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CDPHP Medicare Advantage Plans 2027

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

CDPHP offers Medicare Advantage plans for 2027 in New York’s Capital Region and surrounding counties, and we found no report of CDPHP leaving Medicare Advantage for 2027.

CDPHP (Capital District Physicians’ Health Plan) is a nonprofit health plan based in Albany, New York, founded by local physicians. Its Medicare Advantage plans include HMO and PPO options in its service area.

New York’s 2027 market is shifting, with HCSC leaving and Devoted entering. New Yorkers can also buy Medigap year-round. See compare 2027 Medicare Advantage plans in New York.

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

Key Highlights

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CDPHP is a nonprofit plan based in Albany, New York.

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CDPHP offers HMO and PPO Medicare Advantage plans in its service area.

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New York allows Medigap enrollment year-round.

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

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Annual Enrollment runs October 15 to December 7, 2026.

Compare plans and enroll online

CDPHP Plan Types

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

Benefits CDPHP Plans May Offer

CDPHP 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.

CDPHP Medicare Advantage Plans

What Changed for 2027

Key Takeaway

CDPHP adjusts its plans every year. Read your 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.

Find & Compare Plans Online

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CDPHP vs Other Upstate Options

Option What to Know
CDPHP Capital Region nonprofit plan
MVP Health Care Upstate New York and Vermont
Excellus BlueCross BlueShield Much of Upstate New York
National insurers Humana, UnitedHealthcare, Aetna in many counties
Original Medicare + Medigap Available year-round in New York

New York Help: HIICAP and EPIC

HIICAP offers free Medicare counseling in New York; EPIC helps eligible residents 65 and older with drug costs alongside Part D.

How to compare a UnitedHealthcare plan in Illinois: network, prescription drug costs and enrollment

How Medicare Advantage Works

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, CDPHP 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.

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

CDPHP Drug Coverage for 2027

Most CDPHP 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

1

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.

2

Ask your doctor about alternatives. A covered drug in the same class may work as well and cost less.

3

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.

4

Appeal a denial. If the plan says no, you can appeal, and there are several levels of review.

See steps to appeal a Medicare Part D denial.

If Your Plan Is Ending

If your CDPHP 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.

How to Compare CDPHP Plans for 2027

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.

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.

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

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

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.

Help Paying Medicare Costs

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

Medicare Savings Programs

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Run by your state Medicaid office

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Can pay your Part B premium, and sometimes deductibles and coinsurance

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Income and asset limits vary by state

Extra Help (Part D)

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Run by Social Security

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Lowers Part D premiums, deductibles and copays

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People in a Medicare Savings Program qualify automatically

If you qualify for both Medicare and full Medicaid, you may also be able to join a Dual Special Needs Plan. See help for low-income Part D beneficiaries.

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

CDPHP offers Medicare Advantage plans in New York’s Capital Region for 2027. Confirm your doctors and drugs, compare with MVP, Excellus and national insurers, and enroll during Annual Enrollment, October 15 to December 7, 2026.

Compare plans and enroll online

Frequently Asked Questions

➤ What is CDPHP?

CDPHP is Capital District Physicians’ Health Plan, a nonprofit health plan based in Albany, New York. It offers Medicare Advantage plans in its New York service area, so check whether CDPHP plans are available in your county for 2027.

➤ Where does CDPHP offer Medicare Advantage?

CDPHP offers Medicare Advantage in the Capital Region and surrounding counties in New York. Availability is county by county, so search your ZIP code in Medicare Plan Finder to confirm which CDPHP plans you can join for 2027.

➤ Is CDPHP leaving Medicare Advantage?

We found no report of CDPHP leaving Medicare Advantage for 2027. Still, check your Annual Notice of Change for changes to premiums, copays, drugs or networks, and watch for a non-renewal letter if your specific plan is not continuing.

➤ Can I switch from CDPHP to Medigap?

Yes. New York allows Medigap enrollment year-round without health questions, so you can move from a CDPHP Medicare Advantage plan back to Original Medicare and buy a Medigap plan. Remember to add a standalone Part D plan, since Medigap does not include drug coverage.

➤ Do CDPHP plans include dental and vision?

Many CDPHP Medicare Advantage plans may include dental, vision and hearing benefits, but not all plans offer all benefits. Amounts, limits and networks vary by plan, so review the 2027 plan details before you enroll.

➤ When can I enroll in a CDPHP 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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