Medicare Advantage

Madison Medicare Advantage in 2026: the carriers behind the lineup, and what HMO, PPO and PFFS really mean

People in Madison can choose from 39 Medicare Advantage plans for 2027, against 55 this year. Eleven of this year's plans are gone, 4 are new to Dane County, and 22 that continue have changed their premium, deductible, plan type or name, 9 of them under a new name.

Medicare AdvantageMadison, WI

Madison shoppers opening the 2027 Medicare Advantage lineup will see a lot of names — and a lot of letters after those names. HMO, HMO-POS, PPO, PFFS, MSA, Cost, D-SNP, C-SNP, I-SNP. The good news: once you know which carriers are in town and what those plan types actually mean, the list gets a lot easier to read.

Madison sits in Dane County, and Medicare Advantage availability is set at the county level. That means every Madison resident on Medicare picks from the same county-wide menu. For 2027, Dane County has 39 Medicare Advantage plans offered by 10 carriers, according to the CMS Medicare Advantage Landscape Source File. The table below lists every plan.

The carriers offering plans in Dane County

Ten carriers are on the 2027 Medicare Advantage roster for Dane County. In alphabetical order, they are: Aetna (CVS Health); Centene (WellCare); Dean Advantage; Dean Health Plan, Inc.; Elevance Health (Anthem); Humana; Molina Healthcare of Wisconsin; Network Health Medicare Advantage Plans; Quartz Medicare Advantage (HMO); and UnitedHealthcare.

All ten of those carriers offer Medicare Advantage plans that include Part D drug coverage (MA-PD). In fact, all 39 plans in the county include drug coverage for 2027 — there are no Medicare Advantage-only plans on the local menu.

A bigger plan count from one carrier doesn't mean it's a better choice. It usually just means the carrier is offering more variations — different networks, different supplemental benefits, or different Special Needs Plans. The right question is which plan fits you, not which carrier has the longest list.

How the plan types differ

The letters after each plan name tell you how the plan is set up. Here is the plain-English version.

HMO (Health Maintenance Organization). You choose doctors and hospitals inside the plan's network, and out-of-network care generally isn't covered except for emergencies. Many HMOs ask you to pick a primary care doctor and get referrals for specialists. See the table below for the current HMO count in Dane County for 2027.

HMO-POS (HMO with Point-of-Service). Same idea as an HMO, but the plan lets you go outside the network for certain services, usually at a higher cost. Dane County has 19 HMO-POS plans.

PPO (Preferred Provider Organization). You can see any Medicare-approved provider who agrees to treat you, in-network or out. In-network care costs less, but out-of-network is covered. Referrals usually aren't required. Dane County has 17 PPO plans, including local and regional PPOs.

PFFS (Private Fee-for-Service). You can see any provider who agrees to the plan's terms of payment on the day of service. There's no set network in the traditional sense, but a provider can decline to accept the plan. Dane County has 1 PFFS plan.

MSA (Medical Savings Account) and Cost plans. These are less common. An MSA pairs a high-deductible health plan with a savings account Medicare funds each year. Cost plans work differently from typical Medicare Advantage — you can use non-network providers and still be covered under Original Medicare. Dane County has 1 MSA plan and 2 Cost plans.

Special Needs Plans, and who they're for

Special Needs Plans (SNPs) are Medicare Advantage plans built for people who fit a specific situation. See the table below for the current SNP count in the Dane County 2027 lineup. There are three types:

• D-SNP (Dual Eligible) — for people who have both Medicare and Medicaid.
• C-SNP (Chronic Condition) — for people with certain chronic conditions, like diabetes or heart failure.
• I-SNP (Institutional) — for people who live in a nursing home or need a similar level of care at home.

You have to qualify to enroll in a SNP, and the plan is designed around that group's typical care needs. If you don't fit the category, a SNP isn't the right shopping lane for you.

What all 2027 plans have in common

Whether you pick an HMO, a PPO or something else, some 2027 rules apply across the board:

• The Part D out-of-pocket cap is $2,100. Once your covered drug costs hit that limit, you pay $0 for covered drugs the rest of the year.
• The Part D deductible can't be more than $615.
• The old "donut hole" is gone. Part D now has three phases (deductible, initial coverage and catastrophic).
• The Medicare Prescription Payment Plan is available if you'd rather spread drug costs across the year in monthly installments instead of paying at the pharmacy counter.
• IRMAA — the income-related surcharge on Part B and Part D — kicks in above $109,000 in income for a single filer in 2026.

How to actually narrow it down

A 55-plan menu is intimidating on paper. In practice, most Madison shoppers narrow it down fast by asking a few questions in order:

1. Do you qualify for a Special Needs Plan? If you have Medicaid, a qualifying chronic condition or live in a nursing facility, that shrinks the list right away. 2. How do you want to use a network? If seeing any doctor who takes the plan matters, you're looking at a PPO or PFFS. If you're happy with a network and want simpler rules, an HMO or HMO-POS may fit. 3. Are your doctors, hospitals and drugs covered? This is where medicare.gov's Plan Finder does the real work — it checks each specific plan's network and drug list. 4. What are the total costs? Premium is only one number. Look at the deductible, copays for the care you actually use, and the plan's out-of-pocket max.

Enrollment periods matter too. The Annual Enrollment Period runs Oct. 15 through Dec. 7, and changes made then take effect Jan. 1. If you're already in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period (Jan. 1–March 31) lets you switch once to a different MA plan or go back to Original Medicare.