Medicare Advantage

Before you pick a Medicare Advantage plan in Philadelphia: how HMO, PPO, PFFS and SNP options differ

People in Philadelphia can choose from 98 Medicare Advantage plans for 2027, against 97 this year. Twelve of this year’s plans are gone, 13 are new to Philadelphia County, and 39 that continue have changed their premium, deductible, plan type or name, 9 of them under a new name.

Medicare AdvantagePhiladelphia, PA

If you live in Philadelphia and are shopping for a Medicare Advantage plan, the first choice isn't really which carrier — it's which kind of plan fits how you get care. HMO, HMO-POS, PPO, PFFS and Special Needs Plans all sit under the Medicare Advantage umbrella, but they handle networks, referrals and eligibility in different ways. Sorting that out early makes the rest of the search a lot simpler.

What Medicare Advantage looks like in Philadelphia County

Plan availability in Medicare is set county by county, and Philadelphia is in Philadelphia County. For 2027, CMS lists 89 Medicare Advantage plans available there from 17 carriers, and every one of them includes Part D drug coverage. That's the pool a Philadelphia resident is actually choosing from. Compared with 2026, 76 plans continue, 13 are new, 12 are not returning and 9 have been renamed; 30 continuing plans change something in their terms, and the details are in each plan's ANOC.

The carriers offering MA-PD plans in the county include Aetna (CVS Health), Blue Cross Blue Shield (HCSC), Centene (WellCare), Clover Health, 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, UnitedHealthcare, UPMC for Life, UPMC for Life Complete Care and VISTA Health Plan Inc. The table below lists every plan by carrier so you can see the full lineup in one place.

HMO and HMO-POS: network-first plans

Health Maintenance Organization (HMO) plans expect you to use doctors, hospitals and other providers in the plan's network, except for emergencies. Most HMOs ask you to pick a primary care doctor and get referrals to see specialists. If you go outside the network for routine care, the plan generally won't pay.

HMO-POS ("point of service") plans work the same way but add a limited option to see certain providers out of network, usually at a higher cost share. In Philadelphia County, 42 of the 97 plans are HMOs and 18 are HMO-POS. Carriers with HMO or HMO-POS plans in the county include Aetna, Blue Cross Blue Shield (HCSC), Centene (WellCare), Devoted Health, Geisinger Gold, Highmark Wholecare Medicare Assured, Humana, Independence Blue Cross, Jefferson Health Plans, Perennial Advantage, Provider Partners Health Plans, UnitedHealthcare, UPMC for Life Complete Care and VISTA Health Plan Inc.

PPO: more flexibility, different rules

Preferred Provider Organization (PPO) plans let you see any Medicare-approved provider, in network or out, without a referral. In-network care costs less; out-of-network care costs more. That flexibility is often the draw for people who travel, split time between homes, or have specialists outside a single system.

Carriers offering PPOs in Philadelphia County include Aetna, Blue Cross Blue Shield (HCSC), Clover Health, Devoted Health, Highmark Blue Cross Blue Shield or Highmark Blue Shield, Humana, Independence Blue Cross, Jefferson Health Plans, UnitedHealthcare and UPMC for Life. Some PPOs are "local" (built around a county or set of counties) and some are "regional" (covering a broader multi-county area). The table shows each one.

PFFS: the least common option here

A Private Fee-for-Service (PFFS) plan sets its own payment terms with providers and doesn't require a network in the traditional HMO/PPO sense. Any Medicare-approved provider can choose whether to accept the plan's terms on a visit-by-visit basis, so it's worth confirming acceptance in advance.

PFFS plans are the smallest slice of the Philadelphia County market: just 1 of the 97 plans is a PFFS, and it's offered by Humana.

Special Needs Plans: only for people who qualify

Special Needs Plans (SNPs) are Medicare Advantage plans built for a specific group of people. There are three types:

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

You can only enroll in an SNP if you meet its eligibility rules, and you generally have to keep meeting them to stay on the plan. Of the 97 Philadelphia County plans, 31 are Special Needs Plans. Carriers offering SNPs in the county include Aetna, Blue Cross Blue Shield (HCSC), Centene (WellCare), Devoted Health, Geisinger Gold, Highmark Wholecare Medicare Assured, Humana, Jefferson Health Plans, Perennial Advantage, Provider Partners Health Plans, UnitedHealthcare, UPMC for Life Complete Care and VISTA Health Plan Inc.

Program-level facts to keep in mind for 2027

Whichever plan type you pick, some Medicare rules apply across the board:

• All 97 Philadelphia County MA plans include Part D drug coverage. No stand-alone Part D plans are listed for the area, which matters if you were considering keeping Original Medicare and adding a drug plan.
• Part D has a $2,100 out-of-pocket cap for 2026, and the maximum Part D deductible is $615.
• The coverage gap (the old "donut hole") was eliminated in 2025, so Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread your yearly drug costs into monthly payments if that helps with cash flow.
• IRMAA surcharges on Part B and Part D start above $109,000 in income for a single filer in 2026.
• The Annual Enrollment Period is Oct. 15 – Dec. 7. If you're already in a Medicare Advantage plan, the MA Open Enrollment Period (Jan. 1 – March 31) gives you one more chance to switch.