Medicare Advantage

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

People in Houston can choose from 99 Medicare Advantage plans for 2027, against 114 this year. 37 of this year’s plans are gone, 22 are new to Harris County, and 44 that continue have changed their premium, deductible, plan type or name, 17 of them under a new name.

Medicare AdvantageHouston, TX

When you sit down to compare Medicare Advantage plans in Houston, the first thing that hits you isn't a premium or a benefit — it's an alphabet soup. HMO. PPO. HMO-POS. PFFS. D-SNP. C-SNP. I-SNP. Before any of those letters mean much, it helps to know what each plan type actually is, and which carriers in the Houston area sell which kind.

Houston sits in Harris County, where 15 carriers offer a combined 82 Medicare Advantage plans for 2027, according to the CMS Medicare Advantage Landscape Source File. Every one of those plans includes prescription drug coverage. But they are not all the same shape, and the shape is what determines how you'll see doctors, get referrals, and use your coverage outside the city.

How the four plan types work

HMO (Health Maintenance Organization). You choose a primary care doctor and generally use providers inside the plan's network. Care outside the network usually isn't covered except in an emergency. Many HMOs require a referral before you see a specialist. In Harris County, HMO plans make up the largest slice of the 2027 lineup.

HMO-POS (Point of Service). This is an HMO with a small door cut into it. You still have a network, but the "point of service" option lets you use certain out-of-network providers for specific services, usually at a higher cost. Harris County has HMO-POS plans available for 2027.

PPO (Preferred Provider Organization). PPOs give you the freedom to see any provider who accepts Medicare, in or out of network. You pay less when you stay in network, and referrals typically aren't required. Some PPOs are local; others are regional and cover a wider service area. Harris County has PPO plans available for 2027.

PFFS (Private Fee-for-Service). These plans set their own payment terms, and you can see any Medicare-approved provider who agrees to accept the plan and its terms — that agreement isn't automatic, so it pays to ask before each visit. PFFS remains the smallest category locally for 2027.

What makes a Special Needs Plan different

A Special Needs Plan (SNP) is still a Medicare Advantage plan, but enrollment is limited to people who fit a specific profile. Of the 114 plans in Harris County, 45 are SNPs. They come in three flavors:

• D-SNP (Dual Eligible). For people who have both Medicare and Medicaid.
• C-SNP (Chronic Condition). For people with a qualifying chronic illness, such as diabetes, chronic heart failure, chronic lung disorders, or end-stage renal disease. Each C-SNP names the condition it serves.
• I-SNP (Institutional). For people who live in a nursing home or need a similar level of care at home.

SNPs are required to include drug coverage and to coordinate care around the group they serve. If you don't fit the eligibility rules, you can't enroll — even if the plan looks appealing on paper.

Which Houston-area carriers offer what

The 15 carriers offering MA-PD plans in Harris County for 2027 are listed here alphabetically, along with the plan types each one sells locally. The table below lists every plan in full.

• Aetna (CVS Health) — 10 plans (HMO, PPO; 4 SNPs)
• Blue Cross Blue Shield (HCSC) — 15 plans (HMO, PPO; 2 SNPs)
• Centene (WellCare) — 9 plans (HMO, HMO-POS, PPO; 3 SNPs)
• Community Health Choice — 1 plan (HMO; 1 SNP)
• Devoted Health — 8 plans (HMO; 4 SNPs)
• Elevance Health (Anthem) — 9 plans (HMO, HMO-POS; 7 SNPs)
• Humana — 22 plans (HMO, PFFS, PPO; 5 SNPs)
• Memorial Hermann Health Plan — 3 plans (HMO; 1 SNP)
• Molina Healthcare of Texas, Inc. — 1 plan (HMO; 1 SNP)
• ProCare Advantage — 1 plan (HMO-POS; 1 SNP)
• Provider Partners Health Plans — 1 plan (HMO; 1 SNP)
• SCAN Health Plan — 4 plans (HMO; 2 SNPs)
• Texas Independence Health Plan — 2 plans (HMO; 2 SNPs)
• UnitedHealthcare — 26 plans (HMO, HMO-POS, PPO; 10 SNPs)
• Verda Health Plan of Texas — 2 plans (HMO; 1 SNP)

Some carriers, like Humana and UnitedHealthcare, offer several plan types under one roof. Others concentrate on one shape — Devoted Health, SCAN, Memorial Hermann and Molina, for example, sell HMOs locally. If plan type matters to you (say, you want the out-of-network flexibility of a PPO), that will narrow the field quickly.

How to think about type before you shop

Plan type is a good early filter because it tells you how you'll actually use the plan day to day. A few questions to ask yourself:

• Do you already have doctors you want to keep? Check whether each one is in the plan's network. HMOs are strict about this; PPOs give you more room.
• Do you split time between Houston and another city or state? PPO and PFFS plans can travel better than HMOs, but coverage rules still apply — always confirm before you go.
• Do you want a primary care doctor coordinating everything? HMOs are built around that. PPOs are looser.
• Do you qualify for a Special Needs Plan? If you have Medicaid, a qualifying chronic condition, or live in a facility, an SNP could be worth a look.

Star Ratings from CMS are another piece of the puzzle. Ratings can shift year to year, so treat them as one factor among many.

A few program facts worth knowing for 2027

• The Part D out-of-pocket cap is $2,100 in 2026.
• The Part D maximum deductible is $615.
• The old coverage gap ("donut hole") is gone as of 2025; Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly installments.
• IRMAA surcharges on Part B and Part D premiums begin above $109,000 in income for a single filer in 2026.