Medicare Advantage

Before you pick a Durham Medicare Advantage carrier

For 2027, Durham is looking at 69 Medicare Advantage plans: 6 new, 11 gone since 2026, and 25 still here but changed on premium, deductible, plan type or name, 9 of them under a new name. Below, how the lineup shifted in Durham County and what to compare, with no plan ranked or recommended.

Medicare AdvantageDurham, NC

If you live in Durham and are shopping for a Medicare Advantage plan, the first thing to sort out isn't a carrier name — it's the plan type. HMO, HMO-POS, PPO and Special Needs Plans all fall under the Medicare Advantage umbrella, but they work differently once you actually use them. Understanding those differences up front will save you a lot of second-guessing later.

Durham is in Durham County, where the 2027 Medicare Advantage lineup includes plans from 11 carriers, according to the CMS Medicare Advantage Landscape Source File. The table below lists every plan available in the county. Before you scroll it, though, it helps to know what the letters after each plan name actually mean.

What the plan-type letters mean

Every Medicare Advantage plan in Durham County is labeled with a plan type. Here is the plain-English version of each one you'll see in the roster.

HMO (Health Maintenance Organization). You pick a primary care doctor and generally stay inside the plan's network. Out-of-network care is typically not covered except in emergencies. Referrals are often needed to see specialists.

HMO-POS (Point of Service). An HMO with a small door built in — you can go outside the network for certain services, usually at a higher cost. The rules for what's covered out-of-network vary by plan.

PPO (Preferred Provider Organization). More flexibility. You can see out-of-network providers who accept Medicare, though you'll usually pay more than you would in-network. Referrals typically aren't required.

PFFS (Private Fee-for-Service). A plan that pays providers a set rate, and you can see any provider who agrees to the plan's terms. No PFFS plans are on the Durham County roster for 2027, but you may still hear the term.

Special Needs Plans (SNPs). These are Medicare Advantage plans limited to people who meet certain criteria:

• D-SNP (Dual Eligible) — for people with both Medicare and Medicaid.
• C-SNP (Chronic Condition) — for people with a qualifying chronic condition, such as diabetes or heart failure.
• I-SNP (Institutional) — for people living in a nursing home or who need that level of care at home.

You can only enroll in an SNP if you meet its eligibility rules. If you don't, the plan is not an option regardless of how it looks on paper.

How Durham County's plans break down

Of the 60 plans available in Durham County for 2027, 54 are continuing from this year, 6 are new, 9 have been renamed, and 11 plans offered in 2026 are not returning. Every plan on the roster includes Part D drug coverage, which is why you'll notice there are no stand-alone Part D plans listed separately for the county — drug coverage is built in.

The 12 carriers offering plans in Durham County, in alphabetical order:

• Aetna (CVS Health) — 7 plans (HMO, PPO; 2 Special Needs)
• Blue Cross and Blue Shield of North Carolina — 7 plans (HMO, HMO-POS, PPO; 1 Special Needs)
• Blue Cross Blue Shield (HCSC) — 8 plans (HMO, PPO; 2 Special Needs)
• Centene (WellCare) — 9 plans (HMO-POS, PPO; 4 Special Needs)
• Experience Health — 1 plan (HMO)
• HealthTeam Advantage — 2 plans (PPO)
• Humana — 19 plans (HMO, HMO-POS, PPO; 6 Special Needs)
• Liberty Medicare Advantage — 3 plans (HMO; 3 Special Needs)
• Longevity Health Plan — 1 plan (HMO; 1 Special Needs)
• PruittHealth Premier — 1 plan (HMO; 1 Special Needs)
• Troy Medicare — 2 plans (HMO; 1 Special Needs)
• UnitedHealthcare — 14 plans (HMO-POS, PPO; 7 Special Needs)

The order above is alphabetical, not a ranking. A carrier that offers more plans in Durham County isn't necessarily a better fit for you — it just has more variations on the shelf.

How to think about HMO vs. PPO for your situation

Neither type is inherently better. The right choice usually comes down to how you use care.

An HMO or HMO-POS may fit if:

• Your regular doctors are already in one health system.
• You don't mind coordinating care through a primary care doctor.
• You spend most of the year in the Triangle area.

A PPO may fit if:

• You split time between Durham and another part of the country.
• You want to see specialists without going through referrals.
• You have providers in more than one health system and want to keep options open.

Either way, always confirm with the plan directly whether the specific doctors, hospitals and pharmacies you use are in-network for the plan year you're enrolling in. Networks can change from year to year.

When Special Needs Plans come into play

Among the plans available in Durham County for 2027, Special Needs Plans include D-SNPs (for people with Medicare and Medicaid), along with some C-SNPs and I-SNPs. If you qualify for one, an SNP is worth a close look because the benefits are designed around a specific situation. If you don't qualify, it simply isn't an available option — the plan can't enroll you.

Your local State Health Insurance Assistance Program (SHIP) counselor can walk you through whether you qualify for an SNP and what documentation you'd need.

Dates and figures to keep in mind for 2027

• Annual Enrollment Period: October 15 – December 7, 2026. This is the main window to join, switch or drop a Medicare Advantage plan for 2027.
• Medicare Advantage Open Enrollment: January 1 – March 31. If you're already in an MA plan, you get one chance in this window to switch 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 you hit that in covered drug costs, you pay nothing for covered drugs the rest of the year.
• Part D maximum deductible: $615 in 2026 and $700 in 2027.
• Coverage gap ("donut hole"): Eliminated as of 2025. Part D now has three phases instead of four.
• Medicare Prescription Payment Plan: An optional program that lets you spread drug costs across monthly payments instead of paying at the pharmacy counter.
• IRMAA: Higher-income surcharges on Part B and Part D begin above $109,000 for a single filer in 2026.