Medicare Advantage

Does your doctor take HMO, PPO or HMO-POS in Essex?

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.

NEWARK, N.J. — Fall 2026. When Medicare's Annual Enrollment Period opens Oct. 15, Newark residents comparing 2027 Medicare Advantage plans will see the lineup leaning more toward PPOs than HMOs. In Essex County, where Newark sits, CMS lists 48 Medicare Advantage plans for 2027 from 9 carriers — split into 25 PPOs, 14 HMOs and 9 HMO-POS plans. No private-fee-for-service (PFFS) plans are on the county's 2027 list.

That split matters because the plan "type" — those letters next to the plan name — is what sets the rules for networks, referrals and out-of-network care.

How are Essex County's 2027 Medicare Advantage plans split by type?

In Essex County, the 48 Medicare Advantage plans offered for 2027 break down as 25 PPO plans, 14 HMO plans and 9 HMO-POS plans, according to the CMS Medicare Advantage Landscape Source File. Combining HMO and HMO-POS, 23 of the county's plans are HMO-style and 25 are PPO.

PFFS plans do not appear on the 2027 county list. The table below lists every plan available in Essex County for 2027 so you can see the type next to each name.

What does an HMO Medicare Advantage plan mean for Newark members?

An HMO (Health Maintenance Organization) plan generally asks you to use its contracted network of doctors and hospitals, and often to pick a primary care provider who gives referrals to specialists. Care outside the network is usually not covered except in an emergency or urgent-care situation.

For 2027 in Essex County, HMO plans are offered by Aetna (CVS Health), Centene (WellCare), Clover Health, Elevance Health (Anthem), Horizon Blue Cross Blue Shield of New Jersey, Humana and UnitedHealthcare. Several of those HMO plans are Special Needs Plans (SNPs) built for people with specific conditions or dual Medicare-Medicaid eligibility.

What is an HMO-POS plan, and who offers one in Essex County for 2027?

An HMO-POS (point of service) plan is an HMO with a limited door to out-of-network care — usually only for certain services, and typically at a higher cost share. Rules on referrals vary by plan, so the plan's Evidence of Coverage is the place to check the specifics.

For 2027, Essex County has 9 HMO-POS plans, offered by Centene (WellCare), Elevance Health (Anthem) and UnitedHealthcare.

How does a PPO plan differ, and which carriers sell PPOs in Newark for 2027?

A PPO (Preferred Provider Organization) plan lets you use any Medicare-approved provider, in or out of network, and generally does not require referrals. Out-of-network care is covered but at a higher cost share, so staying in-network still saves money for most visits.

PPO is the largest category in Essex County next year, with 25 plans. The carriers offering PPO plans here for 2027 are Aetna (CVS Health), Clover Health, Devoted Health, Humana, Longevity Health Plan and UnitedHealthcare. Devoted Health is new to the county's PPO lineup compared with what's on offer this year.

Are any PFFS plans available in Newark for 2027?

No. The CMS 2027 landscape for Essex County includes no PFFS (Private Fee-for-Service) plans. PFFS plans let members see any Medicare provider willing to accept the plan's payment terms, but they are rare in New Jersey's urban counties and are not part of Newark's 2027 menu.

How should a Newark reader choose between HMO, HMO-POS and PPO for 2027?

Start with your doctors and hospitals, not the plan type. Call each office you want to keep and ask which 2027 Medicare Advantage plans they contract with; that single step narrows the list fast. From there:

• If your providers are all in one local network and you don't travel much, an HMO or HMO-POS may fit.
• If you want flexibility to see providers outside a network — for a second opinion, a specialist in another state, or because you spend part of the year elsewhere — a PPO's out-of-network coverage may matter.
• If you have a chronic condition or are enrolled in both Medicare and Medicaid, check whether a Special Needs Plan (SNP) is available for your situation.

Costs, drug lists, referral rules and provider networks differ plan by plan. Compare them side by side on the Medicare Plan Finder at medicare.gov, or by calling 1-800-MEDICARE.

What's the deadline, and what happens if I do nothing?

The Annual Enrollment Period runs Oct. 15 through Dec. 7, 2026. A change you make in that window starts Jan. 1, 2027. If you do nothing, your current plan renews for 2027 if it is still offered — with any changes spelled out in the Annual Notice of Change (ANOC) your plan mailed in September.

In Essex County, 10 plans available this year are not returning for 2027, 10 are new, and 2 have been renamed. If your plan is one of the ones leaving, you'll get a non-renewal notice and a Special Enrollment Period to pick a new plan. Medicare Advantage Open Enrollment (Jan. 1 – March 31, 2027) is a second chance to switch Advantage plans or return to Original Medicare.

A few 2027 program figures are already set: the Part D out-of-pocket cap rises to $2,400 (from $2,100 in 2026), and the Part D maximum deductible rises to $700 (from $615 in 2026). CMS typically announces the 2027 Part B premium, deductible and IRMAA income brackets later in the fall.