Medicare Advantage

What does Medicare Advantage look like in Worcester?

For 2027, Worcester is looking at 50 Medicare Advantage plans: 9 new, 17 gone since 2026, and 24 still here but changed on premium, deductible, plan type or name, 4 of them under a new name. Below, how the lineup shifted in Worcester County and what to compare, with no plan ranked or recommended.

WORCESTER, Mass. — If you are shopping for a Medicare Advantage plan here, the first choice you make is not really about a carrier. It is about the plan type. HMO, HMO-POS, PPO, PFFS, D-SNP, C-SNP — those letters decide how you see a doctor, whether you need a referral, and whether an out-of-network visit is even covered.

Worcester sits inside Worcester County, and that is where Medicare sets plan availability. In the county, 11 carriers offer 46 Medicare Advantage plans for 2027, and every one of them includes drug coverage. Of the 2027 lineup, 37 plans continue from this year, 9 are new, 17 are not returning and 4 have been renamed; 20 continuing plans change something in their terms, which the ANOC spells out. Mass Advantage is not offering plans in the county next year.

Below is a plain-English guide to what those plan types actually mean, and which carriers offer which kinds locally. The full carrier-by-carrier table is at the bottom of this page.

HMO: the most common shape in Worcester County

An HMO — health maintenance organization — asks you to use its network of doctors and hospitals. You typically pick a primary care physician, and specialist visits often need a referral. Out-of-network care is generally not covered except in an emergency.

Of the 58 plans available in the county, 30 are HMOs. Carriers offering at least one HMO in the county include Blue Cross Blue Shield of Massachusetts, Commonwealth Care Alliance Massachusetts, Commonwealth Care Alliance, Inc., eternalHealth, Fallon Health, Mass Advantage, Molina Healthcare of Massachusetts, Tufts Health Plan and UnitedHealthcare.

HMOs tend to appeal to people who already use doctors and hospitals inside a single local system and do not travel often for care.

HMO-POS: an HMO with a side door

HMO-POS stands for "HMO with a point-of-service option." It works like an HMO most of the time, but lets you see certain providers outside the network for specific services, usually at a higher share of cost. Rules vary plan by plan.

Seven of the county's plans are structured this way. Carriers with an HMO-POS in the roster include Aetna (CVS Health), Blue Cross Blue Shield of Massachusetts, Mass General Brigham Health Plan and UnitedHealthcare.

PPO: more flexibility, different trade-offs

A PPO — preferred provider organization — lets you see any Medicare-approved provider, in or out of network, without a referral. In-network care costs less; out-of-network care costs more but is still covered.

Worcester County has 21 PPO plans. Carriers offering PPOs locally include Aetna (CVS Health), Blue Cross Blue Shield of Massachusetts, eternalHealth, Humana, Mass Advantage, Mass General Brigham Health Plan, Tufts Health Plan and UnitedHealthcare.

PPOs can be a good match for people who split time between homes, travel a lot, or want to keep the option to see a specialist without going through a primary care doctor.

PFFS: a plan type you may hear about, but not sold here

Private Fee-for-Service (PFFS) plans are a fourth Medicare Advantage design. In a PFFS plan, the insurer sets the payment terms, and any Medicare-approved provider who agrees to those terms can treat you. PFFS plans do not require a network in the same way an HMO or PPO does.

You may see PFFS mentioned in national Medicare materials, but it is not among the plan types listed for Worcester County in the 2027 landscape data.

Special Needs Plans: only if you qualify

Special Needs Plans (SNPs) are Medicare Advantage plans limited to people in specific situations. 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 a nursing facility or need that level of care at home.

Carriers offering SNPs in Worcester County have included Commonwealth Care Alliance Massachusetts, Commonwealth Care Alliance, Inc., Fallon Health, Molina Healthcare of Massachusetts, Tufts Health Plan and UnitedHealthcare. Most of the local SNPs are D-SNPs; UnitedHealthcare has also offered a C-SNP in the county.

You cannot simply pick a SNP the way you pick a regular Medicare Advantage plan. You have to meet the eligibility rule, and the plan may ask for documentation.

How to use the table below

The table below lists every 2027 Medicare Advantage plan available in Worcester County, grouped by carrier and labeled by type. Use it to see, at a glance:

• Which carriers offer HMOs, HMO-POS plans and PPOs in the county.
• Which plans are structured as Special Needs Plans (and require you to qualify).
• Which insurers cover the most plan types (helpful if you want to compare options within one company).

When you find plans you want to compare on premium, copays, drug formulary, provider network or star rating, the official tool is Medicare Plan Finder at medicare.gov/plan-compare. It pulls current-year details straight from CMS.

A few program facts worth knowing for 2027

Whichever plan type you choose, some rules are the same across all of Medicare:

• Part D drug costs are capped at $2,100 out-of-pocket in 2026.
• The Part D deductible cannot exceed $615.
• The old "donut hole" coverage gap is gone as of 2025; Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly installments — it's optional and free to opt into.
• IRMAA income-based surcharges begin above $109,000 for a single filer in 2026.