Medicare Advantage Plans Wilmington NC 2025

Searching for Medicare Advantage plans in Wilmington, NC? Discover the right fit for your healthcare with our no-nonsense guide on Medicare Advantage Plans in Wilmington NC.

Grasp the details of enrollment periods, costs, and plan types—from HMOs to SNPs—provided by top insurers like UnitedHealthcare and Humana. Start making an informed choice today without getting lost in the maze of Medicare options. Dive into our focused insights tailored for Wilmington seniors.

 

Key Takeaways

  • Wilmington, NC offers a range of Medicare Advantage Plans including HMOs, PPOs, PFFS plans, and SNPs, each with different costs, benefits, and rules for accessing healthcare services.

 

  • Beneficiaries in Wilmington can choose from 22 Medicare Advantage Plans offered by providers like UnitedHealthcare, Humana, Aetna, and Blue Cross Blue Shield, with the option to select a $0-premium plan and additional benefits not covered by Original Medicare.

 

  • Medicare Advantage Plans in Wilmington provide unique features such as additional wellness services, access to local healthcare providers, tailored Special Needs Plans, and a variety of enrollment periods to accommodate residents’ needs.

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Navigating Medicare Advantage Plans in Wilmington, NC

 

Medicare Advantage Plans Wilmington NC 2025 Navigating Medicare Advantage Plans in Wilmington, NC

 

Navigating Medicare Advantage Plans in Wilmington may seem daunting given the myriad of options available. However, there’s no need to worry! The city offers a variety of plans, including:

  • Health Maintenance Organizations (HMOs)

 

  • Preferred Provider Organizations (PPOs)

 

  • Private Fee-for-Service (PFFS) plans

 

  • Special Needs Plans (SNPs)

 

These plans cover almost all benefits provided under Medicare Part A and Part B, ensuring that you’re not left wanting when it comes to your Medicare coverage and healthcare needs.

Bear in mind that each plan comes with out-of-pocket costs and specific Medicare rules for using healthcare services, such as needing referrals or remaining in a provider network.

The good news is, every year, you have the chance to compare Medicare Advantage plans, review your current Medicare Advantage Plan, opt for a different plan, or switch back to Original Medicare if it better suits your needs.

 

Decoding Medicare Part C in Wilmington

You might be wondering about the role of Medicare Part C in all this. Well, Medicare Part C, also known as Medicare Advantage, is a bundled alternative to Original Medicare. It’s sold by private insurance companies and covers almost all the medically necessary services that Original Medicare covers, including emergency and urgent care.

Interestingly, Medicare Advantage Plans often provide additional benefits like prescription drug coverage, routine hearing, vision, dental exams, and even fitness club memberships.

In Wilmington, these plans may offer additional benefits not covered by Original Medicare, such as vision and hearing services, making them a valuable choice for those looking for comprehensive coverage.

 

Wilmington’s Medicare Advantage Plan Providers

 

Medicare Advantage Plans Wilmington NC 2025 Wilmington's Medicare Advantage Plan Providers

 

Wilmington residents have numerous choices when it comes to Medicare Advantage Plan providers. Beneficiaries can select from multiple plans provided by a variety of health insurance companies, including:

  • UnitedHealthcare

 

  • Humana

 

  • Aetna

 

 

Wilmington has got you covered.

In fact, as of 2025, there are 22 Medicare Advantage Plans available to beneficiaries in New Hanover County. This means that no matter your healthcare needs or budget, you’re likely to find a plan that works for you.


Enrollment Periods Specific to Wilmington Residents

While selecting a Medicare Advantage Plan is a significant decision, Wilmington residents fortunately have designated enrollment periods to make these decisions. The Annual Enrollment Period runs from October 15 to December 7, which is when most people enroll in, change, or drop their plans.

But that’s not all. There’s also the Medicare Advantage Open Enrollment Period from January 1 to March 31, which allows residents to make changes to their Medicare Advantage Plans.

The same period also serves as the General Enrollment Period for those who missed their initial signup to join Medicare Part B and then a Medicare Advantage Plan.

In addition, Special Enrollment Periods may be triggered by various events such as:

  • significant plan changes

 

  • moving outside a plan’s service area

 

  • losing current health coverage

 

  • specific situations such as after a natural disaster, like a hurricane.

 

Medicare Advantage Plan Features in Wilmington

 

Medicare Advantage Plans Wilmington NC 2025 Medicare Advantage Plan Features in Wilmington

 

Having explored the landscape of Medicare Advantage Plans in Wilmington, it’s time to highlight some of the unique features these plans offer. Residents with Medicare Advantage Plans can access local healthcare providers and hospitals, ensuring continuity of care with familiar and trusted institutions like New Hanover Regional Medical Center and its affiliates.

Beneficiaries should ensure that their key local providers, such as Wilmington Health, are included in the plan’s network to maintain established patient-provider relationships.

Furthermore, the care coordination services offered through Medicare Advantage Plans in Wilmington help beneficiaries manage chronic conditions more effectively, providing a unique, area-specific benefit.

 

Health Maintenance Organization (HMO) Plans in Wilmington

Many Medicare Advantage beneficiaries in Wilmington favor Health Maintenance Organization (HMO) plans. These plans usually require members to receive services through the plan’s local network of providers and often necessitate referrals to see specialists.

Providers such as Wilmington Health accept most Medicare Advantage plans offered by Medicare-approved private companies, including:

  • Aetna Medicare

 

  • Blue Medicare

 

  • Humana Medicare Advantage

 

  • UHC Medicare Advantage

 

This provides a variety of network options for beneficiaries in Wilmington.

With three main types of Medicare Advantage plans available in New Hanover County: HMO, PPO, and HMO-POS, beneficiaries can choose the one that best suits their healthcare needs.

 

Preferred Provider Organization (PPO) Plans in Wilmington

Preferred Provider Organization (PPO) plans offer a healthcare option that doesn’t restrict members to a particular plan’s network of providers. These plans offer members the flexibility to choose both in-network and out-of-network providers for their care.

However, while PPO plans offer greater flexibility, care from out-of-network providers often incurs higher costs than in-network services. This is something to keep in mind when choosing a PPO plan.

 

Special Needs Plans (SNPs) Tailored for Wilmington

Special Needs Plans (SNPs) are available in Wilmington for individuals who need tailored care due to chronic conditions, institutionalized care needs, or dual Medicare and Medicaid eligibility. The benefits, provider options, and drug formularies in Wilmington’s SNPs are specifically designed to meet the unique healthcare requirements of members with significant or chronic health issues.

However, enrollment in SNPs in Wilmington is conditional, requiring members to meet ongoing specific health criteria associated with the plan.

Despite this, the focused services these plans provide for individuals with unique healthcare challenges, like chronic illness management and dual eligibility, make them a valuable choice for those who qualify.

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Cost Comparison of Wilmington’s Medicare Advantage Plans

Understanding the costs associated with a Medicare Advantage Plan is just as important as understanding its benefits when making a selection. Here are some key costs to consider:

  • The average monthly premium for Medicare Advantage Plans in New Hanover County, which includes Wilmington, is approximately $25.18.

 

  • Residents may encounter average out-of-pocket costs of about $5,916 per year for Medicare Advantage Plans.

 

  • The average drug plan deductible is $131.56.

 

  • Beneficiaries have the option to choose a $0-premium Medicare Advantage plan, potentially offering lower out-of-pocket costs when using network providers.

 

It’s clear that the cost differences and the consideration of premium versus out-of-pocket expenses play a critical role when evaluating Medicare Advantage Plans for Wilmington residents.

 

Analyzing Premiums and Deductibles

Keep in mind that when it comes to premiums and deductibles, these figures are just averages. In reality, premiums and deductibles for Medicare Advantage Plans in Wilmington can vary widely.

For instance, the average monthly premium for a Medicare Advantage plan in North Carolina in 2025 is approximately $17.10, while in New Hanover County specifically, the premium averages $25.18 per month.

Some specific Medicare Advantage plans in New Hanover County, such as Humana Gold Plus H1036-291, offer a $0 monthly premium which is coupled with various out-of-pocket maximums and drug deductibles. For plans that include Part D prescription drug coverage, the average drug plan deductible is $131.56 per year.

 

Understanding Co-pays and Coinsurance Rates

Although premiums and deductibles are important, they aren’t the only costs you should consider. Co-pays and coinsurance are types of cost-sharing measures found in Medicare Advantage Plans.

A co-pay is a fixed fee that a plan member pays for certain medical services or prescriptions, while coinsurance is usually a percentage of the cost for services that the plan member pays after meeting their deductible.

Both co-pays and coinsurance rates directly influence the overall healthcare costs that Wilmington residents have to pay out of pocket. Understanding these costs is crucial to balancing expenses with healthcare needs.

 

Extra Benefits and Services Offered in Wilmington

 

Medicare Advantage Plans Wilmington NC 2025 Extra Benefits and Services Offered in Wilmington

 

An added bonus of Medicare Advantage Plans in Wilmington is the extra benefits they provide. These plans typically include benefits such as dental and vision coverage, along with wellness programs beyond what is offered by Original Medicare.

Many plans offer fitness memberships and wellness programs, which contribute to the overall health and preventative care of Wilmington residents. Some plans even enhance their offerings with extra services, like 24/7 nurse helplines, online health management resources, or over-the-counter allowances.

 

Prescription Drug Coverage in Wilmington Plans

Prescription drug coverage is a key benefit for many Medicare Advantage beneficiaries. In Wilmington, Medicare Advantage plans often cover prescription medications as part of the benefits, these plans are specifically known as Medicare Advantage Prescription Drug plans (MAPDs).

However, it’s important for beneficiaries to understand how their plan covers prescriptions, including any coverage rules and the tiering system of prescription drugs, to manage their medication needs affordably.

For instance, Preferred Provider Organization (PPO) plans in Wilmington include prescription drug coverage, and local Medicare Advantage networks may collaborate with pharmacies to improve access to prescriptions with an average deductible of $131.56 per year for plans that cover Part D.

 

Wellness and Preventive Services Enhancements

Staying healthy is about more than just treating illnesses – it’s about preventive care and wellness too. This is where wellness and preventive services enhancements come in.

Some Medicare Advantage plans in Wilmington provide wellness incentives and rewards programs to encourage healthy habits among beneficiaries. In addition to Medicare Advantage, Medicaid services also play a crucial role in ensuring access to healthcare for many individuals.

For residents managing chronic conditions such as diabetes or heart disease, special disease management programs are available through certain Medicare Advantage Plans in Wilmington. Additional health-related benefits include:

  • Adult day-care services

 

  • Meals benefit for qualifying members with certain chronic conditions

 

  • Personal Emergency Response System (PERS) benefit, which provides 24/7 health monitoring, supports independent living, and offers reassurance for beneficiaries and their caregivers.

 

Ancillary Perks: Transportation and Fitness Programs

Moreover, Medicare Advantage plans in Wilmington offer added perks such as non-emergency transportation services and assisting members in reaching healthcare facilities for scheduled visits. They may also offer fitness benefits, like access to gym memberships or fitness programs, as part of their wellness initiatives.

Certain plans even grant a fitness allowance, with some providing up to $300 annually to be used for memberships at fitness centers, golf courses, or sports clubs.

A popular fitness program for seniors included in Wilmington’s Medicare Advantage Plans is the SilverSneakers program, which offers gym access, workout classes, and community activities at no extra cost.

 

How to Select the Right Medicare Advantage Plan in Wilmington

The decision to choose the right Medicare Advantage Plan can significantly impact your health and financial stability. Beneficiaries in Wilmington can use the Medicare Plan Finder tool on Medicare.gov to compare plan details such as costs, coverage, and ratings.

Local independent insurance agents in Wilmington offer personalized help in understanding Medicare Advantage plan networks, benefits, and costs. It’s crucial to verify that your preferred doctors and specialists are part of the plan’s healthcare provider network, as this can significantly influence your choice of plan.

Therefore, key factors to consider when comparing Medicare Advantage Plans include provider network compatibility, plan benefits, and overall costs.

 

Assessing Your Healthcare Provider Preferences

Your healthcare provider preferences play a significant role when choosing a Medicare Advantage Plan. It’s crucial to verify that your preferred doctors and specialists are included in your Medicare Advantage Plan’s network in Wilmington.

Beneficiaries should ensure they understand the level of coverage and the costs attached to services provided by their in-network healthcare providers, as these can significantly vary even within the same medical insurance and hospital insurance plan network.

 

Balancing Costs with Coverage Needs

Another vital step in evaluating Medicare Advantage Plans is to balance costs with coverage needs. Understanding the costs associated with a Medicare Advantage Plan, including:

  • premiums

 

  • deductibles

 

  • copays

 

  • coinsurance

 

Balancing expenses with health care needs is crucial.

Remember, a plan with lower premiums may have higher out-of-pocket costs, and vice versa. Therefore, it’s important to consider both premiums and out-of-pocket costs when assessing the overall cost of a plan.

 

Considering Star Ratings and Member Feedback

Lastly, taking into account star ratings and member feedback can provide a measure of the quality and performance of local Medicare Advantage Plans in Wilmington. The Medicare Advantage Plan star ratings system, as issued by CMS, is a crucial tool for beneficiaries to gauge the quality and performance of local plans.

In New Hanover County, a notable 86% of Medicare Advantage plans have been rated 4 stars or higher by CMS, indicating a high level of quality in available plans.

Considering star ratings based on care quality and member satisfaction provides valuable insights, but it should be complemented with direct member feedback for a comprehensive evaluation of Medicare Advantage plans in Wilmington.

 

Local Resources for Medicare Beneficiaries in Wilmington

 

Medicare Advantage Plans Wilmington NC 2025 Local Resources for Medicare Beneficiaries in Wilmington

 

There are several local resources available for Medicare beneficiaries in Wilmington. The Cape Fear Council of Governments, acting as the Area Agency on Aging (AAA) for Region O, which encompasses Wilmington’s New Hanover County, is designated to plan and coordinate services for older adults, enhancing their quality of life.

In collaboration with the North Carolina Department, they ensure that the needs of Medicare beneficiaries are met effectively.

Educational resources about aging and coordination with the Cape Fear Elder Abuse Prevention Network are other key avenues through which the AAA supports the elderly community.

In addition, the Seniors’ Health Insurance Information Program (SHIIP) offers counseling to Medicare beneficiaries and caregivers regarding Medicare and its various components including Medicare supplements, Medicare Advantage, and Medicare Part D.

Beneficiaries can also attend local seminars and health fairs organized by insurance companies to directly engage with representatives and learn about Medicare Advantage plan options.

Summary

In summary, Medicare Advantage Plans in Wilmington, NC, offer a range of options for beneficiaries, from HMOs and PPOs to SNPs. With varying costs, benefits, and features, these plans cater to a diverse set of healthcare needs.

Understanding the specifics of each plan, considering your healthcare provider preferences, balancing costs with coverage needs, and utilizing available local resources are all crucial steps in choosing the right Medicare Advantage Plan. Remember, the goal is to find a plan that not only meets your healthcare needs but also aligns with your financial capabilities.

 

Frequently Asked Questions

 

→ What are the negatives of a Medicare Advantage plan?

The negatives of a Medicare Advantage plan include potentially higher out-of-network costs and lack of out-of-state coverage, which can be problematic for frequent travelers.

 

→ What is the most highly rated Medicare Advantage plan?

The most highly rated Medicare Advantage plans include UnitedHealthcare, Aetna, Blue Cross Blue Shield, and Humana, with UnitedHealthcare being the top choice for its network size and extra perks. AARP/UnitedHealthcare is the best overall option, featuring high star ratings and the largest provider network.

 

→ How much does a Medicare Advantage plan cost in NC?

In North Carolina, a Medicare Advantage plan with prescription drug coverage costs an average of $16 per month, which is cheaper than the national average, and most residents have options for plans that cost $0 per month.

 

→ What types of Medicare Advantage Plans are available in Wilmington, NC?

In Wilmington, you can find Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, and Special Needs Plans (SNPs) among the available Medicare Advantage Plans. These options provide a range of coverage and flexibility for different healthcare needs.

 

→ How can I compare different Medicare Advantage Plans in Wilmington, NC?

To compare different Medicare Advantage Plans in Wilmington, NC, use the Medicare Plan Finder tool on Medicare.gov for detailed plan comparison and seek personalized assistance from local independent insurance agents.

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 ZRN Health & Financial Services, LLC, a Texas limited liability company

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Speak with a licensed insurance agent

 1-833-641-4938
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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.