Medicare Plans in
Madison County, NY
28 Medicare Advantage Plans Found in Madison County. See Plans
Madison County, NY
Medicare Information
For Madison County’s Medicare beneficiaries, private plans like Medicare Advantage plans offer an alternative to Original Medicare, and Part D plans (PDP) can work alongside your Original Medicare benefits.
Currently, 28 private Medicare plans are available in Madison County, and coverage is provided through Medicare-approved private companies, following rules set by Medicare.
MA plans, which are also referred to as Medicare Part C, may offer additional benefits that aren't available through Original Medicare.
Part D plans, also referred to as PDPs, cover retail prescription drugs.
Some Medicare Part C plans include coverage for prescription medications. Known as Medicare Advantage Prescription Drug plans, or MAPDs, these plans offer comprehensive coverage for seniors who want to minimize their out-of-pocket costs.
Learn more about some of the Medicare plans in Madison County, New York, including average costs, out-of-pocket expenses and what’s involved in obtaining prescription drug coverage.
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
Average Cost of Medicare
Plans in Madison County
| Average Cost of Medicare Advantage Plans in Madison County, New York | |
|---|---|
| Average Monthly Premium | $58.20 |
| Average in-network out-of-pocket spending limit | $8,217.86 |
| Average drug deductible in 2025 (weighted) | $488.53 |
| Percentage of plans rated 4 stars or higher | 21.4% |
| Average Cost of Medicare Advantage Plans in Madison County, New York |
|---|
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Average Monthly Premium $58.20 |
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Average in-network out-of-pocket spending limit $8,217.86 |
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Average drug deductible in 2021 (weighted) $488.53 |
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Percentage of plans rated 4 stars or higher 21.4% |
Learn More About Medicare
Prescription Drug Plans
| Plan Type | Description |
|---|---|
| HMO | HMO enrollees typically receive services through in-network providers and must obtain referrals for visits to specialists. However, most plans permit out-of-network care in emergencies or out-of-area dialysis. HMO plans often include prescription drug coverage. |
| PPO | Members of PPO plans can typically go in or out of network for care, including hospitalization, although visits to non-network providers may cost considerably more. Referrals are usually not needed for visits to specialists, and many PPO plans include prescription drug coverage. |
| PFFS | Private fee-for-service plans determine how much a doctor or facility will be paid for services, and members may seek care from any in or out-of-network provider that agrees to the plan's terms. Some PFFS plans include prescription drug coverage. Otherwise, members may seek coverage for medications through standalone Medicare drug plans, which are also known as Part D plans. |
| SNP | Special Needs Plans are designed for individuals with specific conditions or medical characteristics. Benefits such as providers and drug formularies are tailored to members' unique needs, and most care is provided by in-network physicians and facilities. SNPs are required to provide prescription drug coverage. |
| Plan Type and Description |
|---|
|
HMO enrollees typically receive services through in-network providers and must obtain referrals for visits to specialists. However, most plans permit out-of-network care in emergencies or out-of-area dialysis. HMO plans often include prescription drug coverage.
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Members of PPO plans can typically go in or out of network for care, including hospitalization, although visits to non-network providers may cost considerably more. Referrals are usually not needed for visits to specialists, and many PPO plans include prescription drug coverage.
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Private fee-for-service plans determine how much a doctor or facility will be paid for services, and members may seek care from any in or out-of-network provider that agrees to the plan's terms. Some PFFS plans include prescription drug coverage. Otherwise, members may seek coverage for medications through standalone Medicare drug plans, which are also known as Part D plans.
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Special Needs Plans are designed for individuals with specific conditions or medical characteristics. Benefits such as providers and drug formularies are tailored to members' unique needs, and most care is provided by in-network physicians and facilities. SNPs are required to provide prescription drug coverage.
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Some beneficiaries may be eligible for standalone prescription drug plans. Otherwise known as a PDP or Part D plan, a standalone prescription drug plan adds coverage for prescription medications to Original Medicare and some PFFS plans. It’s important to note that some MA plans, such as HMOs, may disenroll members who sign up for a separate drug plan.
Medicare Advantage Plans
Aetna Inc. Medicare Plans in Madison County, NY
The following table includes cost information and other plan details for Aetna Inc. private Medicare plans available in New York in 2025.
| Plan Name | Plan Code | Monthly Premium | Deductible | Out of Pocket Max |
Prescription Drug Coverage |
Medicare Star Rating |
|---|---|---|---|---|---|---|
| Aetna Medicare Value (HMO-POS) | H3312: 048 | $0 | $450 | $9,350 | Yes | 3.5 out of 5 |
| Aetna Medicare Premier (PPO) | H5521: 077 | $0 | $590 | $7,900 | Yes | 4.5 out of 5 |
| Aetna Medicare Assure (HMO D-SNP) | H3312: 070 | $0 | $0 | $9,350 | Yes | 3.5 out of 5 |
| Aetna Medicare Eagle (PPO) | H5521: 323 | $0 | N/A | $8,900 | No | 4.5 out of 5 |
| Aetna Medicare Discover Value (PPO) | H5521: 340 | $33 | $590 | $7,900 | Yes | 4.5 out of 5 |
| Aetna Medicare Longevity (PPO I-SNP) | H5521: 461 | $72 | $590 | $9,350 | Yes | 4.5 out of 5 |
| Aetna Medicare Platinum (PPO) | H5521: 459 | $139 | $590 | $4,500 | Yes | 4.5 out of 5 |
Humana Inc. Medicare Plans in Madison County, NY
The following table includes cost information and other plan details for Humana Inc. private Medicare plans available in New York in 2025.
| Plan Name | Plan Code | Monthly Premium | Deductible | Out of Pocket Max |
Prescription Drug Coverage |
Medicare Star Rating |
|---|---|---|---|---|---|---|
| Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP) | H3533: 002 | $0 | $0 | $9,350 | Yes | 3 out of 5 |
| Humana USAA Honor Giveback (PPO) | H5970: 016 | $0 | N/A | $4,950 | No | 3.5 out of 5 |
| HumanaChoice SNP-DE H5970-020 (PPO D-SNP) | H5970: 020 | $0 | $0 | $9,350 | Yes | 3.5 out of 5 |
| HumanaChoice H5970-029 (PPO) | H5970: 029 | $28 | $590 | $9,350 | Yes | 3.5 out of 5 |
UnitedHealthcare Medicare Plans in Madison County, NY
The following table includes cost information and other plan details for UnitedHealthcare private Medicare plans available in New York in 2025.
| Plan Name | Plan Code | Monthly Premium | Deductible | Out of Pocket Max |
Prescription Drug Coverage |
Medicare Star Rating |
|---|---|---|---|---|---|---|
| UHC Dual Complete NY-Q001 (HMO-POS D-SNP) | H3387: 015 | $0 | $0 | $9,350 | Yes | 3.5 out of 5 |
| UHC Dual Complete NY-S001 (PPO D-SNP) | H2001: 063 | $0 | $0 | $9,350 | Yes | 4 out of 5 |
| UHC Complete Care NY-31 (HMO-POS C-SNP) | H3379: 054 | $0 | $340 | $8,300 | Yes | 3.5 out of 5 |
| AARP Medicare Advantage from UHC NY-0006 (HMO-POS) | H3379: 039 | $0 | $340 | $7,900 | Yes | 3.5 out of 5 |
| UHC Dual Complete NY-S002 (HMO-POS D-SNP) | H3387: 014 | $0 | $0 | $9,350 | Yes | 3.5 out of 5 |
| AARP Medicare Advantage from UHC NY-0018 (PPO) | H3418: 007 | $19 | $495 | $7,900 | Yes | 3 out of 5 |
Wellcare Health Plans, Inc. Medicare Plans in Madison County, NY
The following table includes cost information and other plan details for Wellcare Health Plans, Inc. private Medicare plans available in New York in 2025.
| Plan Name | Plan Code | Monthly Premium | Deductible | Out of Pocket Max |
Prescription Drug Coverage |
Medicare Star Rating |
|---|---|---|---|---|---|---|
| Wellcare Simple Open (PPO) | H2775: 106 | $0 | $420 | $8,850 | Yes | 2.5 out of 5 |
| Wellcare Giveback Open (PPO) | H2775: 111 | $0 | $420 | $8,850 | Yes | 2.5 out of 5 |
| Wellcare Patriot Simple (HMO-POS) | H4868: 003 | $0 | N/A | $6,700 | No | 3.5 out of 5 |
| Wellcare Simple (HMO-POS) | H4868: 019 | $0 | $420 | $8,300 | Yes | 3.5 out of 5 |
| Wellcare Dual Access Open (PPO D-SNP) | H2775: 112 | $0 | $0 | $9,350 | Yes | 2.5 out of 5 |
| Wellcare Fidelis Dual Access (HMO D-SNP) | H5599: 001 | $0 | $0 | $9,350 | Yes | 3 out of 5 |
| Wellcare Fidelis Simple (HMO-POS) | H5599: 004 | $0 | $420 | $8,300 | Yes | 3 out of 5 |
| Wellcare Assist Open (PPO) | H2775: 113 | $28 | $580 | $8,850 | Yes | 2.5 out of 5 |
| Wellcare Fidelis Assist (HMO-POS) | H5599: 002 | $38 | $460 | $6,900 | Yes | 3 out of 5 |
| Wellcare Assist (HMO-POS) | H4868: 016 | $52 | $590 | $8,850 | Yes | 3.5 out of 5 |
| Wellcare Premium Ultra Open (PPO) | H2775: 105 | $114 | $420 | $3,400 | Yes | 2.5 out of 5 |
