Medicare Advantage

HMO, PPO, or Special Needs Plan? How Cleveland's Medicare Advantage market is built

People in Cleveland can choose from 99 Medicare Advantage plans for 2027, against 112 this year. 31 of this year’s plans are gone, 18 are new to Cuyahoga County, and 37 that continue have changed their premium, deductible, plan type or name, 6 of them under a new name.

Medicare AdvantageCleveland, OH

Cleveland shoppers opening the 2027 Medicare Advantage window will see a lineup organized around a handful of plan types — HMO, HMO-POS, PPO, and Special Needs Plans — offered by 16 carriers across Cuyahoga County. Understanding how those plan types differ is often more useful than counting the plans themselves, because the type shapes how you use the coverage day to day.

The Cleveland lineup at a glance

Cleveland sits in Cuyahoga County, and Medicare Advantage availability is set at the county level. For 2027, CMS lists 93 Medicare Advantage plans from 16 carriers in the county, and every one of them includes Part D drug coverage. The full plan-by-carrier list appears in the table below on this page.

Alphabetically, the carriers offering MA-PD plans in the county are Aetna (CVS Health), Blue Cross Blue Shield (HCSC), CareSource MyCare Ohio, Centene (WellCare), Communicare Advantage, Devoted Health, Elevance Health (Anthem), Humana, Medical Mutual of Ohio, Molina Healthcare of Ohio, Perennial Advantage, SummaCare Medicare Advantage Plans, The Health Plan, UnitedHealthcare, Valor Health Plan, and Zing Health.

The county's 93 plans for 2027 come from carriers offering anywhere from a single plan up to larger slates. The lineup is a mix of HMOs, HMO-POS plans, and PPOs. No local carrier offers a Private Fee-for-Service (PFFS) plan for 2027, though PFFS is still part of the national Medicare Advantage program, which is why we explain it below.

HMO plans: a network, a primary care doctor, and referrals

An HMO — Health Maintenance Organization — is built around an in-network group of doctors and hospitals. You typically pick a primary care physician, and that doctor coordinates referrals to specialists. Care outside the network is generally not covered except in an emergency.

If your doctors are already inside the plan's network, an HMO can be straightforward. If you travel often, or you split your year between Ohio and another state, the network rules deserve a careful look. HMO remains the most common type in Cuyahoga County's 2027 lineup.

HMO-POS: an HMO with a limited out-of-network door

HMO-POS stands for "HMO with a point-of-service option." It works like an HMO, but the plan lets you go out of network for certain services, usually at a higher cost share. The exact services and cost-sharing rules vary plan to plan, so read the plan's Summary of Benefits before you assume a service is covered outside the network.

PPO plans: more flexibility, different tradeoffs

A PPO — Preferred Provider Organization — lets you see any provider that accepts Medicare and the plan's terms, without a referral. You'll pay less when you stay in network. PPOs generally have broader access than HMOs but may have different premiums, deductibles or copays; those specifics belong on each plan's own Summary of Benefits, not in a comparison article like this one.

PFFS: the fourth type you may hear about

Private Fee-for-Service plans work differently: any Medicare-approved provider who agrees to the plan's payment terms can treat you, visit by visit. PFFS plans exist elsewhere in the country but are not part of the Cuyahoga County 2027 lineup, based on the CMS Landscape file. We mention them so the four-way choice you may read about elsewhere makes sense.

Special Needs Plans (SNPs): only for people who qualify

Of the 112 plans in the county, 39 are Special Needs Plans. SNPs are restricted to people who meet specific eligibility rules, and they come in three flavors:

• D-SNPs (Dual Eligible) are for people who have both Medicare and Medicaid.
• C-SNPs (Chronic Condition) are for people with certain qualifying chronic conditions, such as diabetes, cardiovascular disorders or end-stage renal disease. Each C-SNP names the conditions it covers.
• I-SNPs (Institutional) are for people who live in, or need the level of care provided in, a nursing home or similar facility.

If you don't meet the eligibility rules, you can't enroll in an SNP — even if you like the way it's designed. If you do qualify, an SNP may be worth comparing against standard HMO or PPO options because SNPs are built around the specific population they serve.

How to narrow the field without getting overwhelmed

A useful order of operations:

1. Start with eligibility. If you have Medicaid, or a qualifying chronic condition, or you live in a long-term care setting, you have SNP options most people don't. 2. Check your doctors and hospitals. Ask each carrier — or use the plan's provider search — to confirm your providers are in-network for the specific plan you're considering. Networks can differ between two plans from the same carrier. 3. Check your prescriptions. All 93 plans in the county for 2027 include drug coverage, but formularies differ. The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027; the Part D maximum deductible is $615 in 2026 and $700 in 2027. The coverage gap is gone — replaced by a three-phase design that took effect in 2025. The optional Medicare Prescription Payment Plan lets you spread drug costs across the year. 4. Then compare plan type and cost sharing. HMO, HMO-POS, or PPO — pick the structure that fits how you actually use care.

Star Ratings are one more tool. CMS publishes them each year to help beneficiaries compare quality and service; you can look them up on Medicare's Plan Finder.

Key dates for 2027 coverage

The Annual Enrollment Period runs Oct. 15 through Dec. 7. Choices made during that window take effect Jan. 1. If you're already in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period (Jan. 1 – March 31) gives you one chance to switch to another Medicare Advantage plan or return to Original Medicare. High-income beneficiaries should note that IRMAA surcharges on Part B and Part D premiums begin above $109,000 in income for a single filer in 2026.