Medicare Advantage

Before you pick a Philadelphia Medicare Advantage plan for 2027, know how HMO, HMO-POS, PPO and PFFS 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.

PHILADELPHIA — As the Annual Enrollment Period opens Oct. 15, 2026, Philadelphians sorting through Medicare Advantage options for 2027 will notice the choices fall into a few buckets with very different rules: HMO, HMO-POS, PPO and PFFS. Those letters are not marketing jargon. They decide whether you need a referral to see a specialist, whether out-of-network care is covered, and how much flexibility you have when you travel.

Philadelphia is in Philadelphia County, where the Centers for Medicare & Medicaid Services (CMS) counts 98 Medicare Advantage plans from 17 carriers for 2027. By type, that breaks down to 47 HMO plans, 17 HMO-POS plans and 34 PPO plans. (If you add HMO and HMO-POS together, 64 of next year's plans sit on the HMO side of the family.) No carrier in the county is offering a Private Fee-for-Service, or PFFS, plan for 2027.

What the plan type actually controls

Every Medicare Advantage plan has to cover what Original Medicare covers. The plan type controls how you use that coverage.

• HMO (Health Maintenance Organization): You generally pick a primary care doctor, stay inside the plan's network for routine care, and often need a referral to see a specialist. Out-of-network care usually isn't covered except for emergencies and urgent care.
• HMO-POS (Point of Service): An HMO with a limited "point of service" door — a specific list of services you can get out-of-network, typically at a higher cost share. The specifics vary by plan.
• PPO (Preferred Provider Organization): You can see any Medicare-approved provider who agrees to treat you, in or out of network. In-network costs are lower; out-of-network is covered but you pay more. Referrals are usually not required.
• PFFS (Private Fee-for-Service): The plan sets the terms, and any Medicare provider who agrees to those terms can treat you. No PFFS plans are on the Philadelphia County menu for 2027.

None of this makes one type "better." The right type depends on which doctors and hospitals you want to use, how often you travel, and whether you prefer the structure of a network or the flexibility of going outside one.

How Philadelphia County's 2027 lineup splits by carrier

The table below lists every Medicare Advantage plan offered in Philadelphia County for 2027. Here is the shorter version — which carriers offer which plan types next year.

Carriers offering HMO plans for 2027: Aetna (CVS Health), Devoted Health, Geisinger Gold, HealthSpring, 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 for 2027: Aetna (CVS Health), Centene (WellCare), Independence Blue Cross, and UnitedHealthcare.

Carriers offering PPO plans for 2027: Aetna (CVS Health), Clover Health, Devoted Health, HealthSpring, Highmark Blue Cross Blue Shield or Highmark Blue Shield, Humana, Independence Blue Cross, Jefferson Health Plans, UnitedHealthcare, and UPMC for Life.

A few carriers appear in more than one column because they offer plans of more than one type. That's useful to know if you like a particular insurer's brand but want to compare, say, their HMO against their PPO.

Questions to ask before you pick a type

Plan type is one of the few Medicare Advantage decisions that is hard to reverse mid-year, so it is worth thinking through:

• Are my doctors in network? Call each one. Networks can change between years, and a plan's online directory should be checked for 2027.
• Do I want to need a referral? Some people like the coordination; others find it a hassle.
• How often do I travel? Snowbirds and frequent visitors to family out of state often weigh PPO flexibility more heavily.
• How do I feel about surprises? With an HMO, the rules are clear but strict. With a PPO, you have more room to roam, but out-of-network cost shares are higher.
• Does the plan include Part D drug coverage I need? Every Medicare Advantage plan in Philadelphia County for 2027 includes prescription drug coverage, but formularies differ.

What's changing for 2027 in Philadelphia County

Twelve plans in the county are not returning for 2027, 13 are brand new, and 9 are being renamed. If one of these affects you, your plan will say so in the Annual Notice of Change (ANOC) you receive this fall. Read it — the ANOC spells out the specific changes to your plan for next year.

Nationwide, a few program-level numbers are already set for 2027:

• Part D out-of-pocket cap: $2,400 in 2027 (up from $2,100 in 2026).
• Part D maximum deductible: $700 in 2027 (up from $615 in 2026).
• Part D national base beneficiary premium: $41.33 for 2027 (this is a formula input, not the premium any particular plan charges).

CMS has not yet announced the 2027 Part B standard premium and deductible, or the 2027 IRMAA income brackets. Those are usually published in the fall, often in November.

If you do nothing

Nothing dramatic happens. If your current plan is offered in 2027, you'll stay in it automatically, with whatever changes the ANOC describes. The Annual Enrollment Period, Oct. 15 to Dec. 7, 2026, is simply your window to make a change if you want one. Medicare Advantage members also get a second window — the Medicare Advantage Open Enrollment Period, Jan. 1 to March 31, 2027 — to switch to a different Medicare Advantage plan or go back to Original Medicare.