Medicare Advantage

Before you compare Raleigh Medicare Advantage plans, read this

People in Raleigh can choose from 63 Medicare Advantage plans for 2027, against 77 this year. 19 of this year’s plans are gone, 5 are new to Wake County, and 35 that continue have changed their premium, deductible, plan type or name, 15 of them under a new name.

RALEIGH, N.C. — If you are shopping for a Medicare Advantage plan here this fall, the first thing worth knowing is not a price or a benefit — it is the shape of the menu. Raleigh sits in Wake County, and for 2027, nine insurance carriers are offering Medicare Advantage plans to people on Medicare in the county, in a mix of HMO, HMO-POS and PPO designs, plus a set of Special Needs Plans built for specific situations. Knowing what those letters mean before you compare plans makes the rest of the shopping much easier.

Who is offering plans in Wake County for 2027

For plan year 2027, CMS lists these carriers in Wake County (alphabetical), along with how many Medicare Advantage plans each is offering:

• Aetna (CVS Health): 7 plans
• Alignment Health Plan: 7 plans
• Blue Cross and Blue Shield of North Carolina: 8 plans
• Blue Cross Blue Shield (HCSC): 8 plans
• Centene (WellCare): 9 plans
• Experience Health: 1 plan
• Humana: 18 plans
• Liberty Medicare Advantage: 3 plans
• Longevity Health Plan: 1 plan
• PruittHealth Premier: 1 plan
• UnitedHealthcare: 14 plans

The table on this page lists every plan by carrier, along with its plan type and whether it includes drug coverage. All 48 plans in Wake County include Part D drug coverage for 2027, so if you take medications, you can find them bundled inside the Advantage plan rather than layered on separately. (There are zero stand-alone Part D plans specific to this Advantage lineup — most Wake County retirees who want a separate PDP will look at Part D through Original Medicare instead.)

HMO, HMO-POS and PPO — what the letters actually mean

Almost every plan you will compare in Raleigh falls into one of three network structures. Here is how they work at the program level:

HMO (Health Maintenance Organization). You pick a primary care doctor inside the plan's network and generally need a referral to see a specialist. Except for emergencies, care outside the network is usually not covered. Of the 77 Wake County plans, 28 are HMOs.

HMO-POS (HMO with a Point-of-Service option). Same core idea as an HMO, but with a limited ability to see certain providers outside the network, usually at a higher cost share. Twenty-one of the county's plans are HMO-POS.

PPO (Preferred Provider Organization). More flexibility. You can see out-of-network providers who accept the plan, typically at a higher cost, and referrals are usually not required. Twenty-eight of the county's plans are PPOs, including a few "Regional PPO" plans that serve a wider footprint than a single county.

PFFS (Private Fee-for-Service). You may have read about this fourth type. PFFS plans let you see any Medicare-approved provider who agrees to the plan's terms. For 2027, no PFFS plans appear on the Wake County landscape — the choices here are HMO, HMO-POS and PPO.

Special Needs Plans: a separate lane

Thirty of Wake County's 77 plans are Special Needs Plans (SNPs). These are Medicare Advantage plans built around a specific group of people, and you have to qualify to join one.

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

You will see the SNP type spelled out in the plan name in the table below — for example, "HMO D-SNP," "HMO C-SNP" or "HMO I-SNP." If you do not qualify, you cannot enroll in that plan, but your other choices are still open.

How to narrow 77 plans down to a few worth comparing

Seventy-seven is a lot, but the list gets shorter fast once you apply your own facts:

1. Do you qualify for an SNP? If you have Medicaid, or a qualifying chronic condition, or live in a nursing setting, look at the SNPs built for you first. 2. How important is out-of-network flexibility? If you travel or split time with family in another state, a PPO gives you more room than an HMO. 3. Do your doctors and hospitals take the plan? Network membership is decided by the carrier, not by ZIP code. Confirm each doctor and pharmacy on Medicare.gov's Plan Finder or by calling the plan. 4. Do the plan's drug list and pharmacies fit your prescriptions? Every Advantage plan in Wake County includes drug coverage in 2027, but formularies differ.

A few 2027 program facts worth knowing

These are national rules, not Raleigh-specific, but they affect what your total year could look like:

• Part D has a hard out-of-pocket cap on covered drugs: $2,100 in 2026 and $2,400 in 2027.
• The Part D maximum deductible is $615.
• The old coverage gap ("donut hole") is gone — Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the year in level monthly payments if that helps your budget. It is optional and free to sign up.
• IRMAA — the income-related surcharge on Part B and Part D — kicks in above $109,000 for a single filer in 2026.

Dates to circle

• Oct. 15 – Dec. 7: Medicare Annual Enrollment Period. Join, switch or drop a Medicare Advantage or Part D plan for coverage starting Jan. 1.
• Jan. 1 – March 31: Medicare Advantage Open Enrollment Period. If you are already in a Medicare Advantage plan, you get one chance to switch to a different Advantage plan or return to Original Medicare (with a Part D plan if needed).