Medicare Advantage

Before You Pick a Medicare Advantage Plan in Forsyth

Forsyth County has 97 Medicare Advantage plans for 2027. Compared with 2026, 15 plans are not coming back, 13 are new, and 41 continuing plans changed in some way you should check before December 7, 16 of them under a new name. This guide covers what those numbers mean for Winston-Salem, not which plan to pick.

Choosing a Medicare Advantage plan in Winston-Salem usually comes down to two questions: which company do you want to be with, and what kind of plan do you want it to be? The second question trips up a lot of people, because the letters after each plan name — HMO, HMO-POS, PPO, PFFS, D-SNP, C-SNP, I-SNP — aren't just labels. They tell you how the plan works.

Winston-Salem is in Forsyth County, where 13 carriers offer Medicare Advantage plans for 2027, and the roster includes every one of those plan types. Here is a plain-language guide to what each type means, and which carriers in the county offer them.

The carriers offering plans in Forsyth County

Thirteen companies sell Medicare Advantage plans in the county for 2027. In alphabetical order, they are Aetna (CVS Health), Alignment Health Plan, Blue Cross and Blue Shield of North Carolina, Blue Cross Blue Shield (HCSC), Centene (WellCare), Devoted Health, HealthTeam Advantage, Humana, Liberty Medicare Advantage, Longevity Health Plan, Provider Partners Health Plans, PruittHealth Premier and UnitedHealthcare. Compared with 2026, 68 plans continue, 13 are new, 15 are not returning and 16 have been renamed; 25 of the continuing plans change something in their terms, and those changes are spelled out in each plan's Annual Notice of Change.

Not every carrier offers every plan type. Some, like Longevity Health Plan, PruittHealth Premier and Provider Partners, focus entirely on Special Needs Plans for people in nursing homes. Others, like Humana, cover almost the full range. The table below lists every plan.

HMO plans: the "stay in network" model

An HMO — Health Maintenance Organization — asks you to use doctors, hospitals and other providers inside the plan's network, except in emergencies. Most HMOs also ask you to pick a primary care doctor and to get referrals before you see a specialist.

There are 38 HMO plans in Forsyth County. You'll see them from Aetna, Alignment Health Plan, Blue Cross and Blue Shield of North Carolina, Blue Cross Blue Shield (HCSC), Devoted Health, HealthTeam Advantage, Humana, Liberty Medicare Advantage, Longevity Health Plan, Provider Partners Health Plans and PruittHealth Premier.

HMOs tend to be a good fit if your doctors are already in the plan's network and you don't mind the referral step.

HMO-POS plans: an HMO with a side door

HMO-POS stands for HMO with a Point-of-Service option. It works like a regular HMO, but with limited permission to go out of network for certain services — usually at a higher cost to you. The county has 21 HMO-POS plans, from Alignment Health Plan, Blue Cross and Blue Shield of North Carolina, Centene (WellCare), Humana and UnitedHealthcare.

Think of HMO-POS as a middle ground: mostly in-network, but with some flexibility built in.

PPO plans: more freedom, different rules

A PPO — Preferred Provider Organization — lets you see any Medicare-approved provider who agrees to treat you, both in and out of the plan's network. Out-of-network visits usually cost more, and you generally don't need a referral for a specialist.

PPOs are the largest group in the county, with 39 plans. Every carrier except Liberty Medicare Advantage, Longevity Health Plan, Provider Partners Health Plans and PruittHealth Premier offers at least one. You'll see both local PPOs and regional PPOs on the list from Humana; both work the same way from the member's point of view.

PFFS plans: the least common type

PFFS — Private Fee-for-Service — is a plan type that pays providers a set fee for each service. You can see any provider who accepts the plan's terms, though not every provider will. There is 1 PFFS plan in Forsyth County, from Humana. PFFS plans have become less common across the country over the years, but they still exist as an option in some markets.

Special Needs Plans: for specific situations

Special Needs Plans, or SNPs, are Medicare Advantage plans built for people in a particular circumstance. There are three kinds:

• D-SNP (Dual Eligible): For people who have both Medicare and Medicaid.
• C-SNP (Chronic Condition): For people with a qualifying long-term condition, such as diabetes or certain heart conditions.
• I-SNP (Institutional): For people who live in a nursing home or need a similar level of care.

You have to qualify to enroll in an SNP, and the plan's benefits and drug list are tailored to that group. Forsyth County has 39 SNPs in total across the D-SNP, C-SNP and I-SNP categories. Every carrier in the county offers at least one SNP, though the mix varies — some carriers offer only SNPs, while others offer a small number alongside their general plans.

Drug coverage and 2027 program facts

All 99 Medicare Advantage plans in the county include Part D prescription drug coverage. That matters, because there are no stand-alone Part D plans listed in the area's Medicare Advantage roster — drug coverage is bundled in.

A few program-level Part D facts to keep in mind for 2026:

• The maximum Part D deductible is $615.
• Out-of-pocket drug costs are capped at $2,100 for the year.
• The old "donut hole" coverage gap has been eliminated as of 2025; Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly installments instead of paying big amounts at the pharmacy counter.
• IRMAA surcharges — extra premium amounts based on income — start above $109,000 for a single filer in 2026.

When you can change plans

Two windows matter most:

• Annual Enrollment Period: October 15 through December 7. This is when anyone with Medicare can join, switch or drop a Medicare Advantage or Part D plan for the coming year.
• Medicare Advantage Open Enrollment: January 1 through March 31. If you're already in a Medicare Advantage plan, you can switch to a different one or return to Original Medicare (and pick up a stand-alone Part D plan if needed).

Outside those windows, you generally need a Special Enrollment Period — for example, if you move or lose other coverage.