Medicare Advantage

Rochester, N.Y. Medicare Advantage 2027

People in Rochester can choose from 33 Medicare Advantage plans for 2027, against 43 this year. 16 of this year’s plans are gone, 6 are new to Monroe County, and 14 that continue have changed their premium, deductible, plan type or name, 3 of them under a new name.

Medicare AdvantageRochester, NY

ROCHESTER, N.Y. — If you are sorting through Medicare Advantage for 2027, the first thing to know is that your choices in Rochester are set at the county level. Rochester sits in Monroe County, where 9 carriers are offering Medicare Advantage plans next year, and each one puts a different mix of plan types on the table. Before you compare premiums or provider lists, it helps to understand who is selling what — and what the letters HMO, PPO, PFFS and SNP actually mean.

Who sells Medicare Advantage in the Rochester area

In Monroe County, CMS lists 9 carriers offering Medicare Advantage plans for 2027. In alphabetical order, they are Aetna (CVS Health), Centene (WellCare), Elderplan, Excellus Health Plan Community Care LLC, Excellus Health Plan, Inc, MVP HEALTH CARE, Nascentia Health Plus, UnitedHealthcare, and VNS Health Medicare. Humana and iCircle Services of the Finger Lakes, Inc are not offering plans in the county for 2027.

The number of plans each carrier offers varies. Aetna, Humana and MVP each list 5 plans. UnitedHealthcare lists 5 as well, all of them Special Needs Plans. Centene lists 8. Excellus appears under two entities — Excellus Health Plan, Inc has 4 and Excellus Health Plan Community Care LLC has 2. Elderplan and Excellus Community Care each list 2. Nascentia Health Plus and VNS Health Medicare each list 3. iCircle Services of the Finger Lakes lists 1.

That is a wide field. Some carriers focus on general-market HMOs and PPOs; others build their whole lineup around Special Needs Plans. Knowing which is which saves time.

HMO, HMO-POS, PPO and PFFS: what the letters mean

Most Medicare Advantage plans in Monroe County fall into one of four network types. Here is what they mean at the program level, regardless of carrier:

• HMO (Health Maintenance Organization). You pick a primary care doctor and stay in the plan's network, except for emergencies. Referrals are often required for specialists.
• HMO-POS (HMO with Point of Service). An HMO that lets you go outside the network for certain services, usually at a higher cost. Monroe County has 12 of these.
• PPO (Preferred Provider Organization). You can see any Medicare-approved provider, in or out of network, but you pay less in network. Referrals are usually not required. Monroe County has 11 PPO plans.
• PFFS (Private Fee-for-Service). The plan sets how much it will pay providers and how much you pay. You can see any provider who agrees to the plan's terms at the time of service. Monroe County has 2 PFFS plans, both from Centene.

Of the 30 Medicare Advantage plans available in Monroe County for 2027, all 30 include Part D prescription drug coverage.

Special Needs Plans: a big part of the Rochester lineup

Of those 43 plans, 24 are Special Needs Plans (SNPs). These are Medicare Advantage plans that only accept people who meet specific eligibility rules. There are three types:

• D-SNP (Dual Eligible). For people who have both Medicare and Medicaid.
• C-SNP (Chronic Condition). For people with certain qualifying chronic conditions.
• I-SNP (Institutional). For people who live in a nursing home or need that level of care at home.

Several carriers in Monroe County are built entirely around SNPs. Elderplan's 2 plans, Excellus Community Care's 2 plans, iCircle's 1 plan, Nascentia's 3 plans, UnitedHealthcare's 5 plans, and 2 of VNS Health's 3 plans are all Special Needs Plans. Others — like Aetna, Centene, Humana and MVP — mix SNPs into a broader lineup.

If you do not qualify for an SNP, those plans are not options for you, which effectively narrows the 43-plan field. If you do qualify, an SNP may line up more closely with the care you already use.

How to use this to narrow your choices

A useful order of questions:

1. Are you dual-eligible, in a nursing home, or living with a qualifying chronic condition? If yes, look at the D-SNP, I-SNP or C-SNP options first. 2. How important is out-of-network flexibility? If you travel or split time between homes, a PPO or PFFS may fit better than an HMO. 3. Do you already have doctors you want to keep? Confirm they are in the plan's network before you enroll — this is the single most common surprise. 4. What about your prescriptions? Every 2027 Medicare Advantage plan in Monroe County includes drug coverage, but formularies (the drug lists) are different from plan to plan. The Part D maximum deductible is $615 in 2026 and $700 in 2027. The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027.

The table below lists every 2027 Medicare Advantage plan in Monroe County by carrier and type, so you can see the whole field in one place.

Dates to keep in mind

• Annual Enrollment Period: Oct. 15 – Dec. 7. This is when most people join, switch or drop a Medicare Advantage or Part D plan for the coming year.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31. If you are already in a Medicare Advantage plan, you get one chance during this window to switch to another Medicare Advantage plan or return to Original Medicare.
• IRMAA income threshold. In 2026, higher Part B and Part D premiums (IRMAA surcharges) start above $109,000 in income for a single filer.
• Prescription Payment Plan. You can ask your Part D plan to spread your drug costs into level monthly payments across the year, at no extra charge.