Medicare Advantage

San Jose Medicare Advantage in 2027: the HMO-heavy lineup, explained

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, Calif. — As Medicare's Annual Enrollment Period opens Oct. 15, 2026, shoppers in San Jose will notice something about the 2027 Medicare Advantage lineup in Santa Clara County: it leans heavily toward HMOs. Of the 36 Medicare Advantage plans offered in the county for 2027 from 10 carriers, 33 are HMOs, 2 are HMO-POS, and 1 is a PPO, according to the CMS Medicare Advantage Landscape Source File. No plans in the local 2027 lineup are PFFS (Private Fee-for-Service).

That split matters because the plan type — not the carrier's name — is what sets the ground rules for networks, referrals, and what happens if you need care outside the plan's providers.

What each plan type actually means

Medicare Advantage plans come in a few flavors. The letters on the plan name are a quick shorthand for how the plan handles doctors, hospitals and travel.

• HMO (Health Maintenance Organization): You pick a primary care doctor and generally use the plan's network. Many HMOs require a referral to see a specialist. Out-of-network care usually is not covered except in an emergency or urgent situation.
• HMO-POS (HMO with Point-of-Service option): An HMO with a limited door to out-of-network care for certain services. The plan's documents spell out what is covered out-of-network and at what cost share.
• PPO (Preferred Provider Organization): You can see any provider that accepts the plan, in or out of network, usually without a referral. Out-of-network care is typically covered but at a higher cost share than in-network.
• PFFS (Private Fee-for-Service): The plan sets the terms, and any Medicare provider can decide whether to accept them on a case-by-case basis. No PFFS plan is being offered in Santa Clara County for 2027.

None of these types is inherently better or cheaper. The right fit depends on which doctors and hospitals you use, how often you travel, and how you feel about referrals.

How the 2027 San Jose lineup splits

San Jose is in Santa Clara County, where plan availability is set at the county level. For 2027, the CMS Landscape file shows:

• HMO (33 plans). Offered by Aetna (CVS Health), Align Senior Care, Alignment Health Plan, Astiva Health, Blue Shield of California, Elevance Health (Anthem), Imperial Health Plan of California, Inc., Kaiser Permanente, Santa Clara Family Health Plan, and SCAN Health Plan.
• HMO-POS (2 plans). Offered by Aetna (CVS Health).
• PPO (1 plan). Offered by Alignment Health Plan.
• PFFS: none in the county for 2027.

The table below lists every plan by carrier. Counting HMO and HMO-POS together, 35 of the 36 plans in Santa Clara County next year follow HMO-style network rules.

Questions to ask before you pick a type

Plan type sets the frame, but your own situation decides the answer. A few prompts to work through:

• Who are my doctors, and what network are they in? Call each provider's office and ask which 2027 Medicare Advantage plans they will accept. A network can look generous on paper and still leave out the specialist you actually see.
• Do I want to pick my own specialists? If you prefer to self-refer, a PPO (or sometimes HMO-POS) may fit better than a standard HMO.
• How much time do I spend out of the area? If you split the year between California and another state, out-of-network coverage matters more. HMOs typically cover only emergency and urgent care away from home.
• Do I qualify for a Special Needs Plan (SNP)? SNPs are built for people with specific conditions, dual Medicare-Medicaid eligibility, or who live in certain institutions. In Santa Clara County, several HMO SNPs are offered for 2027.

What is changing for 2027

Even if you keep your current plan, read the Annual Notice of Change (ANOC) that arrives in September. It describes what shifts for 2027 — premiums, copays, drug lists, provider networks, extra benefits — plan by plan. Some plans in the county are not returning for 2027, some are new, and some have been renamed; the ANOC and the Medicare Plan Finder are the places to confirm.

Two program-level numbers are already set for 2027: the Part D out-of-pocket cap rises to $2,400 (up from $2,100 in 2026), and the Part D maximum deductible rises to $700 (up from $615 in 2026). CMS has not yet published the 2027 Part B standard premium, Part B deductible, or IRMAA income brackets; those usually come out in the fall.

Timing

The Annual Enrollment Period runs Oct. 15 through Dec. 7, 2026. Any change you make during that window takes effect Jan. 1, 2027. If you do nothing, your current plan simply renews for 2027 if it is still offered, with whatever changes the ANOC describes.

If you choose a Medicare Advantage plan and want to adjust it, the Medicare Advantage Open Enrollment Period from Jan. 1 to March 31, 2027 gives you one more chance to switch to another Medicare Advantage plan or return to Original Medicare.