Guide to Medicare Advantage Plans in Washington County, PA for 2025
There are 67 Medicare Advantage plans available in Washington County, PA for the 2025 plan year, including 35 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. Aetna Medicare Advantra Gold (HMO-POS) — 3,820 enrollees
2. Complete Blue PPO Distinct (PPO) — 3,712 enrollees
3. Aetna Medicare Advantra Silver (HMO-POS) — 2,357 enrollees - Average Monthly Premium: $33.36
- Average Maximum Out-of-Pocket Limit: $6,049
- Average Prescription Drug Deductible: $212.96
- Ratings (Plan Mix): 4+ Stars: 63% · 3 Stars: 37% · Below 3: 0%
- Plan Type Breakdown 19 HMO · 10 HMO-POS · 35 PPO · 1 PFFS · 2 REGIONAL PPO
Washington County, Pennsylvania Medicare Advantage Plans
📊 At a Glance: Medicare Advantage in Washington County
- Average Monthly Premium
- $33.36
- Plans with $0 Premium
- 35
- Average MOOP Limit
- $6,049 ($9,350 max. in 2025)
- Average Rx Deductible
- $212.96
- Plans Without Drug Coverage
- 4 (standalone Pennsylvania Part D plans)
- Plans with 5-Star Ratings
- There are 7 5-star plans.
- Stars Ratings (Plan Mix)
- 4+ Stars: 63% · 3 Stars: 37% · Below 3: 0%
- Plans Available
- 67 (excluding Washington County SNP plans)
- Plan Type Breakdown
- 19 HMO · 10 HMO-POS · 35 PPO · 1 PFFS · 2 REGIONAL PPO
- Countywide Enrollments
- 26,231 (excluding SNP plans)
- Top 3 Plans by Enrollment
- 1. Aetna Medicare Advantra Gold (HMO-POS) — 3,820 enrollees
2. Complete Blue PPO Distinct (PPO) — 3,712 enrollees
3. Aetna Medicare Advantra Silver (HMO-POS) — 2,357 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 Part C, are offered by private insurance companies and provide comprehensive coverage that includes both Medicare Part A (hospital insurance) and Part B (medical insurance). Many of the 67 plans available in Washington County also include additional benefits such as prescription drug coverage, dental, vision, and wellness programs, making them an all-in-one alternative to Original Medicare.
🏥 Health Maintenance Organization (HMO) Plans
HMO plan members must use the plan's network of doctors and hospitals in Washington 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 7,645 residents enrolled in HMO plans in this county. The most popular plan is UPMC for Life HMO Rx Choice .
🔓 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 9,990 Washington County residents enrolled in PPO plans. The most popular of these plans by enrollments is Complete Blue PPO Distinct .
🪟 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 0 Washington County residents enrolled in PFFS plans. The most popular of these plans by enrollments is {top_enrolled_PFFS}.
🔀 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 8,596 residents enrolled in HMO-POS plans in this Washington County. The most popular plan by enrollments is Aetna Medicare Advantra Gold .
Advantages of Enrolling in Medicare Advantage
Medicare Advantage Plans, also known as Part C, provide several key advantages over Original Medicare. Bundle up your healthcare with plans that cover Medicare Parts A and B, plus some extras like prescription meds, dental care, and vision services - it's a package deal! Medicare Advantage can be a smart choice if you want to maximize your healthcare dollars and enjoy extras like additional services and lower out-of-pocket costs.
Here are some of the top advantages these plans offer Washington County residents:
🧑⚕️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
Selecting the ideal Medicare Advantage Plan from the 67 plans available in Washington County involves evaluating several crucial aspects:
🏥1. Provider Network
Ensure your healthcare providers are within the plan's network to maintain continuity of care.
💊 2. Prescription Drug Coverage
Confirm that your current medications are included in the plan's formulary to avoid higher out-of-pocket costs.
💰 3. Costs
Assess the plan’s premium, deductible, and out-of-pocket expenses. The ideal plan aligns with both your financial situation and your healthcare needs.
🎁 4. Additional Benefits
Identify any additional benefits that are important to you, such as fitness programs, routine dental, or over-the-counter medication benefits, and ensure the plan includes them.
⭐ 5. Plan Ratings
If a plan offers the benefits you need at a price you can afford, be sure to check its CMS star ratings. This will help you avoid plans with known problems, like poor customer service.
Discover the key factors to consider when comparing Medicare Advantage Plans.
Medicare Advantage Enrollment Periods
Enrolling in a Medicare Advantage Plan is a straightforward process, but timing is crucial to ensure you don't miss out on the benefits. Understanding when you can enroll will help you take full advantage of the options available in Washington County.
📅 Initial Enrollment Period (IEP)
The IEP is a seven-month window surrounding your 65th birthday, allowing you to sign up for a Medicare Advantage Plan as soon as you become eligible for Medicare.
🗓️ Annual Enrollment Period (AEP)
The AEP runs from October 15 to December 7 each year, giving you the opportunity to change, drop, or enroll in a Medicare Advantage Plan.
🔁 Open Enrollment Period (OEP)
Between January 1 and March 31, if you’re already enrolled in a Medicare Advantage Plan, you can switch plans or revert to Original Medicare.
To learn more about the enrollment periods and steps to take, check out our comprehensive Medicare Enrollment guide.
Frequently Asked Questions
What are the most popular Medicare Advantage plan types in Washington County?
Based on the 2025 plan data, PPO plans are the most common in Washington County. The full breakdown of plan types is: 19 HMO · 10 HMO-POS · 35 PPO · 1 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 Washington County is $6,049 for 2025.
Do any Medicare Advantage plans in Washington County have 5-star ratings?
There are 7 5-star rated Medicare Advantage plans in Washington County, and 63% of all plans have a rating of 4 stars or higher.
What is the average monthly premium for Medicare Advantage plans in Washington County?
The average monthly premium for Medicare Advantage plans in Washington County is $33.36. A total of 35 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 Amity, Avella, Bentleyville, Bulger, Burgettstown, California, Canonsburg, Cecil, Charleroi, Claysville, Coal Center, Daisytown, Donora, Eighty Four, Ellsworth, Finleyville, Fredericktown, Hickory, Houston, Lawrence, Marianna, Mc Donald, Monongahela, New Eagle, Prosperity, Scenery Hill, Venetia, Washington, West Alexander, and all other areas of Washington County, Pennsylvania, including the following zip codes: 15004, 15012, 15017, 15019, 15021, 15022, 15026, 15033, 15038, 15053, 15054, 15055, 15057, 15060, 15062, 15063, 15067, 15078, 15102, 15126, 15129, 15241, 15301, 15311, 15312, 15313, 15314, 15317, 15321, 15322, 15323, 15324, 15329, 15330, 15331, 15332, 15333, 15336, 15339, 15340, 15342, 15345, 15347, 15348, 15350, 15358, 15360, 15361, 15363, 15365, 15366, 15367, 15368, 15376, 15377, 15378, 15379, 15412, 15417, 15419, 15423, 15427, 15429, 15432, 15434, 15450, 15477, 15483.
Citations & References
- CMS.gov, "Medicare Advantage Plan Fact Sheet", Last Accessed 19 March, 2025
- Medicare.gov, "Special Needs Plans (SNP)", Last Accessed 11 June, 2024
- Medicare.gov, "How to compare Medigap policies", 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.