Medicare Advantage

HMO or PPO? Pennsylvania Medicare Advantage for 2027: 200 HMO Plans, 137 PPO

HARRISBURG, Pa. — Pennsylvania's 2027 Medicare Advantage shelf splits almost evenly between two familiar shapes: HMOs that lean on an in-network core, and PPOs that leave room to roam. According to the CMS Medicare Advantage Landscape Source File for CY2027, Pennsylvanians will see 338 Medicare Advantage plans from 20 carriers statewide, with 200 built on an HMO chassis (158 HMO plus 42 HMO-POS), 137 structured as PPOs, and 1 PFFS plan. Not every plan listed statewide is sold in every county; availability is county by county, so the choices on your street will be a subset.

HMO or PPO for 2027Pennsylvania

The statewide split by type

Across Pennsylvania for plan year 2027, CMS counts 338 Medicare Advantage plans offered by 20 carriers. By type, that breaks down as 158 HMO plans, 42 HMO-POS plans, 137 PPO plans and 1 PFFS plan. Grouping the two HMO variants together brings the HMO family to 200. Those are statewide plan counts, each plan counted once; a plan on the state list may or may not reach your ZIP code.

What HMO, HMO-POS, PPO and PFFS mean

These labels describe how a plan handles doctors, hospitals and referrals — not how good a plan is.

• HMO (Health Maintenance Organization): You generally use the plan's network of doctors and hospitals, and many HMOs ask you to pick a primary care physician and get referrals to see specialists. Out-of-network care is usually not covered except in emergencies.
• HMO-POS (Point of Service): An HMO with a limited "point of service" option that lets you go outside the network for certain services under rules the plan sets.
• PPO (Preferred Provider Organization): A network plan that also covers out-of-network care, usually at a different cost-sharing level, and typically without referrals to see specialists.
• PFFS (Private Fee-for-Service): A plan that pays providers on terms the plan sets; you can see any Medicare-approved provider who agrees to the plan's terms at the time of service.

The specifics — cost sharing, referral rules, prior authorization, which providers are in network — live in each plan's Evidence of Coverage and provider directory, not in a statewide summary.

Which carriers offer each type in 2027

The CMS 2027 landscape shows carrier participation by plan type. The full plan-by-plan breakdown is in the tables elsewhere on this page; here is who is in each lane.

Carriers offering HMO plans in Pennsylvania for 2027 include Aetna (CVS Health), American Health Advantage of Pennsylvania, Blue Cross Blue Shield (HCSC), Capital Blue Cross, Devoted Health, Geisinger Gold, Highmark Blue Cross Blue Shield or Highmark Blue Shield, Highmark Wholecare Medicare Assured, Humana, Independence Blue Cross, Jefferson Health Plans, Perennial Advantage, Provider Partners Health Plans, UPMC for Life, UPMC for Life Complete Care, and VISTA Health Plan Inc.

Carriers offering HMO-POS plans are Aetna (CVS Health), Centene (WellCare), Highmark Blue Cross Blue Shield or Highmark Blue Shield, Independence Blue Cross, and UnitedHealthcare.

Carriers offering PPO plans are Aetna (CVS Health), Blue Cross Blue Shield (HCSC), Capital Blue Cross, Clover Health, Devoted Health, Geisinger Gold, Highmark Blue Cross Blue Shield or Highmark Blue Shield, Humana, Independence Blue Cross, Jefferson Health Plans, Peak Health, UnitedHealthcare, and UPMC for Life.

The PFFS plan is from Humana.

Several carriers appear in more than one lane, which means a given company name does not tell you the plan type by itself — you have to look at the specific plan.

How to decide which type fits your doctors and travel

Start with the people and places that already care for you. Make a short list of your primary care doctor, specialists you see regularly, your preferred hospital, and any pharmacy you use. Then ask three practical questions:

1. Who do I need to keep seeing? If every provider on your list is in a plan's network, an HMO can be a clean fit. If you want flexibility to see someone outside the network — or you cross between health systems — a PPO's out-of-network coverage may matter more. 2. How do I feel about referrals? HMOs often route specialist visits through a primary care physician. PPOs typically do not require that step. Neither approach is better in the abstract; it depends on how you like to use care. 3. Do I travel or split time between counties or states? Snowbirds and frequent travelers often weigh out-of-network rules carefully. HMO-POS and PPO plans handle care away from home differently than a standard HMO.

Confirm networks and rules directly with the plan — provider directories change, and only the plan can tell you whether a specific doctor is in network for a specific plan on a specific date.

What to do before December 7

The Annual Enrollment Period for 2027 coverage runs October 15 through December 7, 2026. A plan you choose during that window takes effect January 1, 2027. A sensible checklist:

• Read the Annual Notice of Change from your current plan, if you have one, so you know what is changing.
• List your doctors, hospitals, prescriptions and pharmacies.
• Use the Medicare Plan Finder at medicare.gov to see which plans are offered in your county and compare them side by side.
• Verify networks and drug coverage with the plan itself before you enroll.

Free help

You can compare every plan available in your county at medicare.gov using the Plan Finder, or call 1-800-MEDICARE (TTY 1-877-486-2048), which is available 24 hours a day, 7 days a week. Both are free and come straight from Medicare.