Medicare Plan Types Explained
Last updated October 23, 2026
A plan's type tells you how the plan works. It says if you need to use the plan's doctors, and if you need a referral to see a specialist. Many plan names include the type, for example "(HMO)" or "(PPO)". Each plan sets its own rules, and the rules can change each year.
Plan Types at a Glance
This table shows the general rules for 4 types of Medicare Advantage plans. Other types are further down the page.
| Plan Type | Must Use Network Doctors | Referral Needed for a Specialist | Care Outside the Network | Drug Coverage |
|---|---|---|---|---|
| Health Maintenance Organization (HMO) | In most cases, yes. Emergency care, and urgent care away from home, are covered outside the network. | In most cases, yes. | Not covered in most cases. Without the plan's approval, you may pay the full cost. | Usually included (see the note under the table) |
| HMO Point-of-Service (HMO-POS) | In most cases, yes. | In most cases, yes. | Some services may be covered. You usually pay more. | Usually included (see the note under the table) |
| Preferred Provider Organization (PPO) | No. Network doctors usually cost less. | In most cases, no. | Covered if the doctor agrees to treat you, usually at a higher cost. | Usually included (see the note under the table) |
| Regional PPO | No. Network doctors usually cost less. | In most cases, no. | Covered if the doctor agrees to treat you, usually at a higher cost. | Usually included (see the note under the table) |
If a plan doesn't include drug coverage, you can't add a stand-alone drug plan (Part D) to it.
In any Medicare Advantage plan, you usually need the plan's approval before it covers certain services. This is called prior authorization.
Compare plan types on Medicare.gov (opens in a new tab)
Sources: Medicare.gov: Medicare & You 2027 (PDF) (opens in a new tab) · Medicare.gov: Compare Types of Medicare Advantage Plans (opens in a new tab) · Medicare.gov: Health Maintenance Organizations (HMOs) (opens in a new tab)
7 more sources
Medicare.gov: Preferred Provider Organizations (PPOs) (opens in a new tab) · Medicare.gov: Annual Notice of Change (opens in a new tab) · Medicare.gov: Special Enrollment Periods (opens in a new tab) · Medicare.gov: When Can I Buy Medigap? (opens in a new tab) · Medicare.gov: Avoid Penalties (opens in a new tab) · Federal rule: 42 CFR 422.2 (opens in a new tab) · Federal rule: 42 CFR 422.455 (opens in a new tab)
Last checked October 2026.
HMO and HMO-POS Plans
Health Maintenance Organization (HMO)
An HMO is a type of Medicare Advantage plan. In most cases, you get your care from doctors and hospitals in the plan's network. Emergency care and urgent care away from home are covered outside the network.
In most cases, you pick a primary care doctor. You also need a referral to see a specialist. Some services, like a yearly mammogram, don't need a referral. If you get other care outside the network without the plan's approval, you may have to pay the full cost.
HMO Point-of-Service (HMO-POS)
An HMO-POS plan is an HMO that may cover some care outside the network. It covers only some services this way, and the plan decides which ones. You usually pay more for care outside the network. Ask the plan before you go.
Sources: Medicare.gov: Health Maintenance Organizations (HMOs) (opens in a new tab) · Medicare.gov: Medicare & You 2027 (PDF) (opens in a new tab) · Medicare.gov: Compare Types of Medicare Advantage Plans (opens in a new tab)
1 more source
Last checked October 2026.
PPO and Regional PPO Plans
Preferred Provider Organization (PPO)
A PPO has a network of doctors and hospitals. You can also see doctors outside the network for covered care, if the doctor agrees to treat you. You usually pay more when you do. Before you get care outside the network, ask the plan if it covers that care.
You don't need to pick a primary care doctor. In most cases, you don't need a referral to see a specialist. Emergency and urgent care are always covered. A PPO also has a yearly limit on your costs for care in and out of the network together.
Regional PPO
A Regional PPO is a PPO that serves one or more whole regions set by Medicare. It must have a network. It must also cover care you get in or out of the network.
Sources: Medicare.gov: Medicare & You 2027 (PDF) (opens in a new tab) · Medicare.gov: Preferred Provider Organizations (PPOs) (opens in a new tab) · Federal rule: 42 CFR 422.101 (opens in a new tab)
3 more sources
Federal rule: 42 CFR 422.100 (opens in a new tab) · Federal rule: 42 CFR 422.2 (opens in a new tab) · Federal rule: 42 CFR 422.455 (opens in a new tab)
Last checked October 2026.
Less Common Plan Types
Private Fee-for-Service (PFFS)
A PFFS plan decides how much it pays doctors and hospitals, and how much you pay for care. It isn't the same as Original Medicare or Medigap. At every visit, a doctor can choose whether to accept the plan's payment terms. Show your plan card before you get care.
Doctors outside the plan's network may decide not to treat you, even if you've seen them before. In an emergency, doctors and hospitals must treat you. Some PFFS plans cover drugs. If yours doesn't, you can join a stand-alone drug plan (Part D).
Medicare Cost Plans
A Medicare Cost plan is a health plan offered only in some areas. In 2027, Cost plans are offered in 7 states: Illinois, Iowa, Minnesota, Nebraska, North Dakota, South Dakota and Wisconsin. CMS lists Cost plans with Medicare Advantage plans. This site does too.
If you have Part A and Part B and see a doctor outside the network, Original Medicare covers the care. You pay Original Medicare's deductibles and coinsurance for it. You can leave a Cost plan at any time and go back to Original Medicare. You can get drug coverage from the Cost plan, if it offers it, or from a stand-alone drug plan (Part D).
Medical Savings Account (MSA) Plans
An MSA plan has a high yearly deductible and a savings account. The plan puts money in the account for you to use on health care. It starts to pay for your Part A and Part B care only after you meet the deductible. MSA plans don't cover drugs. For drug coverage, you can join a stand-alone drug plan (Part D).
Sources: Medicare.gov: Private Fee-for-Service (PFFS) Plans (opens in a new tab) · Medicare.gov: Medicare & You 2027 (PDF) (opens in a new tab) · Medicare.gov: Medical Savings Account (MSA) Plans (opens in a new tab)
1 more source
CMS data file: CY2027 Landscape, data as of October 18, 2026 (ZIP) (opens in a new tab)
Last checked October 2026.
Special Needs Plans
A Special Needs Plan (SNP) is an HMO or PPO for one group of people. It may be for people who also have Medicaid (D-SNP), or people with certain chronic conditions (C-SNP). It may also be for people who live in a nursing home or need that level of care (I-SNP). Every SNP covers drugs.
Special Needs Plans in 2027 explains the 3 kinds and what happens when one ends.
Sources: Medicare.gov: Special Needs Plans (opens in a new tab) · Federal rule: 42 CFR 422.2 (opens in a new tab)
Last checked October 2026.
Drug Coverage
- Most Medicare Advantage plans include drug coverage (Part D).
- If you join an HMO or PPO that doesn't cover drugs, you can't add a stand-alone drug plan (Part D). You would need other drug coverage you already have, like employer or retiree coverage. If you don't have it, you would go without drug coverage.
- With an MSA plan, a Cost plan, or a PFFS plan that doesn't cover drugs, you can join a stand-alone drug plan (Part D).
- Every Special Needs Plan includes drug coverage.
- Original Medicare doesn't include drug coverage. A stand-alone drug plan adds it. Drug plans ending in 2027 are on Drug Plans (Part D) Ending in 2027.
- You may have to pay a late penalty if you go 63 days or more in a row without drug coverage. This means Medicare drug coverage, or other drug coverage that is at least as good. While you get Extra Help, you won't be charged this late penalty.
The late penalty on Medicare.gov (opens in a new tab)
Medigap Works Only with Original Medicare
You can't buy Medigap (Medicare Supplement Insurance) while you're in a Medicare Advantage plan, unless you're switching back to Original Medicare. Medigap can't pay your Medicare Advantage plan's costs.
If your Medicare Advantage plan is ending and you switch to Original Medicare, you have a right to buy certain Medigap policies. How the Medigap right works.
Sources: Medicare.gov: Medicare & You 2027 (PDF) (opens in a new tab) · Medicare.gov: Compare Types of Medicare Advantage Plans (opens in a new tab) · Medicare.gov: Private Fee-for-Service (PFFS) Plans (opens in a new tab)
10 more sources
Medicare.gov: Medical Savings Account (MSA) Plans (opens in a new tab) · Medicare.gov: Special Needs Plans (opens in a new tab) · Medicare.gov: Drug Coverage (Part D) Basics (opens in a new tab) · Medicare.gov: Avoid Penalties (opens in a new tab) · Medicare.gov: Annual Notice of Change (opens in a new tab) · Medicare.gov: Special Enrollment Periods (opens in a new tab) · Medicare.gov: When Can I Buy Medigap? (opens in a new tab) · Medicare.gov: Choosing a Medigap Policy (PDF) (opens in a new tab) · Federal rule: 42 CFR 422.2 (opens in a new tab) · Federal law: 42 U.S.C. 1395ss (opens in a new tab)
Last checked October 2026.
Plans Not Offered in 2027, by Plan Type
In 2027, 21,868 Medicare Advantage listings from 2026 are not offered. A listing is one plan in one county. PPO plans have the most: 10,945 listings, or 50% of the 21,868.
Show as a table
| Plan Type | Listings Not Offered |
|---|---|
| PPO | 10,945 |
| HMO | 5,170 |
| HMO-POS | 4,242 |
| Regional PPO | 824 |
| PFFS | 383 |
| Cost | 304 |
County pages list every plan not offered in that county. Find your state and county.
Sources: CMS data file: CY2026 Landscape, data as of September 2, 2026 (ZIP) (opens in a new tab) · CMS data file: CY2027 Landscape, data as of October 18, 2026 (ZIP) (opens in a new tab) · Our method
Last checked October 2026.
If Your Plan Type Changes
If your plan is being replaced, the new plan is usually the same type. Federal rules don't let a company move you from an HMO to a PPO, for example. But the rules count HMO and HMO-POS plans as one type. So an HMO-POS plan can be replaced by an HMO that doesn't cover routine care outside the network. In 2027, 60 HMO-POS listings are being replaced by an HMO. Your Annual Notice of Change shows your plan's type for 2027.
If you pick a plan of a different type, your doctors may not be in its network. Medicare Plan Finder can show if your doctors are in a plan's network. You can also ask your doctor's office.
You may be getting treatment when you join a new Medicare Advantage HMO or PPO. If so, the plan can't ask for a new approval for that Part A or Part B treatment for at least 90 days.
Sources: Medicare.gov: Compare Original Medicare and Medicare Advantage (opens in a new tab) · Medicare.gov: Medicare & You 2027 (PDF) (opens in a new tab) · CMS data file: 2027 Plan Crosswalk, dated October 1, 2026 (opens in a new tab)
4 more sources
CMS data file: CY2027 Landscape, data as of October 18, 2026 (ZIP) (opens in a new tab) · Federal rule: 42 CFR 422.530 (opens in a new tab) · Federal rule: 42 CFR 422.2 (opens in a new tab) · Federal rule: 42 CFR 422.112 (opens in a new tab)
Last checked October 2026.
Free Help
- Call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, 24 hours a day, 7 days a week (except some federal holidays).
- Your State Health Insurance Assistance Program (SHIP) (opens in a new tab) gives free, one-on-one help.
- Open Medicare Plan Finder (opens in a new tab) to compare 2027 plans.
More answers are on Common Questions.
These are general rules. Each plan sets its own rules within its type. If you're in a plan, confirm with your Annual Notice of Change or the letter from your plan.
Source: CMS CY2027 Landscape, data as of October 18, 2026 (release 202610). Source: CMS CY2026 Landscape, data as of September 2, 2026 (release 202609). Plan moves: CMS 2027 Plan Crosswalk, file dated October 1, 2026. Plan types are CMS's "Plan Type" in its plan list. See how we get our numbers.