Guide to Medicare Advantage Plans in Schoharie County, NY (2025)
There are 34 Medicare Advantage plans available in Schoharie County, NY for the 2025 plan year, including 15 plans with $0 premiums. Most plans include prescription drug coverage. These counts exclude Special Needs Plans.
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- Top 3 Plans by Enrollment:
1. CDPHP Value Rx (HMO) — 558 enrollees
2. CDPHP $0 Medicare Rx (HMO) — 493 enrollees
3. MVP Medicare WellSelect with Part D (PPO) — 325 enrollees - Average Monthly Premium: $37.32
- Average Maximum Out-of-Pocket Limit: $7,037
- Average Prescription Drug Deductible: $368.27
- Ratings (Plan Mix): 4+ Stars: 39% · 3 Stars: 48% · Below 3: 13%
- Plan Type Breakdown 18 PPO · 4 HMO · 6 HMO-POS · 4 PFFS · 2 REGIONAL PPO
All 2025 Medicare Advantage Plans
| Plan Name | Type | Premium | MOOP | Rx Ded. | Rating |
|---|---|---|---|---|---|
| Aetna Medicare Eagle* | PPO | $0 | $8,900 | N/A | |
| Aetna Medicare Elite* | PPO | $0 | $8,900 | $590 | |
| Aetna Medicare Platinum* | PPO | $139 | $4,500 | $590 | |
| Aetna Medicare Premier* | PPO | $31 | $9,350 | $450 | |
| CDPHP $0 Medicare Rx* | HMO | $0 | $6,750 | $250 | |
| CDPHP Choice Rx* | HMO | $126 | $6,000 | $0 | |
| CDPHP Core* | HMO | $15 | $6,100 | N/A | |
| CDPHP Focus* | PPO | $0 | $6,100 | N/A | |
| CDPHP Value Rx* | HMO | $62 | $6,400 | $0 | |
| CDPHP Vital Rx* | PPO | $0 | $6,750 | $300 | |
| Complete Rx* | PPO | $70 | $6,000 | $0 | |
| MVP Medicare Preferred Gold without Part D* | HMO-POS | $0 | $7,200 | N/A | |
| MVP Medicare Secure Plus with Part D* | HMO-POS | $96 | $6,000 | $0 | |
| AARP Medicare Advantage from UHC NY-0024 | HMO-POS | $0 | $7,900 | $420 | |
| Aetna Medicare Value | HMO-POS | $0 | $9,350 | $590 | |
| Humana USAA Honor Giveback | PPO | $0 | $4,950 | N/A | |
| HumanaChoice H5970-029 | PPO | $28 | $9,350 | $590 | |
| MVP Medicare Patriot Plan with Part D | PPO | $44 | $7,900 | $350 | |
| MVP Medicare WellSelect Plus with Part D | PPO | $119 | $7,000 | $0 | |
| MVP Medicare WellSelect with Part D | PPO | $0 | $7,800 | $350 | |
| Wellcare Advantage Premium Enhanced | PFFS | $32 | $6,700 | N/A | |
| Wellcare Advantage Simple | PFFS | $0 | $6,700 | N/A | |
| Wellcare Premium Enhanced | PFFS | $40 | $3,400 | $420 | |
| Wellcare Premium Ultra | PFFS | $117 | $3,400 | $420 | |
| AARP Medicare Advantage from UHC NY-0026 | PPO | $19 | $8,900 | $570 | |
| UHC Medicare Advantage NY-0021 | Regional PPO | $75 | $8,900 | $570 | |
| UHC Medicare Advantage Patriot No Rx NY-MA02 | Regional PPO | $0 | $6,700 | N/A | |
| Wellcare Fidelis Assist | HMO-POS | $38 | $6,900 | $460 | |
| Wellcare Fidelis Simple | HMO-POS | $0 | $8,300 | $420 | |
| Wellcare Assist Open | PPO | $28 | $8,850 | $580 | |
| Wellcare Giveback Open | PPO | $0 | $8,850 | $420 | |
| Wellcare Premium Ultra Open | PPO | $114 | $3,400 | $420 | |
| Wellcare Simple Open | PPO | $0 | $8,850 | $420 | |
| Anthem Medicare Advantage | PPO | $75 | $6,200 | $395 | |
| **Certain PFFS, MSA, and HMO-POS plans have a combined in and out-of-network maximum. Limits are detailed on the plan pages. | |||||
📊 At a Glance: Medicare Advantage Statistics in Schoharie County
- Average Monthly Premium
- $37.32
- Plans with $0 Premium
- 15
- Average MOOP Limit
- $7,037 ($9,350 max. in 2025)
- Average Rx Deductible
- $368.27
- Plans Without Drug Coverage
- 4 (standalone New York Part D plans)
- Plans with 5-Star Ratings
- No 5-star plans available.
- Stars Ratings (Plan Mix)
- 4+ Stars: 39% · 3 Stars: 48% · Below 3: 13%
- Plans Available
- 34 (excluding Schoharie County SNP plans)
- Plan Type Breakdown
- 18 PPO · 4 HMO · 6 HMO-POS · 4 PFFS · 2 REGIONAL PPO
- Countywide Enrollments
- 2,598 (excluding SNP plans)
- Top 3 Plans by Enrollment
- 1. CDPHP Value Rx (HMO) — 558 enrollees
2. CDPHP $0 Medicare Rx (HMO) — 493 enrollees
3. MVP Medicare WellSelect with Part D (PPO) — 325 enrollees
Data Sources: CY2025 Landscape, PBP Benefits, Star Ratings Data, Monthly Enrollment by CPSC, and SimpleMaps U.S. Counties. Enrollment data last updated . County demographic data last updated .
Understanding Your Medicare Advantage Options
Medicare Advantage Plans, also known as Medicare Part C, are private health plans that provide all-in-one coverage, including Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). On top of the core benefits, many of the plans in Schoharie County throw in some nice extras - think prescription drug coverage, dental, vision, and wellness programs - making them a solid choice for those in Mohave County looking for something more than Original Medicare.
🏥 Health Maintenance Organization (HMO) Plans
HMO plan members must use the plan's network of doctors and hospitals in Schoharie County, and typically need a referral to see a specialist. Some Medicare Advantage HMO Plans may have lower costs but offer less flexibility in choosing healthcare providers. There are 1,212 residents enrolled in HMO plans in this county. The most popular plan is CDPHP Value Rx .
🔓 Preferred Provider Organization (PPO)
A PPO allows more flexibility in choosing healthcare providers, with the option to see specialists without referrals, though often at a higher cost. Medicare Advantage PPOs usually have higher premiums and out-of-pocket expenses. There are 1,117 Schoharie County residents enrolled in PPO plans. The most popular of these plans by enrollments is MVP Medicare WellSelect with Part D .
🪟 Private Fee-for-Service (PFFS)
Allows members to visit any Medicare-approved doctor or hospital in their area that accepts the plan's payment terms. Medicare PFFS plans offer more flexibility but may result in higher costs. There are 27 Schoharie County residents enrolled in PFFS plans. The most popular of these plans by enrollments is Wellcare Advantage Simple .
🔀 Health Maintenance Organization Point of Sale (HMO-POS)
Medicare HMO-POS plans are a type of HMO that offers a little more flexibility. Like a regular HMO, you typically use the plan's network of doctors and hospitals for care, usually requiring a referral to see specialists. However, an HMO-POS plan lets you receive certain healthcare services outside of the network at a higher cost. There are 216 residents enrolled in HMO-POS plans in this Schoharie County. The most popular plan by enrollments is MVP Medicare Secure Plus with Part D .
Advantages of Enrolling in Medicare Advantage
Many Medicare Advantage Plans offer extra benefits that go beyond Original Medicare, making them an attractive option for some people. These plans provide comprehensive coverage, often including additional services like prescription drug coverage, dental, vision, and wellness programs, all bundled into one plan. By choosing a Medicare Advantage Plan, you can simplify your healthcare and potentially save on costs.
Take a look at the main benefits provided by Medicare Advantage Plans in Schoharie County:
🧑⚕️Coordinated Care
Plans often include care coordination services, which help you manage your healthcare across different providers and services.
💸 Cost Savings
Many plans have low or $0 premiums and offer capped out-of-pocket costs, providing financial protection against high medical expenses.
🧾 Comprehensive Coverage
Includes Medicare Part A, Part B, and often Part D (prescription drug coverage), along with additional benefits like dental, vision, and hearing.
🧘 Wellness Programs
Many Yavapai County plans offer free gym memberships, wellness programs, and preventive care services. You need to stay healthy, right?
Tips for Selecting a Medicare Advantage Plan
Choosing the right Medicare Advantage Plan out of the 34 plans available in Schoharie County requires careful consideration of several key factors:
🏥1. Provider Network
Verify that your current doctors and preferred hospitals are included in the plan's network. Access to your healthcare providers can significantly impact your care experience.
💊 2. Prescription Drug Coverage
Make sure the plan covers your medications, particularly if you have specific prescriptions you rely on regularly.
💰 3. Costs
Examine the plan's premiums, copayments, and out-of-pocket limits. Compare these costs against your budget to avoid unexpected expenses.
🎁 4. Additional Benefits
Consider what extra services, such as dental, vision, or wellness programs, are important to you, and check if the plan offers them.
⭐ 5. Plan Ratings
Look into the plan's star ratings, which provide insight into the plan's overall quality and member satisfaction.
Learn more about the basics of comparing Medicare Advantage Plans.
Medicare Advantage Enrollment Periods
Making sense of Medicare Advantage enrollment periods can seem overwhelming, but it's worth the effort for better health coverage. Missing these key dates could delay your coverage or limit your plan choices for 2025 in Schoharie County.
📅 Initial Enrollment Period (IEP)
This initial enrollment window starts three months before and ends three months after your 65th birthday, offering a total of seven months to enroll in a Medicare Advantage Plan.
🗓️ Annual Enrollment Period (AEP)
Every year from October 15 to December 7, you have the option to change, enroll, or disenroll from a Medicare Advantage Plan.
🔁 Open Enrollment Period (OEP)
Running from January 1 to March 31, this period allows changes to your Medicare Advantage Plan if you’re already enrolled or lets you switch back to Original Medicare.
For comprehensive details on how to enroll, visit our detailed guide on Medicare Enrollment.
Frequently Asked Questions
What are the most popular Medicare Advantage plan types in Schoharie County?
Based on the 2025 plan data, PPO plans are the most common in Schoharie County. The full breakdown of plan types is: 18 PPO · 4 HMO · 6 HMO-POS · 4 PFFS · 2 REGIONAL PPO.
How much can I expect to pay out of pocket for Medicare Advantage plans?
The average maximum out-of-pocket limit (MOOP) in Schoharie County is $7,037 for 2025.
Do any Medicare Advantage plans in Schoharie County have 5-star ratings?
No 5-star rated Medicare Advantage plans are available in Schoharie County for the 2025 plan year. However, 39% of plans have a rating of 4 stars or higher.
What is the average monthly premium for Medicare Advantage plans in Schoharie County?
The average monthly premium for Medicare Advantage plans in Schoharie County is $37.32. A total of 15 offer $0 premiums, though costs vary by plan type and benefits.
More About These Plans
Carrier Plans Offered
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.
Master Plan Pages by Plan ID
The plan pages listed in the table above have been modified for localization to help consumers identify plans available in their area. Most plans are available in multiple areas. The following list of plan IDs link to each plan's master page.
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 Cobleskill, Gilboa, Howes Cave, Jefferson, Middleburgh, Richmondville, Schoharie, Sharon Springs, and all other areas of Schoharie County, New York, including the following zip codes: 12023, 12031, 12035, 12036, 12043, 12053, 12064, 12066, 12071, 12073, 12076, 12092, 12093, 12122, 12131, 12149, 12157, 12160, 12166, 12167, 12175, 12187, 12194, 12469, 13459.
Citations & References
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed 19 March, 2025
- CMS.gov, "Special Needs Plans (SNP)", Last Accessed 24 May, 2024
- Medicare.gov, "What's Medicare Supplement Insurance (Medigap)?", Last Accessed 19 March, 2025
- Plan and enrollment data provided by the Centers for Medicare & Medicaid Services (CMS)
- Data processed and interpreted by MedicareWire.com editorial team.
- Read our methodology and sourcing policy.