Courage Medicare (HMO)
Cigna Preferred Medicare (HMO)
Cigna True Choice Medicare (PPO)
Cigna True Choice Savings Medicare (PPO)
Cigna True Choice Plus (PPO)
Oscar
Great West

Clover Health

Beginning January 1, 2025: Clover Medicare Advantage plans will be out-of-network.

Consumer Health Network

Empire BCBS

Participating through the Blue Card Program

Fidelis Care Formerly known as WellCare

NJ Family Care

Beginning January 1, 2025: Fidelis Medicaid plans will be out-of-network.

First Health

Participating through Aetna Network

GHI

Secondary to Medicare only

Non-participating: Emblem and Comprehensive Benefits Plan (CBP)

Horizon Blue Cross Blue Shield of New Jersey

Direct Access
EPO
HMO
POS
PPO
Indemnity
OMNIA Health Plans
Braven Medicare Advantage Plans
Federal Employees Program (FEP)
State Health Benefit Program (SBHP)/School Employees’ Health Benefits Program (SEHBP)
Horizon NJ Total Care (HMO D-SNP)

Horizon NJ Health

NJ Family Care
Horizon NJ Total Care (HMO D-SNP)

Humana

Local 1199

Participating through the Aetna Network

Magnacare

Medicaid

Medicare

Including Railroad Medicare

Multiplan

Northwell Direct

Qualcare

Tricare Authorized non-network provider

UnitedHealthcare

UnitedHealthcare Medicare plans:
- AARP Medicare Advantage Plans
- Erickson Medicare Advantage Plans
- UnitedHealthcare Medicare Advantage Plans
Veteran Affairs CCN
UHC Community Plan (NJ Family Care & Dual Complete)

US Family Health Plan

Wellcare

Wellcare No Premium (HMO-POS)
Wellcare Dual Liberty (HMO D-SNP)
Wellcare Assist (HMO)
Wellcare No Premium Focus (HMO)
Wellcare Patriot No Premium (HMO)
Wellcare Giveback (HMO)
Wellcare Low Premium Open (PPO)

Beginning January 1, 2025: Wellcare Medicare Advantage and DSNP plans will be out-of-network.

Wellpoint Formerly known as Amerigroup Community Care

NJ Family Care
Amerivantage Balance (HMO)
Amerivantage Dual Coordination (HMO D-SNP)
Amerivantage Dual Secure (HMO-POS D-SNP)
Amerivantage ESRD Care (HMO-POS C-SNP)
Amerivantage Choice (PPO)
Amerivantage Classic (HMO)

UnitedHealthcare commercial plans include EPO, HMO, POS, HMO Plus, PPO, Oxford (Liberty, Freedom, Metro), Nexus ACO, Indemnity, Compass.

New Jersey urgent care insurance plans

Optum accepts most major insurances, including:

Aetna

Aetna Better Health

America’s Choice Provider Network

AmeriHealth

Cigna

Non-participating: Cigna Medicare Plans

Consumer Health Network (CHN)

Coventry

Devon

Fidelis CareFormerly known as WellCare

First Health

Geisinger Health Plan

Southern NJ locations only

HealthSmart Payor Organization

Horizon Blue Cross Blue Shield of New Jersey

Horizon NJ Health

Imagine Health

Independence Blue Cross

Independent Medical Systems (IMS)

Intergroup

MagnaCare

Medicaid NJ

Medicare Including Railroad Medicare

Multiplan/PHCS

Northwell Direct

QualCare

Partners Direct Health

Prime Health Services (PPO Provider Network)

Stratose (NPPN)

Three Rivers Provider Network

Tricare Authorized non-network provider

UnitedHealthcare Including Oxford, UHC Community Plan, Veterans Affairs CCN

US Family Health Plan (USFHP)

Wellcare Health Plans of New Jersey

Workers Comp

WellpointFormerly known as Amerigroup Community Care

Not sure whether you’re in-network?

Optum accepts most major health insurance plans. Before selecting a provider, please check with your insurance company to verify your eligibility and coverage to ensure the provider participates in your plan.

If you have insurance coverage from a company that is not listed above, the services are probably “out-of-network” and you will be responsible for a greater out-of-pocket expense.

For help selecting a plan that participates with Optum, please Contact us.

What if my insurance doesn’t cover my service?

If you are out-of-network or choosing to pay out of pocket, services are still available. Here’s what you need to know:

You have the right to request a good faith estimate of expected charges prior to receiving services.

You will not be billed more than the out-of-pocket maximum limit established by your health plan. This includes the billing of all applicable deductibles, copay and coinsurance.
In compliance with the “No Surprise Act”, a patient is held harmless from the cost of unanticipated out-of-network bills.

Contact us if you have questions or need more information about participating plans, billing or the “No Surprise Act”.