Medicare Advantage

HMO or PPO? New Jersey Medicare Advantage for 2027: 32 HMO Plans, 39 PPO

TRENTON, N.J. — For the 2027 plan year, New Jersey Medicare shoppers will see 71 Medicare Advantage plans offered across the state by 12 carriers, according to the Centers for Medicare & Medicaid Services (CMS) MA Landscape Source File. The lineup splits almost evenly between network styles: 32 are HMO-family plans (21 HMO plus 11 HMO-POS) and 39 are PPO plans.

That near-even split is the headline, but the practical question for most households is simpler: which network type matches the doctors you already see and the way you travel? Here is how the statewide numbers break down, what each plan type actually means at the front desk, and what to do before the Annual Enrollment Period closes December 7, 2026.

The statewide split by plan type

Using the CMS MA Landscape Source File for CY2027, New Jersey's 71 Medicare Advantage plans break out this way:

• HMO: 21 plans
• HMO-POS: 11 plans
• PPO: 39 plans

Grouped together, HMO and HMO-POS make up 32 plans. PPOs make up the single largest category at 39. CMS counts each plan contract once at the state level; the same plan is then offered on a county-by-county basis, so the choices on your screen when you enter a ZIP code will be a subset of the statewide list.

The complete 2027 plan and carrier tables appear elsewhere on this page. The sections below name carriers only where it helps explain a point.

What HMO, HMO-POS, PPO and PFFS mean

These acronyms describe how a plan handles networks, referrals and out-of-network care.

• HMO (Health Maintenance Organization): You generally use the plan's contracted network of doctors, hospitals and pharmacies. Many HMOs ask you to pick a primary care physician and get a referral before seeing a specialist. Out-of-network care is usually not covered except for emergencies, urgent care and dialysis.
• HMO-POS (Point of Service): An HMO with a limited "point of service" option that lets you go outside the network for certain services, usually at a higher cost share. The specifics — which services, which providers, what you pay — are set by the individual plan's Evidence of Coverage.
• PPO (Preferred Provider Organization): You can see any Medicare-approved provider that accepts the plan, in or out of network. You generally pay less when you stay in-network, more when you go out, and referrals are typically not required.
• PFFS (Private Fee-for-Service): A plan that pays providers on its own terms; any Medicare provider who agrees to the plan's terms can treat you. New Jersey's CY2027 landscape does not include a PFFS plan in the counts above, but the term still appears in Medicare materials, which is why it is worth knowing.

Specific rules — prior authorization, referral requirements, out-of-network cost sharing — are set plan by plan. Those details live in each plan's Evidence of Coverage and provider directory, not in the statewide counts.

Which carriers offer each type in 2027

Ten carriers offer HMO plans in New Jersey for 2027: Aetna (CVS Health), AmeriHealth, Blue Cross Blue Shield (HCSC), Centene (WellCare), Clover Health, Elevance Health (Anthem), Horizon Blue Cross Blue Shield of New Jersey, Humana, Jefferson Health Plans, and UnitedHealthcare.

Four carriers offer HMO-POS plans: Aetna (CVS Health), Centene (WellCare), Elevance Health (Anthem), and UnitedHealthcare.

Nine carriers offer PPO plans: Aetna (CVS Health), AmeriHealth, Blue Cross Blue Shield (HCSC), Clover Health, Devoted Health, Humana, Jefferson Health Plans, Longevity Health Plan, and UnitedHealthcare.

Some carriers appear in more than one column — for example, Aetna (CVS Health), AmeriHealth, Blue Cross Blue Shield (HCSC), Clover Health, Humana, Jefferson Health Plans and UnitedHealthcare each show up under more than one plan type. Others appear in only one. Horizon Blue Cross Blue Shield of New Jersey is listed under HMO in the 2027 file; Devoted Health and Longevity Health Plan are listed under PPO. Being listed statewide does not mean a carrier sells every plan in every county.

How to decide which type fits your doctors and travel

A few questions tend to settle the HMO-versus-PPO debate faster than a chart:

1. Where are your doctors? Write down every clinician you want to keep — primary care, specialists, the hospital system, your pharmacy. Then check each plan's provider directory before enrolling. If your team is all inside one network, an HMO can be a clean fit. If your team is scattered, a PPO's out-of-network option may matter. 2. Do you want referrals? Some people like having a primary care physician coordinate specialist visits; others want to self-refer. HMOs lean toward the first style; PPOs lean toward the second. 3. How much do you travel? If you spend months out of state with family, routine care away from home is handled very differently by an HMO than a PPO. Emergency and urgent care are covered either way; routine care is where the plan type shows up on the bill. 4. Do you want a point-of-service option? HMO-POS is a middle path worth asking about if you want HMO structure with a limited outside-the-network door.

Nothing in the plan type alone tells you about premiums, drug coverage, extra benefits or star ratings — those live at the individual plan level on the Medicare Plan Finder.

What to do before December 7

The Annual Enrollment Period runs October 15 – December 7, 2026. Enrollments and changes made during that window take effect January 1, 2027. A workable checklist:

• List your doctors, hospitals, prescriptions and preferred pharmacy.
• Enter your ZIP code at medicare.gov to see which of New Jersey's 71 plans are actually offered in your county.
• Compare each candidate plan's Summary of Benefits and Evidence of Coverage for network rules, referral rules and out-of-network cost sharing.
• Confirm each of your providers in the plan's current directory and call the office to verify.
• Keep notes — plan name, contract number, confirmation number — once you enroll.

Free help

You can compare every plan available at your address, side by side, at medicare.gov using the Medicare Plan Finder, which pulls directly from the CMS MA Landscape Source File. You can also call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week; TTY users call 1-877-486-2048.