Medicare Advantage

HMO, PPO, PFFS or SNP in St. Louis: how the Medicare Advantage types differ

St. Louis city has 80 Medicare Advantage plans for 2027. Compared with 2026, 10 plans are not coming back, 11 are new, and 41 continuing plans changed in some way you should check before December 7, 17 of them under a new name. This guide covers what those numbers mean for St. Louis, not which plan to pick.

Medicare AdvantageSt. Louis, MO

If you live in St. Louis and you are shopping Medicare Advantage for 2027, the first thing worth sorting out is not premiums or perks — it is plan type. HMO, HMO-POS, PPO, PFFS and the different Special Needs Plans all work in different ways at the network and eligibility level, and that shapes almost everything else about the coverage.

St. Louis is in St. Louis city, where the CMS 2027 Medicare Advantage Landscape shows 63 Medicare Advantage plans offered by 11 carriers. Compared with 2026, 52 plans continue, 11 are new, 10 are not returning, and 17 have been renamed; 24 of the continuing plans change something in their terms, and the ANOC has the details. Here is what the plan-type labels actually mean, and how the local lineup is laid out.

What HMO, HMO-POS, PPO and PFFS actually mean

HMO (Health Maintenance Organization). You pick a primary care doctor and generally stay inside the plan's network. Out-of-network care usually is not covered except for emergencies. Many HMOs require a referral to see a specialist. In St. Louis city, 31 of the 79 plans are HMOs.

HMO-POS (Point of Service). An HMO with a narrow exception: it lets you go outside the network for certain services, usually at a higher cost share. There are 20 HMO-POS plans locally.

PPO (Preferred Provider Organization). More flexible. You can see any provider who accepts Medicare, but you pay less when you stay in network, and you don't need referrals. St. Louis city has 27 PPO plans, including some labeled "Regional PPO," which use a multi-state service area defined by CMS.

PFFS (Private Fee-for-Service). The plan sets the payment terms, and any Medicare provider willing to accept those terms can treat you. There is 1 PFFS plan in the local lineup.

None of these labels tell you the premium, the copay or what the plan covers beyond Original Medicare — those vary plan by plan. The type tells you how the plan handles networks and access.

What a Special Needs Plan is (and isn't)

A Special Needs Plan (SNP) is a Medicare Advantage plan limited to people who meet specific eligibility rules. It is not a general option anyone can pick. 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 certain heart conditions.
• I-SNP (Institutional): For people who live in a nursing home or need a similar level of care.

Of the 79 plans in St. Louis city, 34 are SNPs. A SNP is still an HMO or PPO underneath — for example, an "HMO D-SNP" follows HMO rules and is only sold to people who qualify as dual-eligible.

Which carriers offer plans in St. Louis city

Eleven carriers offer Medicare Advantage plans in the area for 2027. In alphabetical order:

• Aetna (CVS Health): 10 plans
• American Health Advantage of Missouri: 2 plans
• Blue Cross Blue Shield (HCSC): 5 plans
• Centene (WellCare): 7 plans
• Devoted Health: 7 plans
• Elevance Health (Anthem): 5 plans
• Essence Healthcare: 5 plans
• Humana: 17 plans
• NHC Advantage: 2 plans
• Provider Partners Health Plans: 3 plans
• UnitedHealthcare: 16 plans

The full list of every plan by carrier appears in the table below on this page, including plan type and whether drug coverage is included. All 79 plans in St. Louis city include Part D drug coverage, and there are no stand-alone Part D plans listed in this local Advantage dataset.

How to think about the type first

A quick way to narrow 79 plans down to a manageable set:

1. Check SNP eligibility first. If you have Medicaid, a qualifying chronic condition, or live in a nursing facility, a SNP may be built for your situation. If none of that applies, set the 34 SNPs aside — you can't enroll in them anyway. 2. Decide how much network flexibility you want. If you travel, split time between states, or want to see specialists without referrals, PPO rules generally give you more room. If you prefer a coordinated model with one primary doctor, an HMO or HMO-POS may fit. 3. Check your doctors. Before you compare anything else, confirm the providers you actually use are in-network for the plans you're considering. Medicare.gov's Plan Finder lets you enter your doctors and drugs. 4. Then compare the specifics. Only after those filters does it make sense to look at premiums, drug formularies, out-of-pocket maximums and extra benefits — which are plan-by-plan, not type-by-type.

Program facts that apply no matter which type you pick

• Annual Enrollment Period: October 15 – December 7. This is when most people switch or join a Medicare Advantage or Part D plan.
• Medicare Advantage Open Enrollment: January 1 – March 31. If you're already in a Medicare Advantage plan, you get one chance to change to another MA plan or return to Original Medicare.
• Part D out-of-pocket cap: $2,100 in 2026 and $2,400 in 2027. Once your covered drug costs hit that, you pay nothing for covered drugs the rest of the year.
• Part D maximum deductible: $615 in 2026 and $700 in 2027.
• Coverage gap: The "donut hole" was eliminated in 2025. Part D now has three phases.
• Medicare Prescription Payment Plan: An optional program that spreads your drug costs into monthly payments across the plan year.
• IRMAA: Income-related surcharges for Part B and Part D start above $109,000 for single filers in 2026.