Medicare Advantage

Winston-Salem Medicare Advantage for 2027: how HMO, HMO-POS, PPO and PFFS compare before you choose

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.

Winston-Salem, N.C. — Fall 2026. If you live in or near Winston-Salem and plan to look at a Medicare Advantage plan for 2027, one of the first forks in the road is the plan type on the front of the brochure: HMO, HMO-POS, PPO or PFFS. In Forsyth County, the county Winston-Salem sits in, the 2027 lineup leans heavily toward HMO and PPO, with a smaller number of HMO-POS plans and a single PFFS plan. The type you choose shapes which doctors you can see, whether you need a referral, and what happens if you get care outside the plan's network.

How do the Medicare Advantage plans in Winston-Salem split by type for 2027?

For plan year 2027, Forsyth County has 97 Medicare Advantage plans from 13 carriers. By type, that is 38 HMO plans, 22 HMO-POS plans, 36 PPO plans and 1 PFFS plan. If you group HMO and HMO-POS together, 60 of the 97 plans use some form of HMO structure.

Those counts come from the CMS Medicare Advantage Landscape Source File for 2027. The table below lists every plan offered in the county, with its type and whether it includes drug coverage, so you can see which plans are HMO, HMO-POS, PPO or PFFS at a glance.

What is the difference between HMO, HMO-POS, PPO and PFFS?

Each plan type is a different set of rules for networks, referrals and out-of-network care. Here is how Medicare describes them at the program level:

• HMO (Health Maintenance Organization): You generally must use doctors, hospitals and other providers in the plan's network, except for emergency care, urgent care and out-of-area dialysis. Many HMOs ask you to pick a primary care doctor and get a referral before you see a specialist.
• HMO-POS (HMO with a Point-of-Service option): Works like an HMO, but adds a limited ability to go out of network for certain services, usually at a higher cost share. The specifics vary plan by plan.
• PPO (Preferred Provider Organization): You can see any provider who takes Medicare, in or out of network. In-network care costs less, out-of-network care costs more, and referrals are usually not required.
• PFFS (Private Fee-for-Service): You can see any Medicare provider who agrees to the plan's payment terms and conditions each time you get care. Some PFFS plans also have networks.

None of these is automatically cheaper or better. The right fit depends on where your doctors are, how often you travel, and how comfortable you are with network and referral rules.

Which Winston-Salem carriers offer each plan type in 2027?

In Forsyth County for 2027, these are the carriers CMS lists under each type:

• HMO: Aetna (CVS Health), Alignment Health Plan, Blue Cross and Blue Shield of North Carolina, Devoted Health, HealthSpring, HealthTeam Advantage, Humana, Liberty Medicare Advantage, Longevity Health Plan, Provider Partners Health Plans, and PruittHealth Premier.
• HMO-POS: Alignment Health Plan, Blue Cross and Blue Shield of North Carolina, Centene (WellCare), Humana, and UnitedHealthcare.
• PPO: Aetna (CVS Health), Alignment Health Plan, Blue Cross and Blue Shield of North Carolina, Centene (WellCare), Devoted Health, HealthSpring, HealthTeam Advantage, Humana, and UnitedHealthcare.
• PFFS: Humana.

Several carriers show up under more than one type, so if you like a particular company, check whether they offer the plan structure that matches how you want to get care. For plan-level details — the doctor network, drug list, monthly premium, copays and star rating — use the Medicare Plan Finder at medicare.gov or call 1-800-MEDICARE.

What's changing in Forsyth County's 2027 lineup?

Compared with 2026, Forsyth County goes from 99 Medicare Advantage plans to 97 for 2027. Behind that near-flat total is more movement than it looks: CMS data shows 15 plans not returning, 13 new plans and 16 renamed plans. The mix by type shifts a little too — HMO-POS edges up and PPO edges down from the 2026 counts.

If you already have a plan, you do not need to do anything to keep it when it renews. The specific changes to your plan — premium, drug list, provider network, copays, extra benefits — are spelled out in the Annual Notice of Change (ANOC) the plan mails each fall. Read that notice next to any new plan you are considering before you switch.

How should Winston-Salem readers decide between an HMO and a PPO for 2027?

Start with the people and places you already use, not the plan brochure. A few questions that usually sort it out:

• Who are your doctors, and which hospital system do you prefer? Check whether they are in-network for the plans you are weighing. If staying with them matters most, a plan whose network includes them is the shortest path.
• How often do you travel or spend time out of state? PPO and PFFS plans tend to be friendlier to out-of-network care; HMO plans generally are not, except for emergencies and urgent care.
• Do referrals bother you? If you want to see specialists directly, note which plans require a referral and which do not.
• Do you take prescriptions? 2027 has a $2,400 Part D out-of-pocket cap and a maximum Part D deductible of $700, but the formulary, tier placement and pharmacy network still vary by plan.

Once you have narrowed by type, compare the specific plans in Medicare's Plan Finder, where premiums, copays, drug costs and star ratings are shown side by side.

When do I need to make a change for 2027 coverage?

The Annual Enrollment Period runs October 15 through December 7, 2026. A plan you pick in that window starts January 1, 2027. If you do nothing, your current Medicare Advantage or Part D plan renews under the terms described in its ANOC — assuming it is being offered again in Forsyth County next year.

There is also the Medicare Advantage Open Enrollment Period from January 1 through March 31, 2027. During that window, if you are already in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or go back to Original Medicare (and add a stand-alone Part D plan). CMS announces the 2027 Part B standard premium, Part B deductible and IRMAA income brackets later in the fall, usually in November.