Medicare Advantage Plans in Washington County, NY:
Your Complete 2025 Guide
Discover 38 Medicare Advantage plans in Washington County for 2025. These plans combine your Medicare Part A and Part B benefits into one convenient plan, and may offer additional benefits such as dental, hearing and/or vision and/or fitness. There may not be a plan in your area that has all of these benefits in one plan.
Take a look at the options below, or contact a licensed insurance agent from HealthCompare at 833-748-3201 (TTY 711) Mon-Fri 5am-6pm, Sat 6am-5pm PST for personalized assistance.
Types of Medicare Advantage Plans in Washington County, NY
With 38 Medicare Advantage plans available in Washington County, it’s easier than ever to find one that meets your healthcare needs. However, there are no 5-star plans available this year. Your 2025 options include:
- Preferred Provider Organization (PPO) Plans: These plans (21 available) offer flexibility with out-of-network care at a higher cost. The average monthly premium for these plans is $44.78.
- Health Maintenance Organization (HMO) Plans: These plans (7 available) require in-network care and generally have lower costs. The average monthly premium for these plans is $49.57.
- HMO Point-of-Service (HMO-POS) Plans: These plans (6 available) blend HMO and PPO features, allowing some out-of-network care. The average monthly premium for these plans is $22.43.
- Private Fee-for-Service (PFFS) Plans: These plans (4 available) let you see any Medicare-approved provider who accepts the plan’s terms. The average monthly premium for these plans is $47.25.
- Special Needs Plans (SNP): These are highly specialized Medicare Advantage plans for individuals with special healthcare needs. We organize these plans here: Medicare Special Needs Plans in Washington County, NY.
Preferred Provider Organization (PPO) Medicare Advantage Plans
Preferred Provider Organization (PPO) plans give you the flexibility to seek care from both in-network and out-of-network providers. While out-of-network care may come with higher costs, PPO plans are ideal for those who prefer more choices in managing their healthcare.
Medicare Advantage PPO Plan Options
- Out-of-Network Costs: PPO plans allow you to see out-of-network providers, but this flexibility often comes with higher costs. Be sure to evaluate how much extra you'll need to pay if you prefer to see providers outside of the plan's network.
- Provider Network: Make sure your preferred doctors and specialists are in the plan's network to keep your costs lower. If you value the ability to choose providers freely, confirm the plan's network coverage meets your needs.
- Premiums and Out-of-Pocket Maximums: Compare the monthly premiums and out-of-pocket maximums across plans. Higher premiums might offer more coverage, but consider whether the additional benefits justify the cost for your situation.
- Additional Benefits: Many PPO plans offer extras like dental, vision, and/or fitness programs. Assess which additional benefits matter most to you and how they align with your healthcare needs. There may not be a plan in your area that has all of these benefits in one plan.
Health Maintenance Organization (HMO) Medicare Advantage Plans
With Health Maintenance Organization (HMO) plans, you typically need to stay within the plan's network of doctors and hospitals. In return, these plans usually offer lower premiums and out-of-pocket costs, making them an attractive option for budget-conscious enrollees.
Medicare Advantage HMO Plan Options
| Plan Name | Rating* | Premium/Mo | MOOP | Rx Ded. |
|---|---|---|---|---|
| CDPHP $0 Medicare Rx | $0 | $6,750 | $250 | |
| CDPHP Choice Rx | $126 | $6,000 | $0 | |
| CDPHP Core | $15 | $6,100 | N/A | |
| CDPHP Value Rx | $62 | $6,400 | $0 | |
| Freedom Plus | $37 | $6,700 | $0 | |
| Senior Blue 652 | $107 | $6,700 | $0 | |
| EmblemHealth VIP Rx Saver | $0 | $6,000 | $395 | |
| * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. | ||||
- In-Network Care: HMO plans generally require you to use in-network providers for all non-emergency care. Be sure to verify that your preferred doctors, specialists, and hospitals are in the plan’s network before enrolling.
- Primary Care Referrals: Many HMO plans require you to get a referral from your primary care doctor before seeing a specialist. Make sure you’re comfortable with this system of care coordination.
- Lower Costs: HMO plans typically offer lower premiums and out-of-pocket costs compared to other plan types, making them an attractive option for those who prioritize cost savings.
- Additional Benefits: Some HMO plans include extra benefits like dental, vision, and/or fitness programs. Consider which additional benefits are most important to you when comparing plans. There may not be a plan in your area that has all of these benefits in one plan.
HMO Point-of-Service (HMO-POS) Medicare Advantage Plans
HMO Point-of-Service (HMO-POS) plans offer a blend of HMO and PPO features. While these plans require in-network care for lower costs, they also allow you to seek care outside of the network at a higher expense. This balance makes HMO-POS plans a flexible option for those who want the best of both worlds.
Medicare Advantage HMO-POS Plan Options
| Plan Name | Rating* | Premium/Mo | MOOP | Rx Ded. |
|---|---|---|---|---|
| MVP Medicare Preferred Gold without Part D | $0 | $7,200 | N/A | |
| MVP Medicare Secure Plus with Part D | $96 | $6,000 | $0 | |
| AARP Medicare Advantage from UHC NY-29 | $0 | $7,200 | $340 | |
| Aetna Medicare Value | $0 | $9,350 | $590 | |
| Wellcare Fidelis Assist | $38 | $6,900 | $460 | |
| Wellcare Fidelis Simple | $0 | $8,300 | $420 | |
| * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. | ||||
- Out-of-Network Costs: While HMO-POS plans allow you to see out-of-network providers, this flexibility comes at a higher cost. Be sure to evaluate how much more you'll need to pay for out-of-network care.
- In-Network vs. Out-of-Network Care: Compare the in-network and out-of-network options available under the plan. If you frequently seek care outside the network, consider whether the additional costs are worth the flexibility.
- Referral Requirements: Like traditional HMO plans, HMO-POS plans often require a referral from your primary care doctor to see specialists. Make sure you’re comfortable with this requirement.
- Additional Benefits: Many HMO-POS plans offer extra benefits such as dental, vision, and/or fitness programs. Consider which additional benefits are important to you when comparing plans. There may not be a plan in your area that has all of these benefits in one plan
Private Fee-for-Service (PFFS) Medicare Advantage Plans
With Private Fee-for-Service (PFFS) plans, you can see any Medicare-approved provider, as long as they agree to the plan’s payment rules. This flexibility makes PFFS plans a good choice for those who want more freedom in choosing their healthcare providers.
Medicare Advantage PFFS Plan Options
| Plan Name | Rating* | Premium/Mo | MOOP | Rx Ded. |
|---|---|---|---|---|
| Wellcare Advantage Premium Enhanced | $32 | $6,700 | N/A | |
| Wellcare Advantage Simple | $0 | $6,700 | N/A | |
| Wellcare Premium Enhanced | $40 | $3,400 | $420 | |
| Wellcare Premium Ultra | $117 | $3,400 | $420 | |
| * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. | ||||
- Provider Agreement: PFFS plans allow you to see any Medicare-approved provider, but only if the provider agrees to the plan’s payment terms. Always confirm that your preferred providers accept the plan before enrolling.
- Flexibility vs. Costs: While PFFS plans offer greater flexibility in choosing providers, they may come with higher out-of-pocket costs compared to other plan types. Make sure to compare costs carefully.
- No Network Requirements: PFFS plans don’t require you to stay within a network of providers, offering more freedom. However, this also means that fewer providers may accept the plan.
- Additional Benefits: Some PFFS plans include extra benefits such as dental, vision, and fitness programs. Consider which additional benefits are important to you when comparing plans.
How and When to Enroll in a Medicare Advantage Plan
Enrolling in a Medicare Advantage Plan in Washington County means understanding your enrollment options. Whether you’re turning 65 or considering a plan change, knowing when and how to enroll ensures that you get the coverage that best fits your healthcare needs.
When to Enroll
- Initial Enrollment Period (IEP): Your first opportunity to enroll in Medicare begins three months before your 65th birthday and ends three months after. This is when you can choose your Medicare Advantage plan. Learn more
- Medicare Advantage Open Enrollment Period (MA OEP): Between January 1 and March 31, people who are currently enrolled in a Medicare Advantage plan can switch to a new one or return to Original Medicare if necessary. Learn more
- Annual Enrollment Period (AEP): From October 15 to December 7, you can review and adjust your Medicare coverage for the next year. Learn more
- Special Enrollment Periods (SEPs): You may qualify for a SEP due to life changes like relocation or losing other coverage, allowing you to make plan changes outside the typical enrollment periods. Learn more
How to Enroll
- Consult a Licensed Agent: Speak with a licensed health insurance agent from HealthCompare 1-833-748-3201 (TTY 711) (Mon-Fri 5am-6pm, Sat 6am-5pm PST) for personalized guidance..
- Contact the Plan Provider Directly: Visit the plan provider’s website or call their customer service team to start the enrollment process.
- Use Medicare.gov: Compare plans and enroll online through the official Medicare website at Medicare.gov.
Understanding Medicare Advantage: Frequently Asked Questions
What types of Medicare Advantage plans are available?
Medicare Advantage plans come in different types, including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS), and Special Needs Plans (SNPs). Each plan type offers different levels of flexibility in choosing healthcare providers and services.
Do Medicare Advantage plans cover prescription drugs?
Many Medicare Advantage plans, known as Medicare Advantage Prescription Drug (MAPD) plans, include prescription drug coverage. These plans bundle Medicare Parts A, B, and D into one plan. However, not all Medicare Advantage plans include drug coverage, so it's important to check before enrolling.
Are there any additional costs with Medicare Advantage plans?
While Medicare Advantage plans often have lower premiums than Original Medicare, you may still have out-of-pocket costs such as copayments, coinsurance, and deductibles. The costs can vary depending on the specific plan and services you use.
Key Enrollment Questions for Medicare Advantage Plans
Can I join a Medicare Advantage plan outside of the standard enrollment periods?
In most cases, you need to enroll in a Medicare Advantage plan during the standard enrollment periods, such as the Initial Enrollment Period (IEP), Annual Enrollment Period (AEP), or Medicare Advantage Open Enrollment Period (MA OEP). However, Special Enrollment Periods (SEPs) may allow you to enroll outside of these windows if you qualify.
What should I consider before enrolling in a Medicare Advantage plan?
Before enrolling in a Medicare Advantage plan, consider factors such as the plan's network of providers, out-of-pocket costs, and any additional benefits like dental or vision coverage. It’s also important to ensure that your preferred doctors and hospitals accept the plan.
How do I disenroll from a Medicare Advantage plan?
You can disenroll from a Medicare Advantage plan during certain enrollment periods, such as the Annual Enrollment Period (AEP) or Medicare Advantage Open Enrollment Period (MA OEP). You may also be able to disenroll during a Special Enrollment Period (SEP) if you qualify based on specific life events.
The MA and MAPD plans on this page are available to people on Medicare enrolled in both Medicare Part A and Part B living in Buskirk, Argyle, Cambridge, Comstock, Fort Ann, Fort Edward, Granville, Greenwich, Hudson Falls, Salem, Whitehall, and all other areas of Washington County, New York.
Plans Offered for Enrollment through Medicare.org
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.