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 Adams County for 2027, the CMS Landscape file lists 14 PPO, 12 HMO-POS and 10 HMO plans, plus 28 Special Needs Plans. Every type includes your Part A and Part B benefits and a yearly out-of-pocket maximum.

The plan types compared

HMO and HMO-POS plans

With an HMO 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 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 for what the point-of-service benefit includes.

PPO plans

A PPO 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 a specialist outside a single health system, or who want some flexibility when traveling. They are the most common standard plan type in both Adams County (14 plans) and Weld County (12 plans) for 2027.

Special Needs Plans

Special Needs Plans limit enrollment to people with specific needs and tailor benefits and care coordination to them. In Adams County for 2027 there are 28 (CY2027 CMS Landscape):

• Dual-eligible SNPs (D-SNPs): for people with both Medicare and Health First Colorado (Colorado Medicaid). Adams County has 19.
• Chronic condition SNPs (C-SNPs): for people with specific conditions such as diabetes, heart failure or chronic lung disease. Adams 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. Adams County has 4.

Plans with and without drug coverage

Most Medicare Advantage plans include Part D. In Adams County, 31 of the 36 standard plans for 2027 include drug coverage and 5 do not. Plans without drug coverage are often chosen by veterans who get prescriptions through the VA, or people with other creditable drug coverage. 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.

What each type costs in Adams County for 2027

Plan type is not just about networks; it shows up in the numbers. These are the 36 standard Medicare Advantage plans filed for Adams County in the CMS CY2027 Landscape file (Special Needs Plans counted separately). The maximum is the in-network out-of-pocket maximum for medical care.

One plan of each type, as examples

To make the types concrete, here is one 2027 Adams County plan of each kind from the CMS CY2027 Landscape file. These are examples to show how the numbers read, not recommendations, and star ratings in parentheses are 2026 ratings for the same contract and plan ID.

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 $4,450 maximum in the example HMO 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, the HMO-POS in the table has the lowest maximum of the four, $3,600, and a hard year would cost $576 in premiums plus at most $3,600 for medical care, $4,176 in all before drugs. The cheapest choice on paper is only cheapest if your doctors are in it.

What I check 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, such as Intermountain Health Platte Valley Hospital in Brighton.
• 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 Health First Colorado, how a D-SNP coordinates the two.

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 Health First Colorado 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. For 2027 the CMS Landscape file lists 28 Special Needs Plans in Adams County (19 dual-eligible, 5 chronic condition, 4 institutional) and 22 in Weld County (16 dual-eligible, 4 chronic condition, 2 institutional).

Timing works differently too. People with Health First Colorado or Extra Help have a Special Enrollment Period to change drug 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 Health First Colorado 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 people often weigh them alongside one. Health First Colorado (HCPF) lists the requirements: you are 55 or older, need a nursing facility level of care, live in a PACE service area, and can live safely in the community with PACE support. A PACE organization then provides and coordinates all of your Medicare and Health First Colorado care. If a parent needs daily help but wants to stay at home, ask HCPF or your county about the PACE program that serves your ZIP code.

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 Health First Colorado, 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. Near Brighton, all three standard types are offered for 2027, along with 28 Special Needs Plans in Adams County. Bring us your doctor list and we will check which plan types actually include them.