Medicare Advantage

Picking an HMO or PPO in Hialeah for 2027? Here's how Miami-Dade's plan types line up

People in Hialeah can choose from 101 Medicare Advantage plans for 2027, against 115 this year. 30 of this year’s plans are gone, 16 are new to Miami-dade County, and 61 that continue have changed their premium, deductible, plan type or name, 20 of them under a new name.

HIALEAH, Fla. — As fall 2026 Medicare shopping gets underway, one of the first forks in the road for Hialeah residents is not the carrier or the drug list — it is the plan type. For 2027, Miami-Dade County's Medicare Advantage lineup splits into 70 HMOs, 10 HMO-POS plans and 21 PPOs, and each kind sets different rules for networks, referrals and care outside the plan's doctors.

That split matters because it decides what happens when you want to see a specialist, travel to another state, or keep a doctor who is not in the plan's network. The window to switch, join or drop a Medicare Advantage plan for 2027 coverage is Oct. 15 – Dec. 7, 2026. If you do nothing, your current plan simply renews for 2027 — with any changes spelled out in the Annual Notice of Change your plan mailed you.

How do Miami-Dade's 2027 Medicare Advantage plans split by type?

For 2027, Miami-Dade County — the county Hialeah sits in — has 101 Medicare Advantage plans from 16 carriers, broken out as 70 HMOs, 10 HMO-POS plans and 21 PPOs. Counting HMO and HMO-POS together, about 80 of the 101 plans use some form of HMO structure, and 21 are PPOs.

No carrier in the county offers a Private Fee-for-Service (PFFS) plan for 2027, so the practical choice in Hialeah is between HMO, HMO-POS and PPO. The full table on this page lists every plan by carrier if you want to see which bucket a specific plan falls into.

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

An HMO (Health Maintenance Organization) plan asks you to use doctors, hospitals and labs inside the plan's network, and often to pick a primary care doctor who coordinates your care and writes referrals to specialists. Care outside the network is generally not covered except for emergencies, urgent care, and out-of-area dialysis.

HMOs are the biggest group locally: 70 of Miami-Dade's 2027 plans are HMOs. Carriers offering HMO plans in the county for 2027 are Aetna (CVS Health), Align Senior Care, AmeriHealth Caritas VIP Care (HMO-D-SNP), Centene (WellCare), Devoted Health, Doctors HealthCare Plans, Inc., Elevance Health (Anthem), Florida Blue HMO, Florida Complete Care, Humana, Leon Health, Inc., Longevity Health Plan, Solis Health Plans and UnitedHealthcare. Many of these are also Special Needs Plans, which only accept members who meet specific eligibility rules (such as having both Medicare and Medicaid, or a qualifying chronic condition).

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

HMO-POS stands for HMO with a "point of service" option. It works like a regular HMO — network doctors, often a primary care gatekeeper — but adds a limited ability to go outside the network for certain services, usually at a higher cost share. The specifics (which services, how much more you pay) are set in each plan's Evidence of Coverage.

Miami-Dade has 10 HMO-POS plans for 2027. Carriers offering HMO-POS plans in the county for 2027 are Centene (WellCare), Florida Complete Care, Gold Kidney Health Plan and UnitedHealthcare. If you want HMO-style pricing most of the time but a safety valve for a specific out-of-network need, this is the category to compare.

What does a PPO Medicare Advantage plan mean for out-of-network care?

A PPO (Preferred Provider Organization) plan has a network, but it also covers care from out-of-network providers who accept Medicare — usually at a higher copay or coinsurance. You typically do not need referrals to see specialists. That flexibility can matter if you split the year between Florida and another state, travel often, or want to keep a doctor who is not contracted with the plan.

Miami-Dade has 21 PPO plans for 2027. Carriers offering PPO plans in the county for 2027 are Florida Blue, Humana and UnitedHealthcare. Some of these are regional PPOs that cover a multi-state area; others are local PPOs tied to Florida. The table below shows which PPOs each carrier is offering.

What about PFFS plans in Hialeah for 2027?

Private Fee-for-Service (PFFS) plans are a fourth Medicare Advantage type. In a PFFS plan, the plan sets the payment terms, and any Medicare provider willing to accept those terms can treat you — there may or may not be a formal network. Nationally, PFFS has become a small slice of the Medicare Advantage market.

In Miami-Dade County, no carrier is offering a PFFS plan for 2027. If a friend or family member in another part of the country has a PFFS plan, that is why you may not find a local equivalent here.

Which plan type is right for me?

There is no single answer. The best type depends on who your doctors are, whether they are in a given plan's network, how often you travel, and whether you want the simplicity of a referral-based system or the flexibility to go out of network. HMOs and HMO-POS plans tend to emphasize coordinated care through a primary doctor; PPOs tend to emphasize choice.

A few steps that help:

• Make a list of the doctors, hospitals and pharmacies you actually use, then check each plan's provider directory on medicare.gov's Plan Finder.
• Read the Annual Notice of Change your current plan sent in September — it spells out any 2027 changes to your plan, including network, formulary and cost-sharing updates.
• For 2027, the Part D out-of-pocket cap is $2,400 (up from $2,100 in 2026) and the Part D maximum deductible is $700 (up from $615 in 2026) — rules that apply across plan types if your plan includes drug coverage.
• The 2027 Part B standard premium, deductible and IRMAA income brackets have not been announced yet; CMS publishes those figures later in the fall.