Medicare Advantage

Before you pick a Medicare Advantage plan in Newark: how HMO, PPO and SNP differ

Essex County has 48 Medicare Advantage plans for 2027. Compared with 2026, 10 plans are not coming back, 10 are new, and 12 continuing plans changed in some way you should check before December 7, 2 of them under a new name. This guide covers what those numbers mean for Newark, not which plan to pick.

Medicare AdvantageNewark, NJ

NEWARK, N.J. — If you are shopping for a Medicare Advantage plan here, the first thing to sort out is not the carrier. It's the plan type. Newark sits in Essex County, where 46 Medicare Advantage plans are offered for 2027 from 9 carriers, and those plans come in a few different shapes — HMO, HMO-POS, PPO, and Special Needs Plans (SNPs). Each one works a little differently, and the right fit depends on how you use care, not on which name you recognize.

What the Newark-area market looks like

Because Medicare Advantage availability is set by county, every plan sold in Newark is available across Essex County. For 2027, that comes to 46 MA plans from 9 carriers. Compared with 2026, 10 plans are new, 10 are not returning, 2 have been renamed, and 10 continuing plans change something in their terms — those changes are spelled out in each plan's Annual Notice of Change. Blue Cross Blue Shield (HCSC) and Braven Health are not offering plans in the county for 2027; Devoted Health is new to the county.

The carriers offering plans in the county, in alphabetical order, are Aetna (CVS Health), Blue Cross Blue Shield (HCSC), Braven Health, Centene (WellCare), Clover Health, Elevance Health (Anthem), Horizon Blue Cross Blue Shield of New Jersey, Humana, Longevity Health Plan, and UnitedHealthcare. The table below lists every plan by carrier.

HMO: one network, one primary doctor

An HMO — Health Maintenance Organization — typically asks you to pick a primary care doctor and get care from providers inside the plan's network. Referrals are often required to see a specialist. If you go outside the network, the plan usually won't pay except for emergencies.

HMOs can be a good match if you already use doctors in a specific system, don't travel often for care, and don't mind coordinating through a primary doctor. In Essex County, HMO options are available from Aetna, Centene (WellCare, which uses HMO-POS), Clover Health, Elevance Health (Anthem), Horizon Blue Cross Blue Shield of New Jersey, Humana, and UnitedHealthcare.

HMO-POS: an HMO with a small side door

HMO-POS stands for "point of service." It works like an HMO — network, primary care doctor, referrals — but adds limited coverage for certain out-of-network services. The rules vary from plan to plan, so read the "point of service" section of the Summary of Benefits carefully. Several Wellcare and UnitedHealthcare plans in the roster are HMO-POS.

PPO: more flexibility, at a cost

A PPO — Preferred Provider Organization — lets you see any Medicare-approved provider, in or out of network, without a referral. You'll pay less when you stay in-network, and more when you go outside it. PPOs make up half of the plans available in Essex County (24 of 48), and are offered by Aetna, Blue Cross Blue Shield (HCSC), Braven Health, Clover Health, Humana, Longevity Health Plan, and UnitedHealthcare.

You may also see "Regional PPO" and "Local PPO" on plan names. Both are PPOs — the difference is the size of the service area CMS approves.

What about PFFS?

Private Fee-for-Service (PFFS) is a fourth Medicare Advantage plan type. In a PFFS plan, the insurer sets the terms of payment, and any Medicare provider who agrees to those terms can see you. For 2027, no PFFS plans are on the Essex County roster, so it isn't a practical choice in Newark right now — but it's worth knowing the term exists.

Special Needs Plans: only if you qualify

Special Needs Plans are Medicare Advantage plans built for 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 long-term condition, such as diabetes, chronic heart failure, or end-stage renal disease.
• I-SNP (Institutional): for people who live in a nursing home or need a similar level of care.

You can't just pick an SNP because you like it — you have to meet the eligibility rules and provide proof. In Essex County, 11 of the 48 plans are SNPs, offered by Aetna, Centene (WellCare), Elevance Health (Anthem), Horizon Blue Cross Blue Shield of New Jersey, Humana, Longevity Health Plan, and UnitedHealthcare.

How to narrow the list

A few questions can shrink 48 plans down to a manageable handful:

• Are your doctors and hospitals in the plan's network? Check every plan you're considering on Medicare's Plan Finder.
• Are your prescriptions on the formulary, and at what tier? All 46 plans in the county include drug coverage. The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. The Part D maximum deductible is $615 in 2026 and $700 in 2027. The coverage gap is gone — replaced by three straightforward phases. The optional Medicare Prescription Payment Plan lets you spread drug costs across the calendar year.
• Do you qualify for a Special Needs Plan? If you have Medicaid, a qualifying condition, or live in an institutional setting, an SNP may fit better than a general MA plan.
• How much do you travel? PPOs generally travel better than HMOs.

Deadlines to keep in mind

The Annual Enrollment Period runs Oct. 15 through Dec. 7 — that's when most people join, switch, or drop a Medicare Advantage or Part D plan. If you're already in a Medicare Advantage plan, you get a second window from Jan. 1 to March 31, when you can switch to a different MA plan or go back to Original Medicare.