Medicare Advantage

Raleigh Medicare Advantage for 2027: how HMO, HMO-POS and PPO plans split

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. — As the Annual Enrollment Period opens Oct. 15, 2026, Wake County shoppers choosing 2027 Medicare Advantage coverage will see the local market lean a little more heavily toward PPO and HMO-POS designs than the straight HMO plans many people picture when they think of managed care.

For plan year 2027, the Centers for Medicare & Medicaid Services lists 63 Medicare Advantage plans from 9 carriers in Wake County, the county Raleigh sits in. They break down by plan type as 18 HMO, 22 HMO-POS and 23 PPO. No PFFS (Private Fee-for-Service) plans are offered locally for 2027. If you include HMO-POS with HMO, 40 of the 63 plans are HMO-family, and 23 are PPO.

That mix matters because the plan "type" letters next to a plan's name — HMO, HMO-POS, PPO — are not marketing labels. They are the rules that decide whether you need a referral to see a specialist, whether your plan pays anything if you go outside its network, and what happens when you travel.

What the plan type actually means

Think of plan type as the rulebook for how you get care.

• HMO (Health Maintenance Organization). You pick a primary care doctor and generally use the plan's network. A referral is often required to see a specialist. Out-of-network care is usually not covered except for emergencies, urgent care and out-of-area dialysis.
• HMO-POS (HMO with a Point-of-Service option). Same HMO backbone, but the plan allows some out-of-network services, often at a higher cost share. Each plan decides which services the POS option applies to.
• PPO (Preferred Provider Organization). You can see any Medicare-approved provider that accepts the plan. In-network care costs less, but out-of-network care is covered — usually at a higher cost share. Referrals are typically not required.
• PFFS (Private Fee-for-Service). A separate type where the plan sets the terms and any Medicare provider can choose whether to accept them visit by visit. None are offered in Wake County for 2027.

None of these types is cheaper or better by nature. What you pay and which doctors you can see depends on the specific plan's network, benefits and cost sharing — details that live in each plan's Evidence of Coverage, not in its type letters.

How Wake County's 2027 lineup splits

Of the 63 Medicare Advantage plans available in Wake County for 2027:

• HMO (18 plans) are offered by Aetna (CVS Health), Alignment Health Plan, Blue Cross and Blue Shield of North Carolina, Humana, Liberty Medicare Advantage, Longevity Health Plan and PruittHealth Premier.
• HMO-POS (22 plans) are offered by Alignment Health Plan, Blue Cross and Blue Shield of North Carolina, Centene (WellCare), Humana and UnitedHealthcare.
• PPO (23 plans) are offered by Aetna (CVS Health), Alignment Health Plan, Blue Cross and Blue Shield of North Carolina, Centene (WellCare), Humana and UnitedHealthcare.

A few carriers appear in only one column; others span two or all three. The table below lists every plan available in Wake County for 2027 with its type, so you can see which carriers field which designs.

How to decide between HMO and PPO

Start with your doctors, not the brochure. Pull up your current primary care doctor, specialists and preferred hospital, and check each plan's provider directory on medicare.gov's Plan Finder or the carrier's own site. A plan that excludes a doctor you want to keep is the wrong plan, regardless of type.

Then think about three questions:

1. Do you travel or spend part of the year outside North Carolina? A PPO's out-of-network coverage can matter here. HMOs typically only cover emergency and urgent care away from home. 2. Do you mind getting a referral to see a specialist? HMOs often require one; PPOs typically do not. HMO-POS rules vary by plan. 3. Do you prefer a tight network with a single care team, or the flexibility to shop around? Both approaches are legitimate — this is personal preference.

Cost sharing, drug coverage, extra benefits and star ratings vary plan by plan. Compare those on Plan Finder once you have narrowed by type and network.

What's changing for 2027

Nationally, two Part D figures are already set for 2027: the out-of-pocket cap on covered drug costs rises to $2,400 (from $2,100 in 2026), and the maximum Part D deductible a plan can charge rises to $700 (from $615 in 2026). CMS has not yet announced the 2027 Part B standard premium and deductible or the 2027 IRMAA income brackets; those usually come out in the fall.

In Wake County, the 2027 landscape also includes 19 plans that are not returning, 5 new plans and 15 plans that have been renamed. If you are currently enrolled, your plan's Annual Notice of Change (ANOC), mailed in September, spells out exactly what is different for your plan next year — including whether your plan type, network or drug list has shifted.

If you do nothing by Dec. 7, 2026, and your plan is offered again in 2027, you stay enrolled with the changes described in the ANOC.