Medicare Advantage

HMO or PPO? Rhode Island Medicare Advantage for 2027: 16 HMO Plans, 6 PPO

PROVIDENCE — For the 2027 plan year, Rhode Islanders shopping Medicare Advantage will see a lineup that leans heavily toward HMO-style designs, with a smaller slate of PPO options. According to the CMS Medicare Advantage Landscape Source File for CY2027, four carriers are offering 22 plans across the state, and the split between network types is one of the first things a shopper should understand before comparing anything else.

How many HMO and PPO Medicare Advantage plans are offered in Rhode Island for 2027?

Rhode Island has 22 Medicare Advantage plans for 2027, divided into 4 HMO plans, 12 HMO-POS plans, and 6 PPO plans. Counting HMO and HMO-POS together as the HMO family, that's 16 HMO-family plans and 6 PPO plans across the state.

Those counts come from the CMS MA Landscape Source File for CY2027 and reflect each plan contract listed once at the state level. Because Medicare Advantage is sold county by county, the plans available in Providence County may not match those in Washington, Kent, Newport or Bristol County. The statewide total tells you how the market is shaped; the Plan Finder at medicare.gov tells you what's actually on the shelf at your ZIP code.

What do HMO, HMO-POS, PPO and PFFS mean for networks, referrals and out-of-network care?

In plain terms: an HMO expects you to use its contracted network and often requires a primary care doctor and referrals to specialists; an HMO-POS (point-of-service) is an HMO with a limited door to certain out-of-network services; a PPO lets you see out-of-network providers who accept the plan, usually at a higher cost share; and a PFFS (private fee-for-service) pays any provider willing to accept the plan's terms. Rhode Island's 2027 landscape includes HMO, HMO-POS and PPO plans; no PFFS plans appear in the statewide block.

Why it matters: if you have a specialist you want to keep, or you spend part of the year outside Rhode Island, the plan type shapes whether that care is covered and at what level. Emergency and urgent care are covered nationwide under Medicare Advantage rules regardless of plan type, but routine out-of-network care is treated very differently depending on whether a plan is HMO, HMO-POS or PPO.

Which Rhode Island carriers offer HMO, HMO-POS and PPO plans for 2027?

For 2027, HMO plans in Rhode Island are offered by Blue Cross & Blue Shield of Rhode Island and Neighborhood Health Plan of Rhode Island. HMO-POS plans are offered by Aetna (CVS Health), Blue Cross & Blue Shield of Rhode Island, and UnitedHealthcare. PPO plans are offered by Aetna (CVS Health) and UnitedHealthcare.

The full plan-by-plan list — with each plan name and the counties where it's sold — appears in the tables elsewhere on this page. Rather than restate every plan here, use those tables to see which specific plans from each carrier fall into HMO, HMO-POS or PPO. Not every carrier offers every type, and not every plan is sold in every county.

How do I decide which Medicare Advantage plan type fits my doctors and travel in Rhode Island?

Start with two questions: Which doctors and hospitals do I use, and how often am I away from Rhode Island? If your providers are all in-state and in one carrier's network, an HMO or HMO-POS may fit comfortably. If you split time between Rhode Island and another state, or regularly see providers outside a single network, a PPO's out-of-network coverage may matter more.

A practical sequence for 2027 shopping: 1. List your doctors, hospitals, and regular prescriptions. 2. Enter your ZIP code and drug list into the Medicare Plan Finder at medicare.gov to see which plans are actually sold in your county. 3. For each plan you're considering, check the plan's own provider directory and Evidence of Coverage — not a summary — to confirm your doctors are in-network and your drugs are on the formulary. 4. Call the plan or 1-800-MEDICARE with questions before you enroll.

This brief doesn't compare premiums, copays, benefits or star ratings for any Rhode Island plan or carrier; those details change and belong to the official plan documents and the Plan Finder.

What should Rhode Island Medicare shoppers do before December 7, 2026?

Before December 7, 2026, review your current coverage against the 2027 options for your county and make any change you want to take effect January 1, 2027. The Annual Enrollment Period for the 2027 plan year runs October 15 – December 7, 2026.

Each fall, your current plan sends an Annual Notice of Change (ANOC) explaining what will differ in 2027. Read it alongside the Plan Finder results. If nothing in your situation has changed and the ANOC looks fine, you don't need to do anything — your plan continues. If your doctor leaves the network, your drug list changes, or your travel pattern shifts, Annual Enrollment is the window to adjust.

Where can Rhode Islanders get free help comparing 2027 Medicare Advantage plans?

Two free resources are available to every Rhode Islander with Medicare: the Medicare Plan Finder at medicare.gov, and 1-800-MEDICARE (TTY 1-877-486-2048), which is staffed 24 hours a day, seven days a week. Both are run by the federal Medicare program and can walk you through the plans available in your specific county for 2027.

You can also contact a plan directly for its Evidence of Coverage, Summary of Benefits, and provider and pharmacy directories. Those documents are the authoritative source for what a plan actually covers.