Medicare Advantage

Four carriers, nine plans: the Santa Rosa 2026 lineup

People in Santa Rosa can choose from 13 Medicare Advantage plans for 2027, against 9 this year. Two of this year’s plans are gone, 6 are new to Sonoma County, and 3 that continue have changed their premium, deductible, plan type or name.

Medicare AdvantageSanta Rosa, CA

SANTA ROSA, Calif. — If you are shopping for Medicare Advantage coverage here for 2027, the first question is not "which plan?" It is "which kind of plan, and from which carrier?" Santa Rosa is in Sonoma County, where five carriers are offering Medicare Advantage plans that come in a few different flavors — mostly HMOs, with a PPO option or two, and several Special Needs Plans built for specific situations. Knowing what those letters mean before you compare benefits can save a lot of head-scratching later.

Who is offering Medicare Advantage in Sonoma County for 2027

Five carriers are on the 2027 Sonoma County Medicare Advantage landscape, listed here in alphabetical order:

• Alignment Health Plan — 2 plans (one HMO, one PPO)
• Elevance Health (Anthem) — 1 plan (a PPO, which is also a Special Needs Plan)
• Imperial Health Plan of California, Inc. — 3 plans (all HMOs, one of which is a Special Needs Plan)
• Kaiser Permanente — 3 plans (all HMOs, one of which is a Special Needs Plan)

The table below lists every plan by carrier. We are not ranking these carriers, and the number of plans a company offers does not tell you whether any single plan is a good fit for you — that depends on your doctors, your prescriptions, and how you like to get care.

HMO vs. PPO: the two plan types you will see here

Most of what is sold in Sonoma County for 2027 is an HMO (Health Maintenance Organization). HMOs generally ask you to:

• Use doctors and hospitals in the plan's network.
• Pick a primary care doctor.
• Get a referral before seeing most specialists.

Out-of-network care usually is not covered except in emergencies. In exchange, HMOs often keep the coordination — and paperwork — simpler.

A PPO (Preferred Provider Organization) works differently. You can generally see any Medicare-approved provider, in or out of network, though you will usually pay more if you go out of network. Referrals are typically not required. Some of the plans in the county for 2027 are PPOs.

You may also hear about HMO-POS ("point of service") plans, which are HMOs that allow some out-of-network care for specific services. It is a term worth knowing when you compare.

What about PFFS plans?

A Private Fee-for-Service (PFFS) plan is a third Medicare Advantage type. It lets you see any provider who agrees to accept the plan's payment terms, on a visit-by-visit basis. PFFS plans exist elsewhere in the country, but none are on the 2027 Sonoma County landscape. If you have heard about them from a friend in another state, that is why — they are simply not part of the local mix here.

Special Needs Plans (SNPs): built for specific situations

Several of the plans in Sonoma County for 2027 are Special Needs Plans. SNPs are Medicare Advantage plans limited to people who meet certain criteria. There are three national types:

• D-SNP (Dual Eligible SNP) — for people who have both Medicare and Medicaid (in California, Medi-Cal).
• C-SNP (Chronic Condition SNP) — for people with certain qualifying chronic conditions, like diabetes or heart failure.
• I-SNP (Institutional SNP) — for people who live in a nursing home or need that level of care at home.

The 2027 Sonoma County roster includes SNP options. Every SNP includes drug coverage, and each has enrollment rules you have to meet — a Medicare counselor can help you check.

A few 2027 program facts that apply no matter which plan you pick

These are set by Medicare, not by any single carrier:

• Part D out-of-pocket cap: $2,100 in 2026 and $2,400 in 2027. Once your drug spending hits that, you pay nothing more for covered drugs the rest of the year.
• Part D maximum deductible: $615.
• The coverage gap ("donut hole") is gone. As of 2025, Part D has three phases instead of four.
• Medicare Prescription Payment Plan. You can choose to spread your drug costs into monthly payments instead of paying at the pharmacy counter.
• IRMAA: Higher-income enrollees pay income-related surcharges on Part B and Part D — these start above $109,000 for a single filer in 2026.

All 13 Sonoma County Medicare Advantage plans for 2027 include Part D drug coverage, so the Part D rules above apply within those plans.

When you can make a change

• Annual Enrollment Period: Oct. 15 – Dec. 7, 2026. This is when most people switch plans for 2027.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31. If you are already in a Medicare Advantage plan, you can switch to another one, or drop back to Original Medicare, during this window.
• Special Enrollment Periods may apply if you move, lose other coverage, or qualify for a SNP.