Medicare Advantage

HMO or PPO? Wisconsin Medicare Advantage for 2027: 59 HMO Plans, 42 PPO

MADISON, Wis. — When Wisconsin residents open the Medicare Plan Finder this fall, the 2027 Medicare Advantage lineup will greet them with 117 plans from 16 carriers, according to the CMS Medicare Advantage Landscape Source File for CY2027. The biggest story in that list is the split between HMO-style plans and PPOs: 59 HMO plans (counting HMO and HMO-POS together) versus 42 PPOs. One Private Fee-for-Service plan, one Medical Savings Account plan and 14 Cost plans round out the statewide picture.

Those are statewide counts. Any given plan is sold county by county, so a plan on the state list may or may not be offered where you live. The point of this explainer is not to pick a plan — it is to help you understand what HMO, HMO-POS, PPO and PFFS actually mean before the Annual Enrollment Period closes December 7, 2026, for coverage that starts January 1, 2027.

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

Wisconsin's 2027 Medicare Advantage landscape contains 117 plans from 16 carriers, divided into 27 HMO, 32 HMO-POS, 42 PPO, 1 PFFS, 1 MSA and 14 Cost plans. Combining HMO with HMO-POS gives 59 HMO-style plans statewide.

That makes PPOs the single largest plan type in Wisconsin for 2027, with HMO-style plans close behind when the two HMO variants are combined. Cost plans — a category that is relatively rare nationally — remain a visible part of Wisconsin's menu with 14 plans. The PFFS and MSA categories each contain a single plan. These are statewide figures from the CMS Landscape file; what shows up in your ZIP code may be a much shorter list.

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

In Wisconsin and nationally, an HMO generally expects members to use the plan's contracted network and, in many cases, to pick a primary care doctor and get referrals for specialists. Out-of-network care is typically covered only for emergencies.

An HMO-POS — "point of service" — is an HMO with a limited out-of-network option on certain services, usually at a higher cost share. A PPO (preferred provider organization) usually lets members see any Medicare-approved provider that accepts the plan, in or out of network, with lower cost sharing in network. A PFFS plan pays providers under terms the plan sets; providers can decide, visit by visit, whether to accept it. Those are the broad rules; the exact referral requirements, networks and cost shares live inside each plan's own Evidence of Coverage.

Which carriers offer HMO, HMO-POS, PPO and PFFS plans in Wisconsin for 2027?

For 2027, the Wisconsin HMO carrier list includes Community Care, Dean Advantage, Elevance Health (Anthem), Group Health Cooperative of Eau Claire, Humana, Molina Healthcare of Wisconsin and Quartz Medicare Advantage (HMO). HMO-POS plans are offered by Aetna (CVS Health), Centene (WellCare), Dean Advantage, Elevance Health (Anthem), Security Health Plan of Wisconsin, Inc. and UnitedHealthcare.

On the PPO side, Wisconsin's 2027 lineup includes Aetna (CVS Health), Elevance Health (Anthem), HealthPartners, Humana, Network Health Medicare Advantage Plans and UnitedHealthcare. The sole PFFS plan for 2027 is offered by Humana. Several carriers — Aetna (CVS Health), Dean Advantage, Elevance Health (Anthem), Humana and UnitedHealthcare — appear across more than one plan type, which means a shopper comparing two plans from the same brand still needs to confirm which type each one is. Full plan-level lists appear in the tables elsewhere on this page.

How should Wisconsin shoppers decide which plan type fits their doctors and travel in 2027?

The practical test for 2027 is to start with the doctors, hospitals and pharmacies you already use and work outward from there. HMO and HMO-POS plans in Wisconsin generally reward staying inside a defined network; a PPO generally offers more flexibility outside it, at a cost share set by the plan.

Travel matters, too. If you spend part of the year outside Wisconsin — a winter in Arizona, a long stretch with grandkids out of state — ask each plan how it covers routine (non-emergency) care away from home. If you split time between two Wisconsin counties, confirm the plan is offered in both, because a statewide list does not guarantee county-level availability. And if you take specific prescriptions, check each plan's drug list on the Medicare Plan Finder before you commit to a plan type.

What should Wisconsin residents do before December 7, 2026?

Before December 7, 2026, confirm whether your current coverage is changing for 2027 and compare it against the other plans offered in your county. Your plan's Annual Notice of Change, mailed in the fall, is the document that spells out next year's rules.

From there, a short checklist helps: list your doctors, hospitals and regular prescriptions; run them through the Medicare Plan Finder at medicare.gov for your ZIP code; note whether each plan you are considering is an HMO, HMO-POS, PPO, PFFS, MSA or Cost plan; and read the Summary of Benefits for anything you don't recognize. Any Annual Enrollment choice you make takes effect January 1, 2027.

Where can Wisconsin residents get free help comparing 2027 Medicare Advantage plans?

Two free, official resources serve every Wisconsin county. The Medicare Plan Finder at medicare.gov lets you enter your ZIP code and prescriptions and see each 2027 plan available to you, with premiums, cost sharing, networks and star ratings attached. For questions by phone, 1-800-MEDICARE is staffed 24 hours a day, seven days a week.

Both sources draw from the same CMS data that produced the statewide counts in this article, and both can confirm whether a plan on Wisconsin's statewide list is actually offered in your county for 2027.