Medicare Advantage Plan Types: HMO, PPO, Special Needs Plans and Star Ratings
Every Advantage plan caps your yearly costs, but the plan type decides which doctors you can see and what happens out of network. Here is how HMOs, PPOs and the other types differ, who Special Needs Plans are for, and what the star ratings measure.
The plan types
| Type | Out-of-network care | Referrals | Fits |
|---|---|---|---|
| HMO | Not covered, except emergencies, urgent care and out-of-area dialysis | Usually needed for specialists | People happy with the plan’s doctors who want the lowest premiums |
| HMO-POS | Some services covered out of network, at a higher cost | Usually needed | HMO pricing with a little flexibility |
| PPO | Covered at a higher cost, with a higher combined out-of-pocket limit | Usually not needed | People who travel, split the year between homes, or want to keep a doctor outside the network |
| PFFS | Any Medicare provider that accepts the plan’s terms; the provider decides at each visit | Not needed | Rural areas with few networks |
| MSA | A high-deductible plan with no network plus a savings account the plan funds; no drug coverage | Not needed | Rarely the best choice; you need a separate Part D plan |
Our rankings by state show each plan’s type next to its in-network out-of-pocket maximum. For a PPO, the worst case if you use out-of-network care is higher: up to $14,800 in 2027.
Special Needs Plans
Special Needs Plans (SNPs) limit membership to people with particular needs and tailor their networks, benefits and drug lists to them. Every SNP includes Part D drug coverage. You can stay in one only while you still meet its rules.
| Type | Who can join |
|---|---|
| D-SNP (dual-eligible) | People with both Medicare and Medicaid. The plan works with your state Medicaid program. |
| C-SNP (chronic condition) | People with specific severe or disabling chronic conditions, such as diabetes, chronic heart failure, end-stage renal disease, cancer, dementia, stroke or chronic lung disease. |
| I-SNP (institutional) | People who live, or are expected to live, at least 90 days in a nursing home or similar facility, or who need that level of care at home. |
People with both Medicare and full Medicaid can join or switch to an integrated D-SNP once a month, and anyone with Extra Help can switch stand-alone Part D plans once a month. Our rankings list general-audience plans only, because SNP eligibility depends on your situation; find SNPs in your area in the Medicare Plan Finder.
What star ratings measure
CMS rates each Advantage and Part D contract from 1 to 5 stars on measures of care quality, member experience, complaints, customer service and, for drug plans, drug safety and pricing accuracy. The 2027 ratings, released October 8, 2026, are the ones shown during this fall’s enrollment.
- 188 Advantage drug-plan contracts (37%) earned 4 stars or more, and 15 earned 5.
- Weighted by enrollment, the average is 3.99 stars, down from 4.01.
- Ratings are per contract, so many plans from one insurer share a rating. They measure quality, not cost.
A 5-star plan opens a special window. You can switch into a 5-star Advantage or Part D plan once between December 8 and November 30 of the following year. See switching Advantage plans after January 1.
Questions
Is a PPO better than an HMO?
Not automatically. A PPO covers out-of-network care, but its premium and out-of-pocket limits are often higher. If all your doctors are in an HMO’s network and you don’t travel much, compare the HMO’s worst-case year first.
Do all Advantage plans include drug coverage?
Most do. If you pick an MSA plan or a PFFS plan without drugs, you can add a stand-alone Part D plan. With other plan types that don’t include drugs, you generally can’t, so you need creditable drug coverage from elsewhere (such as the VA) to avoid a late penalty.
Can I join a D-SNP if I only get help with my Part B premium?
Some D-SNPs accept people with partial Medicaid benefits, such as a Medicare Savings Program; others require full Medicaid. Each plan sets which groups it takes.
Sources
Official sources only, checked October 22, 2026.
- Medicare.gov, “Compare Medicare Advantage plan types” — medicare.gov; “Special Needs Plans” — medicare.gov.
- Medicare.gov, “Special Enrollment Periods” (monthly dual and Extra Help windows, 5-star window) — medicare.gov.
- CMS, 2027 Medicare Advantage and Part D Star Ratings fact sheet — cms.gov.
- CMS, CY 2027 maximum out-of-pocket limits.
Educational information, not a recommendation to join any plan. We are not an insurance agent or broker, and we are not connected with or endorsed by the U.S. government or the federal Medicare program. · Advertiser disclosure