Reviewed by Russell Noga, Licensed Medicare Insurance Broker (all 50 states) — Last updated October 8, 2026
MVP Health Care offers Medicare Advantage PPO plans in Upstate New York and Vermont for 2027 with no verified exit. MVP PPOs cover out-of-network care at a higher cost.
Excellus is ending its Central New York PPOs for 2027, so some members may compare MVP PPOs.
MVP PPOs continue.
Out-of-network at higher cost.
Excellus ends Central NY PPOs.
The national average 2027 Medicare Advantage premium is $12 a month, down from $14.37 (CMS).
Annual Enrollment runs October 15 to December 7, 2026.
| Feature | In Network | Out of Network |
|---|---|---|
| Covered? | Yes | Yes, from providers who accept Medicare |
| Your cost | Lowest copays | Higher copays and coinsurance |
| Referrals | Usually not required | Not required |
| Out-of-pocket maximum | In-network limit | Higher combined limit |
PPOs have two out-of-pocket limits: one for in-network care and a higher combined limit for all covered care. If you plan to use out-of-network providers, compare the combined limit.
MVP Plans May Include
Hospital and medical coverage, the same as Original Medicare Part A and B
Part D prescription drug coverage on most plans
Routine dental, vision and hearing benefits
Fitness programs and over-the-counter allowances
Telehealth visits and care coordination programs
A yearly out-of-pocket maximum on every plan
Not all plans offer all benefits. Benefits vary by plan and county and can change for 2027. Check each plan’s Evidence of Coverage before you enroll.
Key Takeaway
Read your MVP Annual Notice of Change.
Watch for: if your plan is ending, you will get a non-renewal letter. Your coverage continues through December 31, 2026. If you do nothing, you return to Original Medicare without drug coverage.
| Insurer | PPO Plans Cut for 2027 |
|---|---|
| HCSC | 48 |
| Humana | 37 |
| UnitedHealthcare | 34 |
| Aetna | 20 |
| Kaiser Permanente | Its last 3 |
Source: CMS 2027 landscape data as reported by Becker’s, October 1, 2026.
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, MVP 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.
| Feature | HMO | PPO |
|---|---|---|
| Out-of-network care | Not covered except emergencies and urgent care | Covered at a higher cost |
| Referrals for specialists | Usually required | Usually not required |
| Premiums | Usually lower | Usually higher |
| Out-of-pocket maximum | In-network limit | In-network limit plus a higher combined limit |
| Best for | Lower costs, local care | Flexibility, travel, keeping specific doctors |
Advantages
Often a low or $0 premium
A yearly out-of-pocket maximum
Drug coverage usually included
Many plans may include dental, vision and hearing benefits
One card and one plan
Tradeoffs
Networks; HMOs require in-network care except emergencies
Prior authorization and referrals are common
Copays add up if you use a lot of care
Plans and networks can change every year
Switching to Medigap later may require health questions
Most MVP Medicare Advantage plans include Part D drug coverage. Each plan has its own formulary, drug tiers and pharmacy network, and plans commonly charge less at preferred pharmacies and through mail order. For 2027, any plan’s Part D deductible can be up to $700, and the out-of-pocket cap on covered drugs is $2,400.
| Tier | Typical Drugs | Typical Cost |
|---|---|---|
| Tier 1 | Preferred generics | Lowest copay |
| Tier 2 | Generics | Low copay |
| Tier 3 | Preferred brand-name drugs | Moderate copay |
| Tier 4 | Non-preferred drugs | Higher copay or coinsurance |
| Tier 5 | Specialty drugs | Highest coinsurance |
Tier structures vary by plan. Check each plan’s formulary.
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:
If Your Drug Is Not Covered
Ask for a transition fill. In the first 90 days of a new plan year or a new plan, plans generally must give you a temporary supply of a drug you were already taking, so you have time to switch or request an exception.
Ask your doctor about alternatives. A covered drug in the same class may work as well and cost less.
Request a formulary or tiering exception. Your doctor submits a statement explaining why you need the drug or a lower copay. Plans must decide within set time limits.
Appeal a denial. If the plan says no, you can appeal, and there are several levels of review.
If your MVP 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.
If Your Plan Is Ending
Read the non-renewal letter. It confirms your plan is ending and explains your options.
List your doctors and drugs. You will need them to compare replacement plans.
Compare plans for 2027. Check networks, drug coverage and the out-of-pocket maximum, not just the premium.
Choose by December 31 for no gap. Enrolling during Annual Enrollment by December 7 gives you coverage on January 1, 2027.
Use your Special Enrollment Period if needed. People whose plans end generally can still make a choice through the end of February 2027.
If you do nothing: you return to Original Medicare on January 1, 2027, without drug coverage unless you choose a Part D plan. Going without drug coverage can lead to a late enrollment penalty.
Medigap rights: when your Medicare Advantage plan leaves your area, you generally have a guaranteed issue right to buy certain Medicare Supplement plans without health questions, up to 63 days after your coverage ends.
How to Compare
Read your Annual Notice of Change. It lists every change to your current plan for 2027.
Check your doctors and hospitals. Confirm each provider is in the 2027 network, not just the 2026 one.
Check your prescriptions. Confirm each drug, its tier and any prior authorization or step therapy rules.
Compare total yearly cost. Add the premium, typical copays and drug costs, and look at the out-of-pocket maximum.
Check star ratings. Medicare rates plans from 1 to 5 stars on quality and service.
Enroll by December 7. Your new coverage starts January 1, 2027.
| Enrollment Period | Dates | What You Can Do |
|---|---|---|
| Annual Enrollment Period | October 15 to December 7, 2026 | Join, switch or drop a Medicare Advantage or Part D plan for January 1, 2027 |
| Medicare Advantage Open Enrollment | January 1 to March 31, 2027 | If you are in Medicare Advantage, switch to another plan or return to Original Medicare once |
| Initial Enrollment Period | 7 months around your 65th birthday month | Sign up for Medicare and choose your first plan |
| Special Enrollment Periods | Varies | Change plans after events like moving, losing other coverage or your plan leaving your area |
Most people make changes during Annual Enrollment. If you are happy with your current plan, you do not have to do anything; it renews automatically. Still, read your Annual Notice of Change, because premiums, copays, networks and drug lists can all change on January 1.
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.
| Type | Who Qualifies | What Is Different |
|---|---|---|
| Dual Special Needs Plan (D-SNP) | People with both Medicare and Medicaid | Coordinates both programs; often very low costs and added benefits |
| Chronic Condition SNP (C-SNP) | People with qualifying conditions such as diabetes, heart failure or chronic lung disease | Doctors, drugs and programs built around the condition |
| Institutional SNP (I-SNP) | People living in a nursing home or who need that level of care at home | Care delivered where the member lives |
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.
Turning 65 Checklist
Sign up for Part A and Part B, unless you have qualifying employer coverage and choose to delay Part B
Decide between Medicare Advantage and Original Medicare with Medigap
Join a drug plan, or a Medicare Advantage plan with drugs, to avoid a Part D late penalty
If you choose Medigap, buy during your six-month Medigap Open Enrollment Period
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.
Using Star Ratings
A rating of 4 stars or higher is generally a good sign of quality and service
Five-star plans have a special enrollment period, so you can switch into one once during the year
New plans may not have a rating yet, which is not a bad sign by itself
Ratings measure the plan overall, not how well it covers your specific doctors and drugs
| Medicare Advantage | Original Medicare + Medigap | |
|---|---|---|
| Monthly premium | Often low or $0 (2027 average $12, CMS) | Higher; varies by plan letter, age and ZIP |
| Doctors | Usually a network | Any provider in the U.S. that accepts Medicare |
| Costs when you get care | Copays and coinsurance up to a yearly maximum | Low and predictable; little or nothing on Plan G after the Part B deductible |
| Drug coverage | Usually included | Add a separate Part D plan |
| Dental, vision, hearing | Many plans may include some coverage | Not included |
| Changing later | Every year during Annual Enrollment | Health questions in most states after your Medigap Open Enrollment Period |
Guaranteed issue: if your Medicare Advantage plan leaves your area, you generally can buy certain Medicare Supplement plans without health questions, until 63 days after your coverage ends.
If your income and savings are limited, two programs can cut your Medicare costs sharply:
Medicare Savings Programs
Run by your state Medicaid office
Can pay your Part B premium, and sometimes deductibles and coinsurance
Income and asset limits vary by state
Extra Help (Part D)
Run by Social Security
Lowers Part D premiums, deductibles and copays
People in a Medicare Savings Program qualify automatically
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.
Check Every Line
Your 2027 premium and deductible
Copays for doctors, specialists and hospital stays
The out-of-pocket maximum
Updates to your formulary, drug tiers and coverage requirements
Whether your doctors, hospitals and pharmacy are still in network
Changes to dental, vision, hearing and other extras
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:
You May Qualify If
Your plan is leaving your area or ending
You move outside your plan’s service area
You lose employer or union coverage
You qualify for Extra Help or a Medicare Savings Program, or your Medicaid status changes
You want to join a 5-star plan, once a year
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.
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.
Step by Step
Check whether you have a guaranteed issue right. For example, your plan is ending or you are within your first year of Medicare Advantage.
If not, check your state’s rules. Some states give extra rights; most allow health questions.
Apply for Medigap before you leave Medicare Advantage. Make sure you are approved first.
Join a Part D plan. Medigap does not cover drugs.
Leave Medicare Advantage at the right time. During Annual Enrollment or the January to March window.
You do not have to compare plans alone, and you should not have to pay for help. These are the free options:
Free Help Comparing Plans
Medicare Plan Finder on Medicare.gov, available any time
1-800-MEDICARE (1-800-633-4227), available 24 hours a day, seven days a week
Your State Health Insurance Assistance Program (SHIP), which offers free, unbiased counseling
A licensed insurance agent or broker, who can compare plans from several insurers at no cost to you
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.
The Bottom Line
MVP PPOs remain an option for 2027. Compare both out-of-pocket limits.
Yes. MVP Health Care sells Medicare Advantage PPO plans in parts of New York and Vermont, though which PPO options you see depends on your county. Check the 2027 plan list for your ZIP code and read the Annual Notice of Change if you are already a member, since plan details can shift each year.
You can join an MVP plan during Annual Enrollment, which runs October 15 through December 7, 2026, for coverage that begins January 1, 2027. People already in a Medicare Advantage plan also get one switch between January 1 and March 31, 2027, and certain life events can open a Special Enrollment Period.
Your current plan keeps covering you through December 31, 2026, and the insurer must send a non-renewal notice explaining your options. You can pick a replacement during Annual Enrollment or a Special Enrollment Period, and you generally gain a guaranteed issue right to buy certain Medigap plans, usually within 63 days after coverage ends.
A PPO lets you see out-of-network providers, usually at a higher cost share, while an HMO generally limits coverage to its network except in emergencies. PPOs also typically skip referral requirements, but premiums and copays can run higher, so compare both against the doctors you actually use.
It varies by plan. Emergency and urgent care are generally covered anywhere in the country, but routine out-of-network visits in other states depend on the specific PPO’s terms, so confirm travel coverage in the Evidence of Coverage before you enroll.
Usually more than you would in network. PPOs typically charge higher copays or coinsurance outside the network, and many have a separate, larger out-of-pocket limit for combined care, so check the plan’s Summary of Benefits for the exact amounts in your county.
There is no verified report of MVP dropping PPOs for 2027, but several national carriers are trimming PPOs, including UnitedHealthcare, Humana, Aetna and HCSC. If you have an MVP plan now, read your Annual Notice of Change to see exactly what shifts for next year.
Some may. MVP plans may include extras such as dental, vision, hearing or fitness benefits, but not all plans offer all benefits and the details vary by plan and county, so review the 2027 Summary of Benefits before assuming any extra is included.
Possibly, but you need to confirm it. Provider networks change, so call your doctor’s office and check MVP’s 2027 provider directory to see whether they participate; a PPO may still pay something if they do not, at a higher cost to you.
ZRN Health & Financial Services, LLC, a Texas limited liability company
Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 18 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.