5 Star Medicare Advantage Plans in Pennsylvania 2027

Across the country, big carriers are cutting back on PPOs and leaving certain counties for 2027. Pennsylvania members should review their Annual Notice of Change, and anyone who got a non-renewal letter needs to pick a replacement plan by December 31, 2026.

Source: CMS 2027 landscape data as reported by Becker’s, October 1, 2026, and company announcements. Wellmark, Blue Cross Blue Shield of North Dakota and Blue Cross Blue Shield of Mississippi are also exiting Medicare Advantage for 2027.

Medicare rates plans from 1 to 5 stars on measures such as preventive care, managing chronic conditions, member experience, complaints and drug plan service.

You can only use this window to join a 5-star plan, not to leave one for a lower-rated plan. If you move from Medicare Advantage into a 5-star plan without drug coverage, you may lose drug coverage, so check carefully.

Medicare Advantage, also called Part C, is a way to get your Medicare benefits through a private insurance company approved by Medicare. The plan covers everything Original Medicare Part A and Part B cover, except hospice care, which Original Medicare still pays. Most plans also include Part D drug coverage, and many may add extras such as routine dental, vision and hearing benefits.

In exchange, Medicare Advantage plans generally use networks of doctors and hospitals, and may require referrals or prior authorization for some services. Every Medicare Advantage plan has a yearly out-of-pocket maximum for covered medical care, which Original Medicare does not have. You keep paying your Part B premium, plus your plan’s premium if it has one.

If you prefer Original Medicare, a Medicare Supplement (Medigap) plan pays some or all of what Medicare leaves behind, and lets you see any provider in the U.S. that accepts Medicare. Benefits are standardized by plan letter, so compare prices for the same letter across insurers.

Medigap benefits are standardized by plan letter. Prices vary by insurer, age, ZIP code and tobacco use.

Sticking with Original Medicare in Pennsylvania means you’ll want a stand-alone Part D plan alongside it. Use the 2027 Part D plan finder to line up plans against the exact drugs you take and the pharmacies you use.

If your plan will not be offered in your county for 2027, you should have received a non-renewal notice in early October. Your coverage does not stop right away: it continues through December 31, 2026, so you have time to choose.

Special Needs Plans (SNPs) are Medicare Advantage plans built for specific groups. Benefits, networks and drug lists are designed around the members they serve, and many include care coordinators. For 2027, Special Needs Plans are one of the few areas where large insurers are adding plans, even as they cut PPOs.

If you turn 65 in 2027, your Initial Enrollment Period lasts seven months: the three months before your birthday month, your birthday month and the three months after. Signing up during the first three months means your coverage starts on the first day of your birthday month.

If your income and savings are limited, two programs can cut your Medicare costs sharply:

Those who are eligible for Medicare along with full Medicaid might also have the option of enrolling in a Dual Special Needs Plan. Learn more about help for low-income Part D beneficiaries.

Pennsylvania residents can get no-cost, impartial Medicare guidance through PA MEDI. You can also call 1-800-MEDICARE any time or compare plans with a licensed agent at no cost.

Before any call, have your Medicare card, your list of drugs and doses, your doctors and your preferred pharmacies ready. It turns a long conversation into a short one.

Plans must send the Annual Notice of Change by September 30. It is the single most useful document you get each fall, because it tells you exactly how your plan changes on January 1.

Outside the fall and early-year windows, you generally need a Special Enrollment Period to change plans. Common reasons include:

Each Special Enrollment Period has its own time limit, so act as soon as the event happens.

Most Medicare Advantage plans require prior authorization for some services, such as certain surgeries, advanced imaging, skilled nursing stays and some drugs. Your doctor usually requests it, but ask whether a planned service needs approval so a denial does not surprise you.

If a request is denied, you or your doctor can appeal. Medicare rules set deadlines for plans to decide, with faster deadlines when waiting could seriously harm your health.

Every Medicare Advantage plan covers emergency care and urgent care anywhere in the U.S., in or out of network, and you do not need prior approval for an emergency. Routine care away from home is a different story: HMOs generally do not cover it, while PPOs cover out-of-network care at a higher cost.

If you spend months away from home each year, ask each plan how it handles care in your second location. It is one of the most common reasons people switch plans mid-year.

If your plan denies a service, a drug or payment for care, you have the right to appeal. The plan’s denial notice explains how. There are several levels of appeal, starting with the plan and moving to independent reviewers.

For problems that are not about coverage, such as customer service or wait times, you can file a grievance with the plan. You can also contact 1-800-MEDICARE or your State Health Insurance Assistance Program for help.

The Part B premium is the one big number not released with the plans. CMS normally announces it in November. The 2026 Medicare Trustees Report projects a 2027 standard premium of about $209.50 a month and a deductible of about $292, up from $202.90 and $283 in 2026. You keep paying it with Medicare Advantage.

If you miss the Annual Enrollment deadline, your current plan renews automatically for 2027, with the changes in your Annual Notice of Change. If you are in Medicare Advantage, you get one more chance from January 1 to March 31, 2027, to switch Medicare Advantage plans or return to Original Medicare and join a Part D plan.

Many Medicare Advantage plans may cover telehealth visits for some services, sometimes at a lower copay than an office visit. Telehealth is convenient for follow-ups and minor issues, but it does not replace confirming that your regular doctors are in network.

Medicare rates every Medicare Advantage and Part D plan from 1 to 5 stars each fall, based on things like preventive care, how well the plan manages chronic conditions, member complaints, customer service and drug pricing accuracy. The ratings are shown in Medicare Plan Finder.

Sometimes a drug you take is not on a plan’s 2027 formulary, or it carries a rule like prior authorization. You still have options:

See steps to appeal a Medicare Part D denial.

Your six-month Medigap Open Enrollment Period starts the first month you are both 65 or older and enrolled in Part B. It happens only once and cannot be restarted. During it, insurers must sell you any Medigap plan they offer in your state, at the same price as people in good health.

If you keep working past 65 with employer coverage and delay Part B, your Medigap Open Enrollment Period waits until you enroll in Part B. Enrolling in Part B early, when you do not need it, starts the clock and can waste this protection.

If you have coverage from a current employer, you may not need Medigap yet, and delaying Part B can preserve your Medigap Open Enrollment Period for later. Retiree coverage is different: it may work like a supplement, so compare it with Medigap before dropping it, because you may not be able to get retiree coverage back.

When employer or union coverage that pays after Medicare ends, you generally have a guaranteed issue right to buy certain Medigap plans.

If you buy Medigap during your open enrollment period or with a guaranteed issue right, you generally cannot be denied or charged more for health conditions. However, if you did not have creditable coverage before, an insurer may impose a waiting period of up to six months before covering costs for a pre-existing condition. Prior creditable coverage reduces or removes that waiting period.

If you replace one Medigap policy with another, you generally get 30 days to decide whether to keep the new policy. Pay the premiums for both during that time, and do not cancel your old policy until you are sure about the new one.

If a quote includes an introductory discount, ask what the premium becomes after it ends.

If you have full Medicaid, you generally do not need Medigap, and insurers generally cannot sell you a policy that duplicates Medicaid benefits. If you qualify for a Medicare Savings Program, it may pay your Part B premium and, in some cases, deductibles and coinsurance; check whether a Medigap policy still adds value for you.