Medicare Advantage

What HMO, PPO and SNP actually mean for Modesto readers

Stanislaus County has 36 Medicare Advantage plans for 2027. Compared with 2026, 10 plans are not coming back, 8 are new, and 31 continuing plans changed in some way you should check before December 7, 13 of them under a new name. This guide covers what those numbers mean for Modesto, not which plan to pick.

If you live in Modesto and you're weighing a Medicare Advantage plan for 2027, the first thing worth understanding isn't which plan to pick — it's what the different plan types actually mean. HMO, PPO, HMO-POS, PFFS and the various Special Needs Plans each work differently, and knowing the rules of the road makes the shopping much easier.

Modesto is in Stanislaus County, where 9 carriers are offering 23 Medicare Advantage plans for 2027, according to the CMS Medicare Advantage Landscape Source File. Compared with 2026, 15 plans continue, 8 are new, 10 are not returning and 13 have been renamed; 18 of the continuing plans change something in their terms, and the details are in each plan's Annual Notice of Change. Central Health Medicare Plan is not offering plans in the county next year.

How HMO, PPO, HMO-POS and PFFS plans differ

The plan type controls how you get care and what happens when you go outside the plan's network. Here's the plain-English version:

• HMO (Health Maintenance Organization). You pick a primary care doctor and generally use in-network providers. Referrals are often required to see specialists. Out-of-network care usually isn't covered except in emergencies.
• HMO-POS (Point of Service). An HMO with a limited "point of service" option — you can sometimes see out-of-network providers for certain services, usually at a higher cost.
• PPO (Preferred Provider Organization). More flexible. You can see providers outside the network, though you'll typically pay more when you do. Referrals are usually not required.
• PFFS (Private Fee-for-Service). These let you see any provider who agrees to the plan's payment terms. No PFFS plans are listed for Stanislaus County in 2027, so this option isn't on the table locally.

None of these types is automatically "better." The right fit depends on your doctors, your travel habits and how much choice you want.

What Special Needs Plans (SNPs) are

Special Needs Plans are Medicare Advantage plans designed for people who share a specific situation. You have to qualify to enroll. There are three flavors:

• D-SNP (Dual Eligible). For people who have both Medicare and Medicaid (in California, Medi-Cal).
• C-SNP (Chronic Condition). For people living with a qualifying chronic condition, such as diabetes, heart disease or end-stage renal disease.
• I-SNP (Institutional). For people who live in a long-term care setting or need that level of care at home. There are no I-SNPs listed for Stanislaus County in 2027.

Of the 38 plans in the county, 17 are SNPs — a large share, and one of the more distinctive features of the local market.

The carriers offering plans in Stanislaus County

Nine carriers are offering Medicare Advantage plans in the county for 2027. In alphabetical order, they are:

• Alignment Health Plan — 14 plans (HMO, PPO; 7 SNPs)
• Blue Shield of California — 1 plan (HMO)
• Centene (WellCare) — 1 plan (HMO; 1 SNP)
• Central Health Medicare Plan — 4 plans (HMO; 3 SNPs)
• Elevance Health (Anthem) — 2 plans (HMO-POS, PPO; 1 SNP)
• Health Plan of San Joaquin / Mountain Valley Health Plan Advantage D-SNP — 1 plan (HMO; 1 SNP)
• Humana — 4 plans (HMO, PPO)
• Imperial Health Plan of California, Inc. — 3 plans (HMO; 1 SNP)
• Kaiser Permanente — 3 plans (HMO; 1 SNP)
• SCAN Health Plan — 5 plans (HMO; 2 SNPs)

The table below lists every plan by carrier and type. Because plan design, network, cost and star ratings vary from plan to plan, we're not comparing them here — this article is about understanding what you're looking at.

How to narrow the field

A few practical questions can quickly shrink 38 plans to a manageable short list:

1. Do my doctors and preferred hospital take the plan? Networks vary, even between two plans from the same carrier. 2. Do I want to see providers outside a network? If yes, a PPO or HMO-POS may fit better than a strict HMO. 3. Do I qualify for a Special Needs Plan? If you have both Medicare and Medi-Cal, or you live with a qualifying chronic condition, a D-SNP or C-SNP may be an option worth exploring. 4. How do my prescriptions look on each plan's drug list? Every 2027 plan in the county includes Part D drug coverage, but formularies and pharmacy networks differ.

A few 2027 program facts worth knowing

These apply to Medicare nationwide, not to any specific plan:

• Part D now has a $2,100 out-of-pocket cap on covered drugs in 2026.
• The Part D maximum deductible is $615.
• The old coverage gap ("donut hole") was eliminated in 2025; Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly amounts if you opt in.
• IRMAA income-related surcharges start above $109,000 for single filers in 2026.
• Annual Enrollment Period: October 15 – December 7.
• Medicare Advantage Open Enrollment: January 1 – March 31 (one switch allowed for current MA members).