Medicare Advantage

Five new Medicare Advantage plans arrive in Raleigh for 2027: here is the carrier list

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. — When the Medicare Annual Enrollment Period opens on Oct. 15, 2026, shoppers in Wake County will see five Medicare Advantage plans on the shelf that were not there in 2026. The newcomers come from three carriers — Humana, PruittHealth Premier and UnitedHealthcare — and all of them include prescription drug coverage. If you are weighing a switch for 2027 coverage, these are the plans with no local track record yet, which is why they deserve a closer look before you enroll.

What "new for 2027" actually means

Raleigh sits in Wake County, where Medicare Advantage availability is set at the county level. For 2027, CMS data shows five plans that insurers are offering in Wake County for the first time. They sit alongside plans that are simply renewing from 2026 and others that have been renamed.

The practical difference between a new plan and a renewing plan is history. A renewing plan has an Annual Notice of Change (ANOC) you can hold up against last year's benefits, plus a Star Rating built from past performance. A brand-new plan has neither. It still has a full Summary of Benefits, Evidence of Coverage, provider directory and drug formulary — you just cannot compare it to its own prior year, because there is no prior year.

That is not a reason to avoid a new plan or to pick one. It is a reason to read the 2027 documents carefully.

The new Medicare Advantage plans in Wake County for 2027

Listed alphabetically by carrier, the five plans new to Wake County for 2027 are:

• Humana — Humana Gold Plus Giveback H1036-343 (HMO-POS), with drug coverage; and Humana Gold Plus H1036-137 (HMO-POS), with drug coverage.
• PruittHealth Premier — PruittHealth Premier (HMO I-SNP), with drug coverage. An I-SNP is an Institutional Special Needs Plan, generally for people living in a nursing facility or who need that level of care.
• UnitedHealthcare — UHC Dual Complete NC-Q2 (HMO-POS D-SNP), with drug coverage; and UHC Dual Complete NC-S3 (HMO-POS D-SNP), with drug coverage. D-SNP stands for Dual Eligible Special Needs Plan, designed for people who qualify for both Medicare and Medicaid.

Three of the five are Special Needs Plans, which means eligibility is limited to people who meet specific criteria. The other two Humana plans are HMO-POS plans open to Medicare-eligible residents of the service area.

The full table on this page lists every 2027 Medicare Advantage plan in Wake County, not just the new ones.

How the plan types differ

The new plans fall into two structures:

• HMO-POS (Health Maintenance Organization with Point of Service) uses a network of in-network doctors and hospitals, usually with a primary care physician coordinating referrals. The "POS" piece lets you go out-of-network for certain services, typically at a higher cost.
• HMO D-SNP and HMO I-SNP are HMO plans built for a specific population — people with both Medicare and Medicaid (D-SNP) or people in an institutional setting (I-SNP). They include Part D drug coverage and often coordinate benefits across both programs.

Every one of the five new plans includes Part D, so if you take prescriptions you will not need a separate drug plan to pair with them.

Why a new plan has no Star Rating yet

Medicare's Star Ratings are based on data a plan has already produced — things like member experience surveys, customer service metrics and clinical quality measures. A plan in its first year has not produced that data yet, so CMS does not assign it a rating. You may see "not enough data to rate" or a blank where a star count would normally appear on medicare.gov. That is a program fact about how the ratings system works, not a judgment about the plan.

How to check a new plan against your doctors and prescriptions before Dec. 7

The checks are the same ones you would run for any plan — they just matter more when there is no track record to lean on.

1. Go to the Medicare Plan Finder at medicare.gov. Enter your ZIP code and your prescriptions. The tool will show the 2027 plans available in Wake County and estimate your yearly drug costs under each. 2. Check your doctors against the plan's 2027 provider directory. Call your primary care physician's office and any specialists you see, and ask whether they will be in-network for the specific plan in 2027. Networks change year to year, so last year's answer may not hold. 3. Check your prescriptions against the plan's 2027 formulary. Look up each drug by name and dose. Confirm the tier, whether prior authorization or step therapy applies, and which pharmacies the plan treats as preferred. 4. Read the Summary of Benefits. For a new plan, this is your main document. Look at how the plan handles the services you actually use — primary care visits, specialists, imaging, hospital stays, and any extras you count on. 5. Call the plan or 1-800-MEDICARE if anything is unclear. Medicare's helpline is open 24 hours a day, seven days a week.

If you do nothing by Dec. 7, 2026, your current plan simply renews for 2027 if the carrier is still offering it, with the changes spelled out in your ANOC. Nothing is automatic beyond that.

A few 2027 numbers worth knowing

Two Part D figures are already set for 2027 and apply across all Medicare drug plans:

• The Part D out-of-pocket cap rises to $2,400 in 2027, up from $2,100 in 2026.
• The Part D maximum deductible rises to $700 in 2027, up from $615 in 2026.

The 2027 Part B standard premium and deductible, and the 2027 IRMAA income brackets, have not been announced yet. CMS typically publishes them later in the fall.