Cdphp Medicare Advantage
Avg Star Rating
4.5 ★
Compare & Enroll — Part C & Part D
Compare & Enroll in Medicare Plans in Hamilton County, NY
With 34 Medicare Advantage options from 7 insurers, Hamilton County, NY has fewer plan options than the national average, suggesting a competitive market with meaningful insurer variety. Approximately 91% of local MA plans charge $0 beyond the standard Part B premium, reflecting strong price competition. The 6 hospitals within 50.0 miles provide reasonable inpatient access for most plan networks. We've organized the CMS data below to help you cross-reference plan costs, quality ratings, and local provider access. Compare plans below, and when you're ready, enroll directly at Medicare.gov.
📊 Direct from CMS
🚫 No agents or commissions
✓ Just the data, no sales pitch
Compare Plans at Medicare.gov →
Data freshness: CMS data as of February 2026 •
ACS data as of 2023 •
Reviewed & approved on 2026-02-16
Reviewed by: Wes Ward, Founder & Data Lead •
View our methodology
Important: We are not affiliated with Medicare or any government agency. This site displays publicly available CMS data to help you compare plans. We do not sell insurance or represent any insurance company. For official enrollment and complete plan information, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227).
Important: Plan availability, benefits, and CMS Star Ratings shown here come directly from CMS public files. Plan details can change—always verify with the insurer and at Medicare.gov.
Part C Plans
34
Part D Plans
10
Top MA Star
4.5
Top Drug Star
3.5
Medicare Eligibility in Hamilton County, NY
Approximately 2,068 residents (31.6% of the population) in Hamilton County, NY are 65 or older and likely Medicare-eligible. Whether you're approaching 65, already enrolled, or a caregiver comparing options, the plan data below is organized to help you evaluate Part C (Medicare Advantage) and Part D (prescription drug) coverage side by side.
The median household income in Hamilton County, NY is $73,673 (2.0% below the National Average), which may affect eligibility for Extra Help with Part D drug costs.
Part C: Medicare Advantage Plans
Medicare Advantage (Part C) replaces Original Medicare through private insurers who bundle hospital, medical, and often drug coverage into a single plan. Hamilton County, NY's 34 Medicare Advantage plans are evenly split between HMO (16) and PPO (16) networks. 31 plans offer $0 monthly premiums. Quality ratings are mixed—the average is 3.4 stars, so comparing plans carefully is important.
Top Medicare Advantage Plans in Hamilton County, NY
We organize CMS plan data into separate leaderboards so you can compare based on what matters most to you. Part C premiums in Hamilton County, NY range from $0 to $109/month. Among rated plans, 12 plans rated 4+ stars.
Highest CMS Star Ratings
Star Ratings are assigned by CMS based on quality measures including customer service, preventive care, and managing chronic conditions.
| Plan Name | Insurer | Star Rating | Premium | Type | |
|---|---|---|---|---|---|
| Cdphp $0 Medicare Rx (HMO) | Cdphp Medicare Advantage | 4.5 ★ | $0.00/mo | HMO | Enroll |
| Aetna Medicare Signature (PPO) | Aetna Medicare | 4.5 ★ | $0.00/mo | PPO | Enroll |
| Aetna Medicare Premier (PPO) | Aetna Medicare | 4.5 ★ | $0.00/mo | PPO | Enroll |
| Cdphp Choice Rx (HMO) | Cdphp Medicare Advantage | 4.5 ★ | $0.00/mo | HMO | Enroll |
| Cdphp Clear Rx (HMO) | Cdphp Medicare Advantage | 4.5 ★ | $0.00/mo | HMO | Enroll |
Lowest Monthly Premium
Lower premiums can save money, but check total costs including deductibles, copays, and MOOP.
| Plan Name | Insurer | Monthly Premium | MOOP | Star Rating |
|---|---|---|---|---|
| Cdphp $0 Medicare Rx (HMO) | Cdphp Medicare Advantage | $0.00/mo | $6,750 | 4.5 ★ |
| Aetna Medicare Signature (PPO) | Aetna Medicare | $0.00/mo | $9,250 | 4.5 ★ |
| Humanachoice Giveback H5970-030 (PPO) | Humana | $0.00/mo | $9,250 | 3.0 ★ |
| Aetna Medicare Premier (PPO) | Aetna Medicare | $0.00/mo | $8,900 | 4.5 ★ |
| Cdphp Choice Rx (HMO) | Cdphp Medicare Advantage | $0.00/mo | $6,000 | 4.5 ★ |
Lowest Maximum Out-of-Pocket (MOOP)
MOOP caps your financial risk. Once you hit this limit, the plan covers 100% of covered services for the rest of the year.
| Plan Name | Insurer | MOOP (In-Network) | Premium | Star Rating |
|---|---|---|---|---|
| Wellcare Advantage Enhanced (PFFS) | Wellcare | $4,300 | $0.00/mo | 3.0 ★ |
| Medicare Bluesalute (PPO) | Excellus Health Plan, Inc | $4,500 | $0.00/mo | 3.5 ★ |
| Humana Usaa Honor Giveback (PPO) | Humana | $4,950 | $0.00/mo | 3.0 ★ |
| Cdphp Choice Rx (HMO) | Cdphp Medicare Advantage | $6,000 | $0.00/mo | 4.5 ★ |
| Cdphp Core (HMO) | Cdphp Medicare Advantage | $6,100 | $15.00/mo | 4.5 ★ |
Plan Type Mix in Hamilton County, NY
HMO plans require referrals and in-network care. PPO plans offer more flexibility. SNP (Special Needs Plans) serve specific populations. MAPD plans include drug coverage.
| Plan Type | Count | Percentage | Description |
|---|---|---|---|
| PPO | 12 | 35.3% | No referrals; in and out-of-network |
| HMO D-SNP | 5 | 14.7% | Medicare Advantage plan |
| HMO | 5 | 14.7% | Requires referrals; in-network only |
| HMO-POS | 4 | 11.8% | HMO with some out-of-network options |
| PPO D-SNP | 3 | 8.8% | Medicare Advantage plan |
| HMO-POS D-SNP | 2 | 5.9% | Medicare Advantage plan |
| PFFS | 2 | 5.9% | Private Fee-for-Service |
| PPO I-SNP | 1 | 2.9% | Medicare Advantage plan |
Choosing the Right Medicare Advantage Plan
The best Part C plan depends on your doctors, medications, and budget. Key factors to evaluate:
- Provider network: Verify your doctors and hospitals near Hamilton County, NY are in-network before enrolling
- Total cost: A $0 premium may have higher copays—calculate your annual cost
- Star Ratings: 4+ stars indicate above-average quality and member satisfaction
Read our full guide on choosing Medicare Advantage → · Print our enrollment checklist →
Medicare Glossary: HMO, PPO, MOOP & more →
Medicare Advantage Insurers in Hamilton County, NY
7 insurance companies offer Medicare Advantage plans in Hamilton County, NY. Below, we group plans by insurer so you can compare options from each company. More insurers generally means more competition and better benefits for consumers.
Aetna Medicare
Avg Star Rating
3.9 ★
Plan
Premium
MOOP
Stars
Type
Unitedhealthcare
Avg Star Rating
3.8 ★
Mvp Health Care
Avg Star Rating
3.8 ★
Excellus Health Plan, Inc
Avg Star Rating
3.5 ★
Humana
Avg Star Rating
3.0 ★
Plan
Premium
MOOP
Stars
Type
Wellcare
Avg Star Rating
2.8 ★
Plan
Premium
MOOP
Stars
Type
Plan availability, premiums, and benefits shown are based on CMS data and may change. Always verify current details with the insurer and at Medicare.gov before enrolling.
Part D: Prescription Drug Plans (PDP)
Part D covers prescription drugs through standalone plans for those on Original Medicare, or as part of a Medicare Advantage bundle. Among the 10 standalone Part D plans in Hamilton County, NY, some offer $0 annual deductibles while others charge up to the 2026 maximum of $590. 2 plans are at or below the regional premium benchmark, making them eligible for Low Income Subsidy auto-enrollment. The 2026 $2,000 out-of-pocket cap means drug costs are now more predictable regardless of which plan you choose, but formulary coverage still varies significantly—always verify your medications are covered before enrolling.
Part D Formulary Notice: Each Part D plan has its own formulary (list of covered drugs). The same medication may be on different tiers—or not covered at all—depending on the plan. Always check that your specific medications are covered before enrolling.
2026 Out-of-Pocket Cap: Thanks to the Inflation Reduction Act, your total out-of-pocket drug costs are capped at $2,000 per year in 2026. Once you reach this limit, you pay nothing more for covered Part D drugs for the rest of the year. This eliminates the old "donut hole" coverage gap that previously caused higher costs.
Low Income Subsidy (LIS / Extra Help): If you have limited income and resources, you may qualify for Extra Help paying Part D costs. Visit SSA.gov or call 1-800-MEDICARE.
Top Part D Drug Plans in Hamilton County, NY
We organize Part D plans by CMS Star Ratings, premiums, and deductibles so you can find the best fit for your prescription needs. Part D premiums in Hamilton County, NY range from $36 to $174/month. Remember: all Part D plans now cap your annual out-of-pocket drug costs at $2,000 thanks to the Inflation Reduction Act.
Highest CMS Star Ratings (Part D)
Part D Star Ratings measure drug pricing, customer service, member complaints, and pharmacy access.
| Plan Name | Insurer | Star Rating | Premium | Deductible | |
|---|---|---|---|---|---|
| Wellcare Value Script (PDP) | Wellcare | 3.5 ★ | $42.40/mo | $615 | Enroll |
| Wellcare Classic (PDP) | Wellcare | 3.5 ★ | $45.70/mo | $615 | Enroll |
| Silverscript Choice (PDP) | Aetna Medicare | 3.0 ★ | $116.00/mo | $615 | Enroll |
| Humana Basic Rx Plan (PDP) | Humana | 3.0 ★ | $140.90/mo | $615 | Enroll |
| Humana Premier Rx Plan (PDP) | Humana | 3.0 ★ | $173.60/mo | $0 | Enroll |
Lowest Monthly Premium
Lower premiums help with monthly cash flow, but check drug tier costs and the deductible.
| Plan Name | Insurer | Monthly Premium | Drug Deductible | Star Rating |
|---|---|---|---|---|
| Healthspring Assurance Rx (PDP) | Healthspring | $35.70/mo | $615 | 2.5 ★ |
| Wellcare Value Script (PDP) | Wellcare | $42.40/mo | $615 | 3.5 ★ |
| Wellcare Classic (PDP) | Wellcare | $45.70/mo | $615 | 3.5 ★ |
| Healthspring Extra Rx (PDP) | Healthspring | $91.60/mo | $615 | 2.5 ★ |
| Aarp Medicare Rx Saver From Uhc (PDP) | Unitedhealthcare | $105.80/mo | $615 | 2.0 ★ |
Lowest Annual Drug Deductible
The deductible is what you pay out-of-pocket before the plan starts covering drug costs. The 2026 maximum Part D deductible is $590. Many plans offer $0 deductible options.
| Plan Name | Insurer | Drug Deductible | Monthly Premium | Star Rating |
|---|---|---|---|---|
| Humana Premier Rx Plan (PDP) | Humana | $0 | $173.60/mo | 3.0 ★ |
| Aarp Medicare Rx Preferred From Uhc (PDP) | Unitedhealthcare | $130 | $163.70/mo | 2.0 ★ |
| Humana Value Rx Plan (PDP) | Humana | $601 | $158.90/mo | 3.0 ★ |
| Healthspring Assurance Rx (PDP) | Healthspring | $615 | $35.70/mo | 2.5 ★ |
| Wellcare Value Script (PDP) | Wellcare | $615 | $42.40/mo | 3.5 ★ |
Understanding drug tiers: Part D plans organize medications into 5 cost tiers — Tier 1 (Preferred Generic) is cheapest; Tier 5 (Specialty) is most expensive. Two plans with the same premium can have very different costs for your drugs depending on tier placement. Learn more about drug tiers →
Choosing the Right Part D Drug Plan
The right Part D plan depends on your specific medications. Key factors to evaluate:
- Formulary: Verify your drugs are covered before enrolling
- Preferred pharmacies: Lower copays at certain locations—check your pharmacy is in-network
- Total annual cost: Premium + deductible + copays for your drugs
Read our full guide on choosing Part D →
What is a formulary? See our Medicare Glossary →
Part D Drug Plan Insurers in Hamilton County, NY
5 insurance companies offer standalone Part D drug plans in Hamilton County, NY. Below, we group plans by insurer.
Wellcare
Avg Star Rating
3.5 ★
Humana
Avg Star Rating
3.0 ★
Aetna Medicare
Avg Star Rating
3.0 ★
Plan
Premium
Deductible
Stars
Type
Healthspring
Avg Star Rating
2.5 ★
Unitedhealthcare
Avg Star Rating
2.0 ★
Plan availability, premiums, and benefits shown are based on CMS data and may change. Always verify current details with the insurer and at Medicare.gov before enrolling.
Ready to Enroll in Hamilton County, NY?
Compare plans side-by-side at Medicare.gov or speak with a licensed Medicare specialist.
📋 Print our Medicare Enrollment Checklist — gather your info before you compare.
📅 Enrollment Dates & Deadlines · 🩺 Questions to Ask Your Doctor
Medicare.gov is the official U.S. government site for Medicare. Available 24/7.
Pharmacy Access in Hamilton County, NY
Part D plans have preferred pharmacy networks where you'll pay lower copays. Here's a look at pharmacy options in and around Hamilton County, NY.
Total Pharmacies
1
within 25.0 miles
Chain Pharmacies
1
CVS, Walgreens, etc.
Independent Pharmacies
0
locally owned
| Pharmacy | Address & Phone | Distance | Type |
|---|---|---|---|
| WALGREEN CO | 284 MAIN ST NORTH CREEK, NY 12853 518-825-3777 | 20.8 mi | Chain |
| WALGREEN CO | 212 N MAIN ST NORTHVILLE, NY 121343550 518-886-6524 | 28.7 mi | Chain |
| WALGREEN CO | 6272 STATE RTE 9 CHESTERTOWN, NY 128170139 518-849-3211 | 29.4 mi | Chain |
| KPH HEALTHCARE SERVICES, INC. | 2964 STATE RT 28 OLD FORGE, NY 13420 315-539-5466 | 30.2 mi | Independent |
| WALGREEN CO | 3864 MAIN ST WARRENSBURG, NY 128851432 518-862-9251 | 31.6 mi | Chain |
| PRICE CHOPPER OPERATING CO INC | 3761 MAIN ST WARRENSBURG, NY 128851837 518-862-2993 | 32.0 mi | Chain |
| STONE'S PHARMACY INC. | 1 MAIN ST LAKE LUZERNE, NY 12846 518-869-3214 | 34.1 mi | Independent |
| ADIRONDACK APOTHECARY, LLC | 1081 MAIN ST SCHROON LAKE, NY 12870 518-853-7575 | 34.7 mi | Independent |
| WALGREEN CO | 2160 STATE ROUTE 9 LAKE GEORGE, NY 128456120 518-866-0043 | 36.7 mi | Chain |
| NATHAN LITTAUER HOSPITAL ASSOCIATION | 99 E STATE ST GLOVERSVILLE, NY 120781203 518-877-5583 | 37.6 mi | Independent |
Pharmacy data from CMS. Network participation varies by plan—always verify with your specific Part D plan.
Local Healthcare Access in Hamilton County, NY
Before choosing a plan, consider the healthcare infrastructure in Hamilton County, NY. Medicare Advantage plans restrict you to in-network hospitals, so understanding local hospital quality helps you pick the right plan — not just the cheapest one.
Note: The facilities below do not indicate which providers are in-network for any specific plan. Always verify network status with your plan before enrolling.
Hospitals Nearby
6
within 50.0 miles
Top-Rated Hospitals near Hamilton County, NY
If hospital access matters to your plan choice, check quality ratings before you enroll. These are the highest CMS-rated hospitals near Hamilton County, NY — click a hospital name to see its full profile and verify it's in your plan's network.
| Hospital | CMS Rating | Distance | Beds |
|---|---|---|---|
| Adirondack Medical Center - Saranac Lake | 4 ★ | 51.1 mi | 95 |
| Saratoga Hospital | 3 ★ | 46.8 mi | 171 |
| Nathan Littauer Hospital | 2 ★ | 37.6 mi | 74 |
| Glens Falls Hospital | 2 ★ | 42.7 mi | 442 |
| St Mary's Healthcare | 2 ★ | 46.3 mi | 149 |
| Wynn Hospital | 1 ★ | 57.1 mi | 372 |
| Little Falls Hospital | Not Rated | 45.6 mi | 25 |
| Four Winds Of Saratoga | Not Rated | 48.9 mi | 83 |
| Mohawk Valley Psychiatric Center | Not Rated | 56.1 mi | 189 |
| Lewis County General Hospital | Not Rated | 57.0 mi | 25 |
View all 6 hospitals near Hamilton County, NY to check quality before you enroll →
Hospital data from CMS Hospital Compare and Provider of Services file. Distance calculated from center of Hamilton County, NY.
Telehealth in Hamilton County, NY: Is Your Internet Ready?
Many Medicare Advantage and some Part D plans now include telehealth benefits, making routine check-ins and prescription refills easier from home. But telehealth requires reliable internet—here's a look at connectivity in Hamilton County, NY. For official guidance on virtual visits, see Telehealth.HHS.gov from the U.S. Department of Health & Human Services.
Check Internet Providers at Your Address
Telehealth works best with reliable internet. Use this tool (provided free by ISP Reports) to see what's available at your address.
Opens ISP Reports in a new tab. This is not a paid relationship. Special thank you to ISP Reports for allowing free use of their address tool.
Internet Coverage in Hamilton County, NY
Fiber Available
81.8%
of households
Cable/DSL Available
95.3%
of households
Top Provider
Frontier
92.4% coverage
No Broadband
1.8%
of households
Internet coverage data from ISP Reports. View full internet report for Hamilton County, NY.
Medicare-Relevant Demographics in Hamilton County, NY
Understanding Hamilton County, NY's demographics helps contextualize why insurers offer the plans they do. Areas with more seniors and higher incomes tend to attract more insurer competition, while areas with higher Medicaid enrollment may have more Dual-Eligible Special Needs Plans (D-SNP) available.
Total Population
6,541
Population 65+
2,068
31.6% of total
Median Age
57
18.8 years older than the national average
Median Income
$73,673
2.0% below the National Average
On Medicare
1,857
28.4% of residents
On Medicaid
1,051
16.1% of residents
Uninsured
225
3.4% of residents
Social Security Recipients
3,025
46.2% of population
Demographic data from U.S. Census Bureau American Community Survey (2023). View full Hamilton County, NY demographics (BestNeighborhood.org).
Local Medicare FAQ: Hamilton County, NY
Common decision points based on Hamilton County, NY's specific plan market and local healthcare landscape.
How does Hamilton County, NY's Medicare Advantage market compare?
Hamilton County, NY has 34 Medicare Advantage plans from 7 insurers. This is below the national average of approximately 57 plans. In areas with fewer competing plans, it's especially important to compare the available options carefully. The local mix includes 16 HMO and 16 PPO plans. Plan availability updates annually during the Medicare Annual Enrollment Period (October 15 – December 7).
Should I choose an HMO or PPO Medicare Advantage plan in Hamilton County, NY?
With 6 hospitals nearby, a PPO plan may offer valuable flexibility if your preferred providers aren't all in the same network. HMO plans (16 available) cost less but limit your choices. In Hamilton County, NY, the market is balanced between HMO and PPO options. Always verify your doctors are in-network before enrolling in any plan.
What's the real cost of $0 premium plans in Hamilton County, NY?
31 plans (91% of available options) in Hamilton County, NY charge $0 beyond the standard Part B premium. This high percentage reflects strong insurer competition in the area. However, $0 premium doesn't mean $0 cost. These plans may have higher copays, coinsurance, or out-of-pocket maximums. In Hamilton County, NY, maximum out-of-pocket limits range from $4,300 to an average of $8,307. We recommend calculating your total expected annual cost (premium + copays + drug costs) rather than choosing based on premium alone.
How does the 2026 $2,000 drug cap affect Hamilton County, NY beneficiaries?
The Inflation Reduction Act capped annual out-of-pocket drug spending at $2,000 starting in 2025, eliminating the old "donut hole" coverage gap. This applies to all 10 standalone Part D plans in Hamilton County, NY.
What this means locally:
- Cost predictability — No matter which of the 10 Part D plans you choose, your drug costs are capped at $2,000/year
- $0 deductible options — Some local plans offer $0 deductibles, meaning coverage starts immediately
- Low-income options — 2 plans meet the regional benchmark for Extra Help/LIS eligibility
While the out-of-pocket cap standardizes maximum costs, formulary coverage still varies significantly between plans. A drug that costs $5/month on one plan's formulary might cost $50 on another. Always check that your specific medications are covered and compare tier placement before enrolling.
See all Medicare FAQs in our complete guide → · Enrollment checklist →
Medicare Glossary · Enrollment Dates & Deadlines · Doctor Questions
About the Data & Editorial Team
Wes Ward
Founder & Data Lead
Wes Ward is the founder of InsuranceDataNow.org and reviews all content for data accuracy and methodology compliance.
With 25+ years in data analytics — including work with highly regulated genomic data at Ancestry.com — Wes brings enterprise-level rigor to consumer data tools. He is also a co-founder of BestNeighborhood.org, CrimeGrade.org, and ISPReports.org.
Role: Reviews and approves all content for data accuracy, source verification, and methodology compliance.
Transparency & Disclosures
InsuranceDataNow is an advertising-supported publisher based in South Jordan, Utah. We are not affiliated with or endorsed by Medicare or the U.S. government.
TPMO Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (24 hours a day/7 days a week) to get information on all of your options.
Sources
- CMS Medicare Plan Finder Data (Part C & D): cms.gov
- CMS Provider Directory: Hospital and pharmacy data from data.cms.gov
- American Community Survey: Demographic data from census.gov
- FCC Broadband Map: Internet availability data from broadbandmap.fcc.gov
- ISP Reports: Internet provider coverage for Hamilton County, NY from ispreports.org
- Telehealth.HHS.gov: Official telehealth guidance from U.S. Dept. of Health & Human Services
- BestNeighborhood.org: Community demographic profiles for Hamilton County, NY from bestneighborhood.org
All data is sourced from official government databases and trusted third-party providers. Data is updated regularly—see page header for last refresh dates.