Medicare Advantage

HMO or PPO? South Carolina Medicare Advantage for 2027: 37 HMO Plans, 59 PPO

COLUMBIA, S.C. — South Carolinians sorting through Medicare Advantage choices for 2027 will see the market tilt toward PPO-style plans. According to the CMS Medicare Advantage Landscape Source File for CY2027, 97 Medicare Advantage plans are offered statewide from 12 carriers. Of those, 59 are PPOs, 37 are HMOs (counting 30 HMO plans and 7 HMO-POS plans), and 1 is a PFFS plan. Availability is county by county, so a plan listed statewide may or may not appear on your doorstep.

HMO or PPO for 2027South Carolina

The deadline on the calendar is December 7, 2026: that is the last day of the Annual Enrollment Period that runs October 15 – December 7, 2026, and a choice made in that window takes effect January 1, 2027.

How many Medicare Advantage plans are offered in South Carolina for 2027, and how do they split by type?

South Carolina has 97 Medicare Advantage plans for 2027 from 12 carriers, split into 30 HMO, 7 HMO-POS, 59 PPO and 1 PFFS plan, per the CMS MA Landscape Source File for CY2027. Grouping HMO and HMO-POS together, 37 plans use an HMO structure and 59 use a PPO structure.

These are statewide totals. A plan appears on your Medicare Plan Finder results only if the carrier files it in your specific county, so a Charleston resident and a Greenville resident can see very different menus even though the state-level count is the same.

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

In plain English: HMOs usually ask you to use in-network providers and may require a referral to see a specialist; PPOs let you go out of network, usually at a higher cost share; HMO-POS adds a limited "point-of-service" option to an HMO; and PFFS plans let you see any Medicare-approved provider who agrees to the plan's terms.

• HMO (Health Maintenance Organization): care is coordinated through in-network doctors and hospitals; out-of-network care is generally not covered except in emergencies. Some HMOs require a referral to see specialists.
• HMO-POS (Point of Service): an HMO with a defined out-of-network option for certain services. The "POS" piece varies by plan.
• PPO (Preferred Provider Organization): you can see out-of-network providers who accept Medicare and the plan's terms, typically at a higher out-of-pocket cost. Referrals are usually not required.
• PFFS (Private Fee-for-Service): you can see any Medicare-approved provider willing to accept the plan's payment terms at the time of service.

The specific rules, cost shares and provider lists live in each plan's Evidence of Coverage and provider directory — not in the statewide count.

Which South Carolina carriers offer HMO, HMO-POS, PPO and PFFS plans for 2027?

For 2027, the carriers filing each type in South Carolina are listed in the plan-type tables on this page. In summary:

• HMO carriers: Aetna (CVS Health), Centene (WellCare), Devoted Health, First Choice VIP Care (HMO D-SNP), HealthSpring, Humana, Molina Healthcare of South Carolina, NHC Advantage, and PruittHealth Premier.
• HMO-POS carriers: Centene (WellCare) and UnitedHealthcare.
• PPO carriers: Aetna (CVS Health), Blue Cross Blue Shield of South Carolina, Centene (WellCare), Clover Health, Devoted Health, HealthSpring, Humana, and UnitedHealthcare.
• PFFS carrier: Humana.

A few carriers appear across multiple structures. Aetna (CVS Health), Centene (WellCare), Devoted Health, HealthSpring and Humana each file both HMO and PPO plans statewide for 2027, which means the HMO-vs-PPO question is not always a change of carrier — sometimes it is a change of product within the same carrier's lineup.

How should a South Carolinian decide which Medicare Advantage type fits their doctors and travel?

The practical starting point is to list the doctors, hospitals and pharmacies you actually use, then check which 2027 plans include them. Network fit — not plan type — is usually the deciding factor.

A few questions help narrow it:

• Do your current doctors and your preferred hospital participate with the plan for 2027? Networks can change year to year.
• Do you travel often, split time between states, or spend part of the year outside South Carolina? PPO and PFFS structures generally give more flexibility outside the network; HMOs generally do not, outside emergencies.
• Are you comfortable asking a primary-care doctor for a referral before seeing a specialist, if the plan requires it?
• Do you need prescription drug coverage built into the plan, and is each of your medications on that plan's formulary?

Those answers point toward a plan type. The Medicare Plan Finder at medicare.gov lets you enter your ZIP code, your doctors and your drugs to see which specific plans — HMO, HMO-POS, PPO or PFFS — are offered where you live and what each one costs.

What should South Carolina Medicare beneficiaries do before December 7, 2026?

Before December 7, 2026, review your current plan's Annual Notice of Change (ANOC), compare it with the 2027 options for your county on medicare.gov, and make any switch you want effective January 1, 2027. That is the function of the Annual Enrollment Period, which runs October 15 – December 7, 2026.

A simple checklist:

1. Read the ANOC your current plan mailed in September 2026 for changes to premiums, cost sharing, drug list and network. 2. Enter your ZIP code, doctors, hospitals and prescriptions into the Plan Finder at medicare.gov. 3. Confirm directly with each doctor's office and pharmacy that they will be in the 2027 network of any plan you are considering. 4. If you decide to change, enroll by December 7, 2026 for a January 1, 2027 effective date.

Doing nothing is also a choice: if your plan still exists in 2027 and you take no action, you generally stay in it with its 2027 terms.

Where can South Carolinians get free help comparing 2027 Medicare Advantage plans?

Free, official help is available year-round from Medicare itself. Call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, seven days a week, or use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code.

These channels give you plan-specific premiums, cost sharing, drug lists, network details and star ratings for every 2027 Medicare Advantage plan offered in your South Carolina county — the specifics this explainer, by design, does not.