Medicare Advantage

Before you pick a Cincinnati Medicare Advantage plan for 2027, here is how HMOs, PPOs and PFFS actually differ

For 2027, Cincinnati is looking at 82 Medicare Advantage plans: 16 new, 30 gone since 2026, and 26 still here but changed on premium, deductible, plan type or name, 5 of them under a new name. Below, how the lineup shifted in Hamilton County and what to compare, with no plan ranked or recommended.

CINCINNATI — As Medicare's Annual Enrollment Period opens Oct. 15, 2026, shoppers in Hamilton County will see a lineup for 2027 that still leans on two familiar labels: HMO and PPO. The split matters more than most people realize, because those letters decide which doctors you can see, whether you need a referral, and what happens if you get sick while visiting family out of state.

For plan year 2027, Hamilton County — the county Cincinnati is in — has 82 Medicare Advantage plans from 14 carriers, according to the CMS Medicare Advantage Landscape Source File. Of those, 37 are HMOs, 14 are HMO-POS plans, and 31 are PPOs. The one Private Fee-for-Service (PFFS) plan that was offered for 2026 is not on the 2027 list.

How are Cincinnati's Medicare Advantage plans split by type for 2027?

In Hamilton County for 2027, the 82 Medicare Advantage plans break down into 37 HMOs, 14 HMO-POS plans and 31 PPOs. Counting HMO and HMO-POS together, 51 of the 82 plans use an HMO-style framework, and 31 use a PPO framework.

That is a shift from 2026, when the county had 96 plans split 40 HMO, 18 HMO-POS, 37 PPO and 1 PFFS. The table below lists every plan available for the upcoming year, with its type and whether it includes drug coverage.

What does HMO mean for your doctors and referrals?

An HMO — Health Maintenance Organization — asks you to pick a primary care doctor inside the plan's network and, in most cases, get a referral before you see a specialist. Care outside the network is generally not covered except for emergencies, urgent care, and out-of-area dialysis.

For 2027, carriers offering HMO plans in Hamilton County include Aetna (CVS Health), CareSource MyCare Ohio (HMO D-SNP), Centene (WellCare), Communicare Advantage, Devoted Health, Elevance Health (Anthem), HealthSpring, Humana, Medical Mutual of Ohio, MediGold, Molina Healthcare of Ohio, Perennial Advantage and Valor Health Plan. Before you enroll, confirm your doctors and hospitals are in that plan's network for 2027 by checking the plan's directory or the Medicare Plan Finder at medicare.gov.

What is an HMO-POS plan, and how is it different?

HMO-POS stands for HMO with a Point-of-Service option. It works like an HMO — network, primary care doctor, usually referrals — but adds a limited ability to use out-of-network providers for certain services, usually at a higher share of the cost.

In Hamilton County for 2027, HMO-POS plans are offered by Aetna (CVS Health), Elevance Health (Anthem), Humana, Perennial Advantage and UnitedHealthcare. The specifics of what the point-of-service feature covers vary by plan, so the Evidence of Coverage is where to look.

What does PPO mean for out-of-network care in Cincinnati?

A PPO — Preferred Provider Organization — lets you see any Medicare-approved provider who agrees to treat you, in or out of the plan's network, usually without a referral. In-network care costs less; out-of-network care is covered but typically costs more.

For 2027, carriers offering PPO plans in Hamilton County are Aetna (CVS Health), Devoted Health, Elevance Health (Anthem), HealthSpring, Humana, Medical Mutual of Ohio and UnitedHealthcare. PPOs often appeal to people who travel, split time between states, or want the freedom to see a specialist without a referral — but "covered" out of network is not the same as "cheap," so it is worth checking the plan's cost-sharing before you decide.

What happened to PFFS plans in Hamilton County for 2027?

PFFS — Private Fee-for-Service — plans do not appear in the 2027 Hamilton County lineup. For 2026, there was one PFFS plan available in the county; for 2027, there are zero.

PFFS plans let members see any Medicare provider willing to accept the plan's payment terms, with no network in the HMO/PPO sense. Nationally they have grown rare, and that is reflected locally this year.

Which type is right for someone in Cincinnati?

There is no single answer — the right type depends on which doctors and hospitals you use, whether you travel, and how you feel about referrals. CMS rules keep all Medicare Advantage plans covering the same Part A and Part B services, but the way you get to that care is what the HMO/HMO-POS/PPO/PFFS label describes.

A practical way to narrow things down: list your doctors, your regular prescriptions, and the places you spend time during the year. Then run that list through the Medicare Plan Finder at medicare.gov, which checks each plan's network and drug list against your specifics. For questions you'd rather ask a person, call 1-800-MEDICARE (TTY 1-877-486-2048), available 24 hours a day, seven days a week.

What should Cincinnati readers remember about the 2027 enrollment window?

The Annual Enrollment Period runs Oct. 15 through Dec. 7, 2026, and any change you make takes effect Jan. 1, 2027. If you do nothing, your current plan renews — assuming it's offered next year — with the changes described in its Annual Notice of Change, which plans mail out in the fall.

A few program-level figures to keep in mind as you compare: for 2027, the Part D out-of-pocket cap rises to $2,400 (up from $2,100 in 2026), and the Part D maximum deductible is $700 (up from $615 in 2026). The 2027 Part B standard premium and the 2027 IRMAA income brackets have not been announced yet; CMS typically publishes those later in the fall.