Medicare Advantage

HMO or PPO? West Virginia Medicare Advantage for 2027: 24 HMO Plans, 45 PPO

CHARLESTON, W.Va. — When West Virginians open the Medicare Plan Finder this fall, the first fork in the road isn't a carrier name or a premium figure. It's the plan type. For 2027, the state's Medicare Advantage menu leans heavily toward PPOs, with HMOs making up the next-largest share and a single PFFS plan rounding out the list. Understanding what those letters mean — and which carriers offer each type — is the fastest way to narrow the field before Annual Enrollment 2027 closes on December 7, 2026.

The counts below come from the CMS Medicare Advantage Landscape Source Files for CY2026 and CY2027. Availability is county by county, so a plan listed statewide may or may not be sold in your ZIP code. Use this as a map, not a quote.

How many Medicare Advantage plans does West Virginia have for 2027, and how do HMO and PPO split?

West Virginia has 70 Medicare Advantage plans for 2027, offered by 9 carriers. By type, that's 15 HMO plans, 9 HMO-POS plans, 45 PPO plans, and 1 PFFS plan. Grouping HMO and HMO-POS together — because both are built around an HMO network — gives 24 HMO-style plans versus 45 PPOs statewide.

PPOs make up the majority of the 2027 menu, but that doesn't mean a PPO is sold in every county, or that an HMO isn't. Counties in the eastern panhandle, the Ohio Valley, and the southern coalfields each have their own subset of these 70 plans. The full plan-by-plan list is rendered as a table elsewhere on this page.

What do HMO, HMO-POS, PPO and PFFS mean for West Virginia enrollees?

In plain terms: HMO plans ask you to use a defined network of doctors and hospitals, and most require a referral from a primary care physician before you see a specialist. Out-of-network care is generally not covered except in an emergency.

HMO-POS — the "point of service" variation — is still an HMO at its core, but with a limited option to go outside the network for certain services, usually at a higher cost share. PPO plans (preferred provider organizations) let you see any Medicare provider who will accept the plan; in-network care costs less, out-of-network care costs more, and referrals typically aren't required. PFFS, or private fee-for-service, works differently again: the plan sets the payment terms, and providers decide visit by visit whether to accept them. West Virginia has only one PFFS plan on the 2027 landscape, offered by Humana.

Which West Virginia carriers offer HMO, HMO-POS, PPO and PFFS plans for 2027?

For 2027, the carriers offering each type in West Virginia are:

• HMO: Aetna (CVS Health), Communicare Advantage, Elevance Health (Anthem), Highmark Blue Cross Blue Shield, The Health Plan, West Virginia Senior Advantage.
• HMO-POS: Elevance Health (Anthem), Humana, UnitedHealthcare.
• PPO: Aetna (CVS Health), Highmark Blue Cross Blue Shield, Humana, Peak Health, The Health Plan, UnitedHealthcare.
• PFFS: Humana.

Several carriers appear on more than one list — Aetna (CVS Health), Highmark Blue Cross Blue Shield, The Health Plan, Humana, UnitedHealthcare, and Elevance Health (Anthem) each offer at least two plan types in the state. That matters when you're comparing: the same carrier name on two plans can mean two very different sets of network rules.

How should West Virginians decide between an HMO and a PPO for 2027?

Start with your doctors and your travel pattern. If the physicians and hospitals you already use are all in one network and you rarely leave the state, an HMO or HMO-POS can be a clean fit. If you split time between, say, Morgantown and a grandchild's house in Ohio, or you snowbird to Florida each winter, a PPO's out-of-network coverage may matter more to you than any other feature.

Three questions to work through before you choose:

1. Are my primary care doctor, specialists, and preferred hospital all in the plan's network for 2027? 2. Does the plan require referrals, and am I comfortable routing specialist visits through a PCP? 3. If I need care while traveling outside West Virginia, what will that plan cover?

Answers to those questions live in each plan's Evidence of Coverage and provider directory — not in a statewide count. The Medicare Plan Finder at medicare.gov will show you the exact plans sold in your county and let you check doctors and prescriptions against each one.

What should West Virginia Medicare enrollees do before December 7, 2026?

Annual Enrollment 2027 runs October 15 – December 7, 2026. A choice you make inside that window takes effect January 1, 2027. If you do nothing, your current plan generally renews with whatever changes the carrier filed for 2027 — which is why it's worth at least reading your Annual Notice of Change, even if you're happy.

A short checklist for the weeks before December 7, 2026:

• Read the Annual Notice of Change your current plan mailed in September.
• List your doctors, hospitals, and prescriptions.
• Run those against the plans available in your county on medicare.gov.
• Confirm the plan type (HMO, HMO-POS, PPO, or PFFS) and the network rules that come with it.

Where can West Virginians get free Medicare help for 2027?

Two no-cost, non-sales resources are available to every West Virginian: medicare.gov and 1-800-MEDICARE (1-800-633-4227), which is staffed 24 hours a day, seven days a week. Both can confirm which plans are offered in your county, show provider and drug coverage, and walk you through enrollment during Annual Enrollment 2027.