Types of Medicare Advantage Plans in Arizona

Medicare Advantage plans come in several types, and the type tells you how the network works. HMOs generally require you to use the plan's doctors and often need referrals. HMO-POS plans add some out-of-network coverage. PPOs 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. According to the CY2027 CMS Landscape file, Maricopa County's 52 standard Advantage plans are 29 HMOs, 14 PPOs, 7 HMO-POS plans and 2 Regional PPOs, with 40 more Special Needs Plans on top.

HMO and HMO-POS plans

In most HMO plans you can only use doctors, other providers and hospitals in the plan's network, except for emergencies, urgent care when you are out of the area, and temporary out-of-area dialysis. You usually choose a primary care doctor, and you may need a referral to see a specialist.

HMOs often have the lowest copays and out-of-pocket maximums. In the CY2027 CMS Landscape, Maricopa County HMOs average an out-of-pocket maximum of about $4,305, compared with about $6,046 for PPOs. The trade-off is less flexibility: if your doctor leaves the network, you generally need to change doctors or change plans at the next opportunity.

An HMO with a point-of-service option (HMO-POS) works like an HMO but lets you get some services out of network, usually at a higher cost. What is covered out of network varies a lot from plan to plan, so read the Evidence of Coverage rather than assuming. Maricopa County has 7 HMO-POS plans and Pinal County 6 for 2027 (CY2027 CMS Landscape).

Preferred Provider Organization (PPO)

In a PPO you pay less when you use network providers and more when you go out of network, but out-of-network care is covered. You usually do not need referrals. PPOs suit people who want a safety valve, such as a specialist outside the network or care while spending time in another state.

PPOs have two maximums: one for in-network care and a higher combined one for in-network and out-of-network care together. Both counties have 14 local PPOs for 2027, and both also have 2 Regional PPOs, which cover a wider multi-state region (CY2027 CMS Landscape).

Local plan types for 2027 at a glance

Special Needs Plans (SNPs)

Special Needs Plans limit membership to people with specific needs and tailor their benefits, doctors and drug lists to those groups. There are three kinds:

• Dual-eligible SNPs (D-SNPs) for people who have both Medicare and AHCCCS (Arizona Medicaid). Maricopa and Pinal each have 10 D-SNPs for 2027.
• Chronic condition SNPs (C-SNPs) for people with specific conditions such as diabetes, chronic heart failure or cardiovascular disorders. Maricopa has 25 and Pinal 14 for 2027.
• Institutional SNPs (I-SNPs) for people who live in, or need the level of care of, a nursing facility. Maricopa has 5 for 2027; the CY2027 Landscape lists none in Pinal.

Private Fee-for-Service (PFFS) and Medical Savings Account (MSA) plans

A PFFS plan sets how much it pays providers and how much you pay. Some PFFS plans have networks; with others, you can see any Medicare-approved provider who agrees to the plan's terms, which they can decide visit by visit. The CY2027 Landscape data for Maricopa and Pinal shows no PFFS plans in the standard plan list.

An MSA plan pairs a high-deductible plan with a bank account that Medicare deposits money into each year. You use the account for care before the deductible is met. MSAs do not include drug coverage, so you add a standalone Part D plan. For 2027, CMS caps the MSA deductible at $18,900 (CMS CY2027 Rate Announcement).

Choosing a type that fits how you get care

Plan types describe the rules, but networks and benefits are set plan by plan and change every January. Before you enroll, read the plan's Summary of Benefits and check the provider directory and drug list. Rise Up Benefits Group can walk you through the plans we offer in your county; for every plan in your area, use Medicare.gov or call 1-800-MEDICARE.

Keep the plan documents that arrive in the fall. The Annual Notice of Change lists what is different next year, and the Evidence of Coverage is the full contract. Those two documents settle most questions about what a plan type really allows.

• If your doctors are all in one health system and you rarely travel, an HMO built around that system may give you lower copays.
• If you want the option to see someone out of network, or you split time between Arizona and another state, look at PPOs and compare their out-of-network costs.
• If you have AHCCCS, a qualifying chronic condition or live in a care facility, ask whether a Special Needs Plan would coordinate your care better.
• Whatever the type, check every doctor and every prescription before you enroll. The type tells you the rules; the network and formulary tell you whether the plan works for you.

Star ratings and what they tell you

Medicare rates plans from 1 to 5 stars each year on quality of care, member experience, customer service and drug plan performance. Ratings for 2027 are not yet loaded, so the figures here are 2026 star ratings attached to the CY2027 plans in the CMS Landscape file.

In Maricopa County, 15 of the 52 standard Medicare Advantage plans carry a 2026 rating of 4 stars or more, and 12 of them are rated 4.5. In Pinal County the figures are 13 and 12. No plan in either county is rated 5 stars, and 12 Maricopa plans and 10 Pinal plans are too new or too small to be rated.

Stars are a useful signal, not a verdict. A 4.5-star plan whose network leaves out your cardiologist is still the wrong plan for you. Use stars to break ties between plans that already fit your doctors and drugs.

Questions to ask about any Advantage plan

• Are my primary care doctor, my specialists and my preferred hospital in network for 2027?
• Do I need referrals to see specialists, and which services need prior authorization?
• What is the in-network out-of-pocket maximum, and for a PPO, the combined maximum?
• What are the copays for specialist visits, outpatient surgery, imaging, and a hospital stay?
• Are all my prescriptions on the formulary, on which tiers, and is my pharmacy preferred?
• What happens when I travel within the U.S.: is routine care covered, or only emergencies and urgent care?
• How do the dental, vision and hearing benefits actually work: dollar limits, networks, and waiting periods?

---

The bottom line

The plan type tells you how much freedom you have and what it costs. HMOs trade flexibility for lower costs, PPOs trade higher costs for out-of-network coverage, and Special Needs Plans focus on specific groups. In Maricopa and Pinal for 2027 most plans are HMOs and PPOs, so start with your doctors and your travel, then narrow down by type.