Medicare Advantage

Santa Ana Medicare Advantage for 2027: what HMO, HMO-POS and PPO actually mean before you pick

Orange County has 111 Medicare Advantage plans for 2027. Compared with 2026, 21 plans are not coming back, 28 are new, and 51 continuing plans changed in some way you should check before December 7, 19 of them under a new name. This guide covers what those numbers mean for Santa Ana, not which plan to pick.

SANTA ANA, Calif. — As the Annual Enrollment Period opens Oct. 15, 2026, Santa Ana residents weighing a Medicare Advantage plan for 2027 will find the lineup tilts hard in one direction: most of the plans sold in Orange County next year are HMOs, with a smaller slice of HMO-POS plans and a handful of PPOs. That split matters, because the plan "type" controls how you see a doctor, whether you need a referral, and what happens if you need care outside the network.

How are Santa Ana's 2027 Medicare Advantage plans split by type?

Santa Ana is in Orange County, where 111 Medicare Advantage plans from 16 carriers are offered for 2027. By plan type, that works out to 84 HMO plans, 23 HMO-POS plans and 4 PPO plans. Counting HMO and HMO-POS together, 107 of the county's 111 plans use some version of an HMO structure.

There are no PFFS plans in the county's 2027 lineup. If you have heard about PFFS from a friend in another state, it simply is not on the menu here next year.

The full roster, with each plan's type and whether it includes drug coverage, is in the table on this page.

What does HMO mean for networks and referrals in a Medicare Advantage plan?

An HMO (Health Maintenance Organization) plan asks you to use doctors, hospitals and other providers in the plan's network, and usually to pick a primary care doctor who coordinates your care. For most specialist visits, you need a referral from that primary care doctor. Care from a provider outside the network is generally not covered except in an emergency, for urgent care away from home, or for out-of-area dialysis.

For 2027, these Orange County carriers offer HMO plans: Aetna (CVS Health), Align Senior Care, Alignment Health Plan, Astiva Health, Blue Shield of California, CalOptima Health OneCare, Centene (WellCare), Champion Heath Plan, Clever Care Health Plan, Elevance Health (Anthem), Humana, Imperial Health Plan of California, Inc., Kaiser Permanente, SCAN Health Plan and UnitedHealthcare.

What is an HMO-POS plan, and how is it different from a regular HMO?

An HMO-POS (Point-of-Service) plan is still built around a network and often still uses a primary care doctor, but it adds a limited option to use certain out-of-network providers for some services, usually at a higher cost share. The specifics — which services, which providers, how much more you pay — vary plan by plan and are spelled out in the plan's Evidence of Coverage.

For 2027, the carriers offering HMO-POS plans in Orange County are Aetna (CVS Health), Champion Heath Plan, Elevance Health (Anthem), UnitedHealthcare and VillageHealth. There are 23 HMO-POS plans among the county's 111 Medicare Advantage plans next year.

What does a PPO Medicare Advantage plan cover out of network?

A PPO (Preferred Provider Organization) plan still has a network, but it also covers care from out-of-network providers who accept Medicare, typically at a higher share of the cost than an in-network visit. PPOs generally do not require referrals to see specialists.

For 2027, Orange County has 4 PPO plans, all from Humana. If seeing a provider outside a network — because of travel, a snowbird schedule, or a specialist you want to keep — is important to you, that is where the PPO question comes in.

What about PFFS plans in Orange County for 2027?

Private Fee-for-Service plans are not offered in Orange County for 2027. PFFS plans work differently from HMOs and PPOs: they set the terms of payment, and providers decide visit by visit whether to accept them. Because none are on the local menu, Santa Ana shoppers can effectively narrow the choice to HMO, HMO-POS and PPO.

Which plan type is right for a Santa Ana resident?

There is no single "right" type — it depends on your doctors, where you spend time during the year, and how you like to get care. A few plain questions to work through:

• Are your current doctors and the hospital you prefer in the plan's network? Check each plan's provider directory, not just the carrier's name.
• Are you comfortable going through a primary care doctor for referrals, or do you want to self-refer to specialists?
• Do you travel often, or live part of the year outside California? That is where out-of-network coverage can matter.
• Do you take prescriptions? If so, confirm each drug is on the plan's formulary at a tier you can live with.

The Medicare Plan Finder at medicare.gov lets you enter your ZIP code, doctors and prescriptions and compare plans side by side, including the plan type and network rules.

What is changing for 2027, and when is the deadline?

Compared with 2026, the Orange County lineup goes from 104 plans and 17 carriers to 111 plans and 16 carriers for 2027. Behind that count, 21 plans are not returning, 28 are new, and 19 have been renamed. If your current plan is renewing, your Annual Notice of Change (ANOC) spells out what is different for 2027 — including any change in network, drug list or cost sharing.

The Annual Enrollment Period runs Oct. 15 through Dec. 7, 2026. A choice made in that window takes effect Jan. 1, 2027. If you do nothing and your plan is offered next year, it renews automatically with the changes in the ANOC. For Medicare Advantage members, there is also a second window, the Medicare Advantage Open Enrollment Period, from Jan. 1 through March 31, 2027, to make one change.

A couple of program-level 2027 figures that apply to any Part D or Medicare Advantage plan with drug coverage: the Part D out-of-pocket cap rises to $2,400 (from $2,100 in 2026), and the Part D maximum deductible is $700 (from $615 in 2026). The 2027 Part B premium and deductible, and the 2027 IRMAA brackets, are set to be published by CMS later in the fall.