In most of the country this is a preference. In New York it is often decided by your county before you get a say. CDPHP sells HMO plans only. Excellus sells HMO and HMO-POS in the Rochester region and PPOs everywhere else. MVP sells both across most of its footprint. Downstate, both types are widely available.
HMO AND HMO-POS
You use the plan’s network and name a primary care doctor who coordinates referrals. Out-of-network care is generally not covered except in an emergency. HMO-POS plans allow some out-of-network care at a higher cost share, usually with its own yearly limit. In exchange, these plans carried the lowest out-of-pocket maximums in New York in 2026 — as low as $6,000 on one MVP plan. See our guide to Medicare Advantage HMO plans 2027.
PPO
You can see out-of-network providers without a referral, at a higher cost share. Every PPO carries two spending caps: one for in-network care and a higher combined cap for in-network and out-of-network together. The combined figure ran as high as $13,900 on New York PPOs in 2026, and it is the number most people never check. See our guide to Medicare Advantage PPO plans.
Snowbirds and second homes. If you spend part of the year outside New York, an HMO is the harder fit. Emergency care travels with you on any plan, but routine care generally does not. A PPO, or a plan with a national network, is usually the better trade.
Upstate New York took an unusual hit. A 2023 change to the Medicare wage index lowered hospital payment rates in the region, and the regional not-for-profit plans absorbed most of it. Excellus says that change alone costs it about $100 million a year. CDPHP cited the same issue when it cut its service area from 33 counties to 18 and dropped its PPO plans entirely. MVP pointed to rising costs plus the new cap on member drug spending, which shifts drug costs from members onto plans.
If you are upstate, check that your plan still exists. This is not the usual advice to compare plans. Three of the largest upstate carriers narrowed their lineups or service areas in a single year, and your Annual Notice of Change, mailed by September 30, is what tells you whether yours survived.
There is also a merger in progress. CDPHP and Excellus now share a parent company, and a full merger of CDPHP into Excellus Health Plan is planned for early 2027 subject to New York State approval. Both have said CDPHP keeps its local brand for most members. For your coverage, what matters is the specific plan sold in your county, not the corporate structure above it.
