Medicare Advantage

Madison Medicare Advantage in 2027: how HMO, HMO-POS, PPO and PFFS compare before you pick

People in Madison can choose from 48 Medicare Advantage plans for 2027, against 55 this year. Eleven of this year’s plans are gone, 4 are new to Dane County, and 31 that continue have changed their premium, deductible, plan type or name, 9 of them under a new name.

Madison, Wis. — As the Annual Enrollment Period for 2027 Medicare coverage opens Oct. 15, 2026, shoppers in Madison have a clear choice to make before they compare benefits or drug lists: what type of Medicare Advantage plan fits the way they actually use care. In Dane County, where Madison sits, the 2027 lineup splits across HMO, HMO-POS, PPO and PFFS plans — four labels that decide how networks, referrals and out-of-network care work.

Those letters are not marketing. They are the rules of the road for using the plan.

How do Dane County's 2027 Medicare Advantage plans split by type?

For 2027, Dane County has 48 Medicare Advantage plans from 10 carriers. By plan type, that is 15 HMO, 13 HMO-POS, 16 PPO, 1 PFFS, 1 MSA and 2 Cost plans. If you group HMO and HMO-POS together, 28 plans use an HMO-style network.

The table below lists every plan available in the county for 2027. The split matters because the letters after a plan's name tell you how to use it — not what it costs.

What does HMO mean for a Madison Medicare Advantage plan?

An HMO (Health Maintenance Organization) plan expects you to use its network of doctors and hospitals, and it generally requires you to pick a primary care doctor and get a referral to see a specialist. Out-of-network care is usually not covered except for emergencies and urgent care.

In Dane County for 2027, HMO plans are offered by Dean Advantage, Elevance Health (Anthem), Humana, Molina Healthcare of Wisconsin and Quartz Medicare Advantage (HMO). HMOs tend to suit people whose doctors are already in one system and who do not need to use providers outside the area.

What is an HMO-POS plan, and how is it different?

HMO-POS stands for HMO with a Point-of-Service option. It works like an HMO — network first, usually with a primary care doctor — but it adds a limited ability to see some out-of-network providers for certain services, at the plan's defined cost share.

For 2027 in Dane County, HMO-POS plans are offered by Centene (WellCare), Dean Advantage and UnitedHealthcare. The "POS" piece can be useful if you occasionally need care that falls outside the network, but the rules of what is covered out of network are set by each plan.

What does PPO coverage look like in Dane County for 2027?

A PPO (Preferred Provider Organization) plan has a network, but it also covers out-of-network care — just at a higher cost share than in-network. You generally do not need a referral to see a specialist.

For 2027, PPO plans in Dane County come from Aetna (CVS Health), Humana and UnitedHealthcare. PPOs are often chosen by people who travel, spend part of the year outside Wisconsin, or want more flexibility to see providers who are not in the plan's network.

What is a PFFS plan, and who offers one in the county?

A Private Fee-for-Service (PFFS) plan sets its own payment terms and lets you see any Medicare-approved provider who agrees to accept the plan's terms and payment. There is no traditional network in the HMO/PPO sense, but providers can decide visit by visit whether to accept the plan.

For 2027 in Dane County, Humana offers the single PFFS plan in the lineup. PFFS is less common nationally and is worth a careful look at how your usual providers handle it before enrolling.

When should Madison residents make a change for 2027?

The Annual Enrollment Period runs Oct. 15 through Dec. 7, 2026, and a change made in that window takes effect Jan. 1, 2027. If you do nothing, your current plan renews for 2027 if it is still offered — with any changes described in its Annual Notice of Change.

For Dane County, CMS data shows that going into 2027, 11 plans are not returning, 4 are new and 9 have been renamed. A rename does not necessarily change the plan type or how it works, but the ANOC is where to confirm. There is also a Medicare Advantage Open Enrollment Period from Jan. 1 through March 31, 2027, if you are already in a Medicare Advantage plan and want to switch once.

A couple of program-level numbers worth knowing as you compare drug coverage: for 2027, the Part D out-of-pocket cap is $2,400 (up from $2,100 in 2026) and the Part D maximum deductible is $700 (up from $615 in 2026). CMS publishes the 2027 Part B premium and deductible, and the 2027 IRMAA income brackets, later in the fall.