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HMO Medicare Advantage Plans 2027

Reviewed by Russell Noga, Licensed Medicare Insurance Broker (all 50 states) — Last updated October 8, 2026

A Medicare Advantage HMO covers care from a network of doctors and hospitals, usually with lower costs than a PPO, in exchange for using in-network providers except for emergencies and urgent care and, often, getting referrals for specialists.

HMOs are the most common type of Medicare Advantage plan, and 2027 is likely to make them more common still: UnitedHealthcare, Humana, Aetna and HCSC are cutting more than 130 PPO plans, so many people who had a PPO will see mostly HMOs in their options.

This guide explains how HMOs work, what they cost, how they compare with PPOs and how to choose one. See Medicare Advantage plans 2027.

✔ Licensed in all 50 states
✔ Based on CMS 2027 data
✔ Free plan comparison

Key Highlights

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HMOs cover in-network care except emergencies, urgent care and some dialysis.

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Referrals for specialists are often required.

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HMOs usually have lower premiums and copays than PPOs.

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Large insurers are cutting more than 130 PPOs for 2027.

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The national average 2027 Medicare Advantage premium is $12 a month, down from $14.37 (CMS).

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How a Medicare Advantage HMO Works

The Basics

1

Choose a primary care doctor. They coordinate your care.

2

Use in-network providers. Out-of-network care is generally not covered.

3

Get referrals when required. For many specialists.

4

Emergencies and urgent care are covered anywhere. In or out of network.

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

HMO vs HMO-POS vs PPO

Type Out-of-Network Care Referrals Typical Cost
HMO Not covered except emergencies Often required Lowest
HMO-POS Some services covered out of network Often required Low to moderate
PPO Covered at a higher cost Usually not required Higher

Understanding Medicare Advantage Plans

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Who an HMO Fits

HMO May Fit If

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Your doctors are in the network

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You get most care locally

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You want lower premiums and copays

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You are comfortable with referrals

Consider Other Options If

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You travel or split time between homes

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You want specific out-of-network specialists

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You do not want referrals

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You prefer any-doctor freedom with Medigap

Why HMOs Are More Common for 2027

PPOs cost insurers more to run, and for 2027 several large insurers are cutting them: UnitedHealthcare 34, Humana 37, Aetna 20 and HCSC 48, while Kaiser drops its last 3 PPOs. If your PPO is ending, an HMO may be the main Medicare Advantage choice in your county, which makes checking networks especially important.

What HMOs Cost

Premium

Often low or $0.

Copays

Usually lower than PPOs.

Out-of-Pocket Max

Caps your covered medical costs.

Part B Premium

You still pay it.

Introducing 2027 Medicare Advantage HMO Options

Benefits HMOs May Offer

HMO Plans May Include

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Hospital and medical coverage, the same as Original Medicare Part A and B

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Part D prescription drug coverage on most plans

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Routine dental, vision and hearing benefits

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Fitness programs and over-the-counter allowances

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Telehealth visits and care coordination programs

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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.

How to Choose an HMO

How to Compare

1

Read your Annual Notice of Change. It lists every change to your current plan for 2027.

2

Check your doctors and hospitals. Confirm each provider is in the 2027 network, not just the 2026 one.

3

Check your prescriptions. Confirm each drug, its tier and any prior authorization or step therapy rules.

4

Compare total yearly cost. Add the premium, typical copays and drug costs, and look at the out-of-pocket maximum.

5

Check star ratings. Medicare rates plans from 1 to 5 stars on quality and service.

6

Enroll by December 7. Your new coverage starts January 1, 2027.

If Your Plan Is Ending

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.

If Your Plan Is Ending

1

Read the non-renewal letter. It confirms your plan is ending and explains your options.

2

List your doctors and drugs. You will need them to compare replacement plans.

3

Compare plans for 2027. Check networks, drug coverage and the out-of-pocket maximum, not just the premium.

4

Choose by December 31 for no gap. Enrolling during Annual Enrollment by December 7 gives you coverage on January 1, 2027.

5

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.

2027 Enrollment Dates

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.

Medicare Advantage or Medigap?

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

Reading Your Annual Notice of Change

Check Every Line

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Your 2027 premium and deductible

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Copays for doctors, specialists and hospital stays

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The out-of-pocket maximum

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Changes to your drug list, tiers and coverage rules

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Whether your doctors, hospitals and pharmacy are still in network

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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.

Special Enrollment Periods

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

You May Qualify If

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Your plan is leaving your area or ending

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You move outside your plan’s service area

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You lose employer or union coverage

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You qualify for Extra Help or a Medicare Savings Program, or your Medicaid status changes

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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.

Prior Authorization and Referrals

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.

Emergency, Urgent and Out-of-Area Care

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.

Appeals and Complaints

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 2027 Part B Premium

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 December 7

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.

Telehealth

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.

Pros and Cons of Medicare Advantage

Advantages

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Often a low or $0 premium

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A yearly out-of-pocket maximum

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Drug coverage usually included

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Many plans may include dental, vision and hearing benefits

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One card and one plan

Tradeoffs

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Networks; HMOs require in-network care except emergencies

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Prior authorization and referrals are common

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Copays add up if you use a lot of care

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Plans and networks can change every year

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Switching to Medigap later may require health questions

Special Needs Plans

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

Turning 65 in 2027

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

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Sign up for Part A and Part B, unless you have qualifying employer coverage and choose to delay Part B

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Decide between Medicare Advantage and Original Medicare with Medigap

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Join a drug plan, or a Medicare Advantage plan with drugs, to avoid a Part D late penalty

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If you choose Medigap, buy during your six-month Medigap Open Enrollment Period

Star Ratings

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

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A rating of 4 stars or higher is generally a good sign of quality and service

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Five-star plans have a special enrollment period, so you can switch into one once during the year

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New plans may not have a rating yet, which is not a bad sign by itself

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Ratings measure the plan overall, not how well it covers your specific doctors and drugs

Getting Help

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

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Medicare Plan Finder on Medicare.gov, available any time

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1-800-MEDICARE (1-800-633-4227), available 24 hours a day, seven days a week

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Your State Health Insurance Assistance Program (SHIP), which offers free, unbiased counseling

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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.

Bottom Line

The Bottom Line

Medicare Advantage HMOs offer lower costs in exchange for network rules and referrals, and with PPO cuts for 2027 they will be the main choice in many counties. Confirm your doctors are in network and compare total costs during Annual Enrollment, October 15 to December 7, 2026.

Compare plans and enroll online

Frequently Asked Questions

➤ What is an HMO Medicare Advantage plan?

An HMO Medicare Advantage plan covers care from a network of providers, usually with lower costs, and requires in-network care except emergencies and urgent care. Many HMOs ask you to choose a primary care doctor who coordinates your care. HMOs may include extra benefits, but not all plans offer all benefits.

➤ Do HMOs require referrals?

Often, for specialists. Many HMOs require a referral from your primary care doctor before you see a specialist, but rules vary. Check each plan’s Evidence of Coverage or call the plan before you enroll so you know which services need a referral or prior authorization.

➤ Can I see out-of-network doctors with an HMO?

Generally not, except emergencies, urgent care and some dialysis. An HMO-POS may cover some out-of-network services, usually at a higher cost. If you want flexibility to see doctors outside a network, compare PPO plans, though several large insurers are cutting PPOs for 2027.

➤ Are HMOs cheaper than PPOs?

Usually, in premiums and copays. HMOs tend to cost less because you agree to use the plan’s network and follow its referral rules. Compare the out-of-pocket maximum, drug coverage and network for each plan, since the lowest premium is not always the lowest total cost.

➤ Why are there fewer PPOs for 2027?

Several large insurers are cutting PPOs for 2027: UnitedHealthcare 34, Humana 37, Aetna 20 and HCSC 48. As a result, HMOs may make up more of the options in some counties. If your PPO is ending, you will get a non-renewal notice and a Special Enrollment Period to choose a new plan.

➤ When can I enroll in a Medicare Advantage plan for 2027?

Annual Enrollment runs October 15 to December 7, 2026, with coverage starting January 1, 2027. If you are already in Medicare Advantage, you can also make one change from January 1 to March 31, 2027.

➤ What happens if my Medicare Advantage plan is ending?

You will get a non-renewal notice, and your coverage continues through December 31, 2026. You can choose a new plan during Annual Enrollment or a Special Enrollment Period, and you generally have a guaranteed issue right to buy certain Medigap plans.

Have Questions?

Speak with a licensed insurance agent

1-855-398-0716

TTY users 711

Mon-Fri: 8am-9pm ET

Find & Compare Plans Online

Speak with a licensed insurance agent

1-855-398-0716TTY 711

Mon-Fri: 8am-9pm ET

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