Medicare Advantage

Before you pick a Medicare Advantage plan in San Jose: the carriers and plan types for 2027

People in San Jose can choose from 36 Medicare Advantage plans for 2027, against 46 this year. 15 of this year’s plans are gone, 5 are new to Santa Clara County, and 31 that continue have changed their premium, deductible, plan type or name, 13 of them under a new name.

San Jose shoppers looking at Medicare Advantage for 2027 will see a field of carriers and a mix of plan types on the shelf. Knowing who offers what — and what the letters after each plan name actually mean — is the first step to sorting through the choices with confidence.

San Jose is in Santa Clara County, where 10 carriers are offering 23 Medicare Advantage plans for 2027, according to the CMS Medicare Advantage Landscape Source File. Every one of those plans includes prescription drug coverage. Compared with 2026, 15 plans are not returning, 5 are new, 13 have been renamed, and 18 continuing plans change something in their terms — details are in each plan's Annual Notice of Change. Central Health Medicare Plan and UnitedHealthcare are not offering plans in the county for 2027.

Which carriers offer plans in Santa Clara County

Ten carriers are on the 2027 Medicare Advantage lineup for the county. In alphabetical order, they are:

• Aetna (CVS Health) — 4 plans (HMO-POS, PPO)
• Align Senior Care — 3 plans (HMO; 2 Special Needs)
• Alignment Health Plan — 14 plans (HMO, PPO; 7 Special Needs)
• Astiva Health — 3 plans (HMO; 1 Special Needs)
• Blue Shield of California — 1 plan (HMO)
• Central Health Medicare Plan — 5 plans (HMO; 3 Special Needs)
• Elevance Health (Anthem) — 3 plans (HMO, HMO-POS; 1 Special Needs)
• Imperial Health Plan of California, Inc. — 3 plans (HMO; 1 Special Needs)
• Kaiser Permanente — 4 plans (HMO; 2 Special Needs)
• Santa Clara Family Health Plan — 1 plan (HMO; 1 Special Needs)
• SCAN Health Plan — 4 plans (HMO; 2 Special Needs)
• UnitedHealthcare — 1 plan (HMO-POS)

The table below on this page lists every plan by carrier. The count next to a carrier only tells you how many doors they open in this county — not whether a particular plan will fit your doctors, prescriptions or budget. That comparison is personal.

HMO plans: the most common choice here

An HMO — Health Maintenance Organization — asks you to use a set network of doctors and hospitals, and usually to pick a primary care doctor who coordinates your care. Referrals are often required to see a specialist. Out-of-network care is typically not covered except in emergencies.

HMOs make up the largest share of the county's Medicare Advantage lineup, with 38 of the 46 plans. Every carrier on the list above offers at least one HMO.

HMO-POS: a small step outside the network

HMO-POS stands for "point of service." It works like an HMO, but with a limited ability to see certain providers outside the network, usually at a higher cost share. The rules on what you can do out-of-network vary by plan, so read the plan documents carefully.

Five plans in the county use this design for 2026. Aetna, Elevance Health (Anthem) and UnitedHealthcare each offer HMO-POS plans.

PPO: broader access, different trade-offs

A PPO — Preferred Provider Organization — lets you see doctors both in and out of network, generally without referrals. Out-of-network care usually costs more than in-network care. PPO plans are offered in the county for 2027 by Aetna and Alignment Health Plan.

A word about PFFS: Private Fee-for-Service plans are another Medicare Advantage type at the program level. They let members see any Medicare-approved provider who agrees to the plan's payment terms. For 2027, no PFFS plans are offered in Santa Clara County.

Special Needs Plans: built for specific situations

Special Needs Plans (SNPs) are Medicare Advantage plans limited to people who meet certain criteria. There are three kinds:

• D-SNP (Dual Eligible): for people who have both Medicare and Medicaid.
• C-SNP (Chronic Condition): for people with a qualifying chronic condition, such as diabetes or heart failure.
• I-SNP (Institutional): for people who live in, or need the level of care provided by, a nursing home or similar setting.

Twenty of the 46 plans in the county are SNPs. You can only enroll if you meet the plan's eligibility rules, and you may have special enrollment rights outside the usual windows if your situation changes.

A few 2027 program facts worth knowing

These apply everywhere, not just San Jose:

• Part D 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") no longer exists — Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly payments if you choose to opt in.
• IRMAA surcharges on Part B and Part D premiums begin above $109,000 in income for a single filer in 2026.
• Annual Enrollment Period: October 15 – December 7. Medicare Advantage Open Enrollment: January 1 – March 31.