Types of Medicare Advantage Plans: HMO, PPO, SNP and More

Medicare Advantage plans come in several types, and the type decides how you use doctors. HMO plans require you to use the network and usually need referrals for specialists. HMO-POS plans add some out-of-network coverage. PPO plans let you go out of network for a higher cost. Special Needs Plans are built for people with Medicaid, certain chronic conditions, or who live in a facility. In Camden County for 2027, the CMS Landscape file lists 25 PPO, 8 HMO-POS and 7 HMO plans and 1 Regional PPO, plus 13 Special Needs Plans. Every type includes your Part A and Part B benefits and a yearly out-of-pocket maximum.

The plan types compared

Source: CMS Medicare Advantage and Part D Landscape, contract year 2027 (New Jersey counties).

HMO and HMO-POS plans

With an HMO (health maintenance organization) you pick a primary care doctor who coordinates your care, and you use doctors, hospitals and pharmacies in the plan network. Outside emergencies and urgent care, out-of-network care is generally not covered. That trade usually buys lower copays.

An HMO-POS (HMO with a point-of-service option) works the same way but lets you use some out-of-network services, often at a higher copay. The details differ a lot between plans, so read the Evidence of Coverage, the plan's full rule book, for what the point-of-service benefit includes.

PPO plans

A PPO (preferred provider organization) has a network, but it also pays for covered care from out-of-network providers who accept Medicare, at a higher share of the cost. You usually do not need referrals. PPOs list two out-of-pocket maximums: one for in-network care and a higher combined one for all care.

PPOs suit people who see specialists in different health systems, including across the river in Philadelphia, or who want some flexibility when traveling. They are the most common standard plan type in Camden County for 2027: 25 of the 41 standard plans, plus one Regional PPO, a PPO that covers a multi-state region rather than a single county list (CMS CY2027 Landscape).

Special Needs Plans

Special Needs Plans limit enrollment to people with specific needs and tailor benefits and care coordination to them. In Camden County for 2027 there are 13 (CMS CY2027 Landscape, via THE BRAIN):

• Dual-eligible SNPs (D-SNPs): for people with both Medicare and NJ FamilyCare (New Jersey Medicaid). Camden County has 5.
• Chronic condition SNPs (C-SNPs): for people with specific conditions such as diabetes, heart failure or chronic lung disease. Camden County has 5.
• Institutional SNPs (I-SNPs): for people who live, or are expected to live, 90 days or more in a nursing facility, or who need that level of care at home. Camden County has 3.

Plans with and without drug coverage

Most Medicare Advantage plans include Part D. In Camden County, 34 of the 41 standard plans for 2027 include drug coverage and 7 do not. Plans without drug coverage are often chosen by veterans who get prescriptions through the VA, or by people with other creditable drug coverage, such as retiree coverage that pays at least as well as Medicare's standard benefit. If you choose one without other creditable coverage, you risk the Part D late penalty, and you generally cannot add a standalone Part D plan to an HMO or PPO.

A useful detail: the lowest in-network maximum in Camden County, $4,150, belongs to a plan without drug coverage. Among plans that do include drug coverage, the lowest maximum anywhere in New Jersey for 2027 is $4,500. Compare like with like.

How the types show up across South Jersey

Plan counts below are standard Medicare Advantage plans, not counting Special Needs Plans, from the CMS CY2027 Landscape file.

Source: CMS Medicare Advantage and Part D Landscape, contract year 2027 (New Jersey counties).

A worked example: the out-of-network specialist

A hypothetical case shows why type matters more than premium. Say you see a cardiologist whose practice is not in a plan network. In an HMO, routine visits to that cardiologist are generally not covered at all, and what you pay does not count toward the in-network maximum, so the maximum does not protect you from that bill. In an HMO-POS, it depends on what the point-of-service benefit covers. In a PPO, the visit is covered at the out-of-network cost share and counts toward the combined maximum.

Now flip it. If every doctor you use is inside one network, an HMO with a low maximum can be the least expensive hard year. A low-cost plan on paper only stays low-cost if your doctors are in it.

Special Needs Plans: who qualifies and when you can join

Special Needs Plans are only open to people who meet the plan's condition, and the plan checks. A dual-eligible plan verifies your NJ FamilyCare or Medicare Savings Program status; a chronic condition plan asks your doctor to confirm the diagnosis; an institutional plan applies to people in, or needing the level of care of, a nursing facility.

Timing works differently too. People with Medicaid or Extra Help have Special Enrollment Periods to change coverage outside the fall window, and a chronic condition plan can generally be joined when you are diagnosed with a qualifying condition. Our Medicare and NJ FamilyCare guide explains the dual-eligible rules in detail.

PACE: an option next to Medicare Advantage

Programs of All-Inclusive Care for the Elderly (PACE) are not Medicare Advantage plans, but families often weigh them alongside one. A PACE organization provides and coordinates all of a person's Medicare and Medicaid care, usually through a day center, so an older adult who needs daily help can stay at home. In New Jersey, PACE is only available in certain counties (NJ FamilyCare 2026 Aged, Blind, Disabled brochure). Your county Office on Aging, reachable through the statewide line 1-877-222-3737, can tell you whether a PACE program serves your ZIP code.

What Jackie checks for you

• Each of your doctors, by name and office location, in the 2027 directory of each plan, and whether a PPO would cover them out of network.
• Your hospital, for both planned stays and the nearest emergency room.
• Referral and prior authorization rules for the specialists and services you use most.
• The in-network maximum and, for PPOs, the combined maximum.
• Whether you qualify for a Special Needs Plan, and if you have NJ FamilyCare, how a D-SNP coordinates the two.

How to choose a type

• If your doctors all work within one health system and you are fine with referrals, an HMO may give you the lowest copays.
• If you see specialists in different systems, or want out-of-network coverage, look at PPOs.
• If you have NJ FamilyCare, ask whether a D-SNP coordinates your benefits better than a standard plan.
• In every case, check your specific doctors and drugs against the specific plan, not just the plan type.

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The bottom line

The plan type tells you how the network works: HMO for lower costs inside a network, HMO-POS for a little flexibility, PPO for more freedom at a higher cost, and Special Needs Plans if you qualify. In Camden County, all of these are offered for 2027, along with 13 Special Needs Plans. Bring Jackie your doctor list and she will check which plans actually include them: (856) 727-4221.