Medicare Advantage Plans in Jefferson County, NY:
Your Complete 2025 Guide
Medicare Advantage Plans in Jefferson County, NY:
Your Complete 2025 Guide
Discover 46 Medicare Advantage plans in Jefferson County for 2025. These plans combine your Medicare Part A and Part B benefits into one convenient plan, often with extra perks like dental, vision, and fitness memberships.
Take a look at the options below, or contact a licensed HealthCompare agent at 877-388-0596 (TTY 711) for personalized assistance.
Types of Medicare Advantage Plans in Jefferson County, NY
With 46 Medicare Advantage plans available in Jefferson County, it’s easier than ever to find one that meets your healthcare needs. There are 1 5-star plans available that qualify for the 5-star special enrollment period. Your 2025 options include:
- Preferred Provider Organization (PPO) Plans: These plans (30 available) offer flexibility with out-of-network care at a higher cost. The average premium for these plans is $27.97.
- Health Maintenance Organization (HMO) Plans: These plans (9 available) require in-network care and generally have lower costs. The average premium for these plans is $30.41.
- HMO Point-of-Service (HMO-POS) Plans: These plans (5 available) blend HMO and PPO features, allowing some out-of-network care. The average premium for these plans is $56.88.
- Private Fee-for-Service (PFFS) Plans: These plans (2 available) let you see any Medicare-approved provider who accepts the plan’s terms. The average premium for these plans is $20.00.
- Special Needs Plans (SNP): These are highly specialized Medicare Advantage plans for individuals with special healthcare needs. We organize this plans here: Jefferson County, NY Medicare Special Needs Plans.
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
Factors to Consider When Choosing a PPO Plan
- 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 wellness programs. Assess which additional benefits matter most to you and how they align with your healthcare needs.
Ready to explore your Medicare Advantage options further? Speak with a licensed HealthCompare agent today at 1-877-388-0596 (TTY 711).
Health Maintenance Organization (HMO) Medicare Advantage Plans
Health Maintenance Organization (HMO) plans offer lower costs in exchange for using in-network providers. These plans are a great choice for those who are comfortable with a more restricted network and want to keep their healthcare expenses predictable and affordable.
Medicare Advantage HMO Plan Options
Plan Name | Rating | Premium | MOOP | Rx Ded. |
---|---|---|---|---|
CDPHP Choice | $40 | $6,100 | N/A | |
CDPHP $0 Medicare Rx | $0 | $7,000 | $250 | |
CDPHP Basic RX | $31 | $6,700 | $0 | |
CDPHP Choice Rx | $124 | $6,100 | $0 | |
CDPHP Value Rx | $54 | $6,400 | $0 | |
Aetna Medicare Value Plan | $0 | $7,900 | $0 | |
Humana Gold Plus H3533-006 | $0 | $7,550 | $350 | |
Humana Gold Plus H3533-013 | $25 | $6,000 | $275 | |
Wellcare No Premium | $0 | $8,300 | $425 |
Factors to Consider When Choosing an HMO Plan
- 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 wellness programs. Consider which additional benefits are most important to you when comparing plans.
Ready to explore your Medicare Advantage options further? Speak with a licensed HealthCompare agent today at 1-877-388-0596 (TTY 711).
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 | MOOP | Rx Ded. |
---|---|---|---|---|
MVP Medicare Preferred Gold with Part D | $147 | $5,800 | $0 | |
MVP Medicare Secure Plus with Part D | $98 | $7,550 | $0 | |
MVP Medicare Secure with Part D | $40 | $7,550 | $150 | |
AARP Medicare Advantage from UHC NY-0006 | $0 | $7,550 | $0 | |
MVP Medicare Preferred Gold without Part D | $0 | $6,700 | N/A |
Factors to Consider When Choosing an HMO-POS Plan
- 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 wellness programs. Consider which additional benefits are important to you when comparing plans.
Ready to explore your Medicare Advantage options further? Speak with a licensed HealthCompare agent today at 1-877-388-0596 (TTY 711).
Private Fee-for-Service (PFFS) Medicare Advantage Plans
Private Fee-for-Service (PFFS) plans allow you to see any Medicare-approved provider who agrees to the plan’s payment terms. These plans offer greater flexibility in choosing healthcare providers, but be sure to confirm that your preferred doctors and hospitals accept the plan.
Medicare Advantage PFFS Plan Options
Plan Name | Rating | Premium | MOOP | Rx Ded. |
---|---|---|---|---|
Wellcare Advantage No Premium | $0 | N/A | ||
Wellcare Advantage Premium Enhanced | $40 | N/A |
Factors to Consider When Choosing a PFFS Plan
- 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 wellness programs. Consider which additional benefits are important to you when comparing plans.
Ready to explore your Medicare Advantage options further? Speak with a licensed HealthCompare agent today at 1-877-388-0596 (TTY 711).
How and When to Enroll in a Medicare Advantage Plan
Enrolling in a Medicare Advantage Plan in Jefferson 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, you have the chance to switch your Medicare Advantage plan 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
- Speak with a Licensed Agent: Call 1-877-388-0596 (TTY 711) to get personalized advice and support from a licensed HealthCompare agent.
- Reach Out to the Plan Provider: Visit the plan provider’s website or call their customer service line to enroll directly.
- Go to Medicare.gov: Explore plan options and enroll online 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.
Frequently Asked Questions About Medicare Advantage Enrollment
When can I enroll in a Medicare Advantage plan?
You can enroll in a Medicare Advantage plan during the Initial Enrollment Period (IEP), which starts three months before your 65th birthday and lasts three months after. You can also enroll during the Annual Enrollment Period (AEP) from October 15 to December 7, or during a Special Enrollment Period (SEP) if you qualify due to certain life events.
Can I change my Medicare Advantage plan after enrolling?
Yes, you can change your Medicare Advantage plan during the Annual Enrollment Period (AEP) or the Medicare Advantage Open Enrollment Period (MA OEP). Special Enrollment Periods (SEPs) may also allow plan changes if you qualify based on specific life events.
What happens if I miss my enrollment period?
If you miss your enrollment period, you may have to wait until the next Annual Enrollment Period (AEP) to make changes to your Medicare Advantage plan. In some cases, Special Enrollment Periods (SEPs) may allow you to enroll or make changes outside the standard enrollment windows.
Plan Availability
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 Adams, Adams Center, Alexandria Bay, Antwerp, Black River, Brownville, Calcium, Cape Vincent, Carthage, Chaumont, Clayton, Dexter, Evans Mills, Fort Drum, Henderson, La Fargeville, Mannsville, Philadelphia, Redwood, Sackets Harbor, Theresa, Watertown, and all other areas of Jefferson 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 Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
This page was last updated on .