Guide to Medicare Advantage Plans in Wake County, NC for 2025
There are 52 Medicare Advantage plans available in Wake County, NC for the 2025 plan year, including 38 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. Blue Medicare Essential Plus (HMO-POS) — 8,188 enrollees
2. AARP Medicare Advantage from UHC NC-0015 (HMO-POS) — 5,588 enrollees
3. Blue Medicare PPO Enhanced (PPO) — 4,526 enrollees - Average Monthly Premium: $14.64
- Average Maximum Out-of-Pocket Limit: $6,058
- Average Prescription Drug Deductible: $267.50
- Ratings (Plan Mix): 4+ Stars: 69% · 3 Stars: 31% · Below 3: 0%
- Plan Type Breakdown 17 HMO-POS · 12 HMO · 20 PPO · 3 REGIONAL PPO
Wake County, North Carolina Medicare Advantage Plans
📊 At a Glance: Medicare Advantage in Wake County
- Average Monthly Premium
- $14.64
- Plans with $0 Premium
- 38
- Average MOOP Limit
- $6,058 ($9,350 max. in 2025)
- Average Rx Deductible
- $267.50
- Plans Without Drug Coverage
- 4 (standalone North Carolina Part D plans)
- Plans with 5-Star Ratings
- There are 2 5-star plans.
- Stars Ratings (Plan Mix)
- 4+ Stars: 69% · 3 Stars: 31% · Below 3: 0%
- Plans Available
- 52 (excluding Wake County SNP plans)
- Plan Type Breakdown
- 17 HMO-POS · 12 HMO · 20 PPO · 3 REGIONAL PPO
- Countywide Enrollments
- 51,891 (excluding SNP plans)
- Top 3 Plans by Enrollment
- 1. Blue Medicare Essential Plus (HMO-POS) — 8,188 enrollees
2. AARP Medicare Advantage from UHC NC-0015 (HMO-POS) — 5,588 enrollees
3. Blue Medicare PPO Enhanced (PPO) — 4,526 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 Wake County throw in some nice extras - think prescription drug coverage, dental, vision, and wellness programs - making them a solid choice for those in Wake 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 Wake 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 4,785 residents enrolled in HMO plans in this county. The most popular plan is Experience Health Medicare Advantage .
🔓 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 13,816 Wake County residents enrolled in PPO plans. The most popular of these plans by enrollments is Blue Medicare PPO Enhanced .
🔀 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 33,022 residents enrolled in HMO-POS plans in this Wake County. The most popular plan by enrollments is Blue Medicare Essential Plus .
Advantages of Enrolling in Medicare Advantage
Enrolling in a Medicare Advantage Plan can offer significant benefits compared to Original Medicare. These plans provide all-in-one coverage, including hospital and medical insurance, and often come with added perks like drug coverage, dental care, and wellness programs. With a Medicare Advantage Plan, you can access a wider range of services while potentially reducing your overall healthcare costs.
Below are some of the key benefits you can enjoy in Wake County with a Medicare Advantage Plan:
🧑⚕️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 52 plans available in Wake 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 Wake County.
📅 Initial Enrollment Period (IEP)
This is your first opportunity to enroll in a Medicare Advantage Plan when you first become eligible for Medicare. Your Initial Enrollment Period lasts for seven months, starting three months before your 65th birthday.
🗓️ Annual Enrollment Period (AEP)
Occurs every year from October 15 to December 7. During the Annual Enrollment Period, you can switch, drop, or join a Medicare Advantage Plan.
🔁 Open Enrollment Period (OEP)
From January 1 to March 31, you can switch Medicare Advantage plans or return to Original Medicare if you’re already enrolled in a Medicare Advantage Plan.
For more detailed information on the enrollment periods and how to enroll, visit our comprehensive guide on Medicare Advantage Plan Enrollment.
Frequently Asked Questions
What are the most popular Medicare Advantage plan types in Wake County?
Based on the 2025 plan data, PPO plans are the most common in Wake County. The full breakdown of plan types is: 17 HMO-POS · 12 HMO · 20 PPO · 3 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 Wake County is $6,058 for 2025.
Do any Medicare Advantage plans in Wake County have 5-star ratings?
There are 2 5-star rated Medicare Advantage plans in Wake County, and 69% of all plans have a rating of 4 stars or higher.
What is the average monthly premium for Medicare Advantage plans in Wake County?
The average monthly premium for Medicare Advantage plans in Wake County is $14.64. A total of 38 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 Apex, Cary, Fuquay Varina, Garner, Holly Springs, Knightdale, Morrisville, New Hill, Raleigh, Rolesville, Wake Forest, Wendell, Willow Spring, Zebulon, and all other areas of Wake County, North Carolina, including the following zip codes: 27501, 27502, 27511, 27512, 27513, 27518, 27519, 27520, 27522, 27523, 27526, 27529, 27539, 27540, 27545, 27560, 27562, 27571, 27587, 27588, 27591, 27592, 27596, 27597, 27601, 27602, 27603, 27604, 27605, 27606, 27607, 27608, 27609, 27610, 27611, 27612, 27613, 27614, 27615, 27616, 27617, 27619, 27620, 27622, 27623, 27624, 27625, 27626, 27627, 27628, 27629, 27634, 27635, 27636, 27640, 27650, 27656, 27658, 27661, 27668, 27675, 27676, 27690, 27695, 27697, 27698, 27699, 27703, 27713.
Citations & References
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed 19 March, 2025
- UHC.com, "What are Special Needs Plans?", Last Accessed 19 March, 2025
- 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.