Medicare Advantage

Choosing a 2027 Medicare Advantage plan in St. Paul? Here's how HMO and PPO rules actually differ

For 2027, St. Paul is looking at 27 Medicare Advantage plans: 8 new, 18 gone since 2026, and 9 still here but changed on premium, deductible, plan type or name, 3 of them under a new name. Below, how the lineup shifted in Ramsey County and what to compare, with no plan ranked or recommended.

St. Paul, Minn. — Fall 2026. If you live in St. Paul and are looking at a Medicare Advantage plan for 2027, one of the first things you'll notice on the Medicare Plan Finder is a short string of letters next to each plan's name: HMO, HMO-POS, PPO or PFFS. Those letters are not just insurance jargon. They decide which doctors you can see, whether you need a referral to a specialist, and what happens if you get sick while visiting the grandkids out of state.

Here's how the plan types break down in Ramsey County — the county St. Paul sits in — for the 2027 plan year, and what each type actually means for your care.

How do HMO, HMO-POS, PPO and PFFS plans differ?

All four are types of Medicare Advantage (Part C), but they handle networks and out-of-network care differently.

• HMO (Health Maintenance Organization): You generally must use doctors, hospitals and pharmacies in the plan's network, except for emergencies and urgent care. Many HMOs ask you to pick a primary care doctor and get a referral before seeing a specialist.
• HMO-POS (HMO with a Point-of-Service option): Works like an HMO, but with a limited ability to go outside the network for certain services. The plan's Evidence of Coverage spells out what's included in the POS benefit.
• PPO (Preferred Provider Organization): You can see any Medicare-approved provider, in or out of network, usually without a referral. Out-of-network care is almost always covered at a higher cost share than in-network care.
• PFFS (Private Fee-for-Service): You can see any Medicare-approved provider who agrees to the plan's payment terms. No PFFS plans are listed in Ramsey County for 2027.

None of these types is automatically cheaper or better. The right fit depends on whether your doctors are in the network, whether you want the freedom to see specialists directly, and how often you travel outside Minnesota.

How many Medicare Advantage plans are offered in Ramsey County for 2027, and by what type?

For plan year 2027, Ramsey County has 27 Medicare Advantage plans from 6 carriers, per the CMS Landscape Source File. By type, that breaks down as 3 HMO plans and 24 PPO plans (the HMO count includes HMO-POS). No PFFS plans are offered in the county next year.

That is a different mix than Ramsey County had for 2026, when 37 plans were available from 7 carriers. For 2027, 18 plans are not returning, 8 are new, and 3 are renamed. If one of those changes affects your current plan, the specifics are in your Annual Notice of Change — the ANOC — which plans mail in September.

Which carriers offer HMO plans in St. Paul for 2027?

Three carriers offer HMO (or HMO-POS) Medicare Advantage plans in Ramsey County for 2027, listed alphabetically: Blue Plus, HealthPartners and Medica. If you prefer the structure of an HMO — a primary care doctor coordinating your care, and most services kept within a defined network — these are the carriers to look at first on the Medicare Plan Finder.

The table below lists every plan available in the county, so you can see which specific HMO plans each of these carriers offers.

Which carriers offer PPO plans in St. Paul for 2027?

Five carriers offer PPO Medicare Advantage plans in Ramsey County for 2027, listed alphabetically: Aetna (CVS Health), Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica and UnitedHealthcare. PPOs are the larger share of the local lineup for 2027 — 24 of the 27 plans in the county.

A PPO can be a reasonable fit if you want to keep the option of seeing out-of-network providers without a referral, or if you split your year between Minnesota and another state. Just remember that "covered out of network" and "covered at the same cost" are not the same thing; the plan's Summary of Benefits will show the in- and out-of-network cost shares side by side.

What should I check before I pick an HMO or a PPO?

A few practical questions sort this out faster than a spreadsheet:

• Are your doctors in the network? Call your clinic and ask which 2027 Medicare Advantage plans they will accept. Networks can change year to year.
• Do you want to see specialists without a referral? If yes, lean PPO. If you don't mind a referral, HMOs are worth comparing.
• How much do you travel? If you spend months out of state, a PPO's out-of-network coverage may matter. HMOs generally cover only emergency and urgent care outside the network.
• What about drugs? 32 of this year's local plans include Part D drug coverage; check that your prescriptions are on the plan's formulary and that your pharmacy is in-network.

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). The 2027 Part B standard premium, Part B deductible and IRMAA income brackets have not yet been announced; CMS typically publishes those figures later in the fall.

When do I need to decide for 2027 coverage?

The Annual Enrollment Period runs Oct. 15 through Dec. 7, 2026. A change you make in that window takes effect Jan. 1, 2027. If you do nothing, your current plan renews for 2027 as described in its ANOC — assuming the plan is being offered again in Ramsey County.

If you join a Medicare Advantage plan for 2027 and want to switch, the Medicare Advantage Open Enrollment Period (Jan. 1 – March 31, 2027) gives you one chance to change to a different Advantage plan or return to Original Medicare.