PPO Medicare Advantage in Brooklyn, NY

HMO vs. PPO Medicare Advantage in Brooklyn, NY: The Real 2026 Numbers

By Paul Barrett, CMIP | The Modern Medicare Agency | Melville, NY 18+ years Medicare-exclusive experience | Licensed in 37 states | 40+ carriers Last updated: July 2026

Here’s something almost nobody tells you when they explain HMO vs. PPO: nationally, insurance companies are pulling back from PPOs and pushing everyone toward HMOs. That’s a real, documented trend for 2026. But when I pulled the actual Kings County numbers, Brooklyn doesn’t fully follow the script — and one of the differences might surprise you.

If you’ve been told “HMOs are cheaper, PPOs are more flexible” and left it at that, you’ve got the general idea but not the Brooklyn-specific picture. Let’s fix that with real numbers, not talking points.

I’m independent — I represent more than 40 carriers, so nothing here is written to steer you toward one plan type over another. It’s written so you can see exactly what you’re choosing between.

KEY TAKEAWAYS

• Brooklyn has 13 HMO plans, 14 PPO plans, and 11 HMO-POS plans in 2026 — a far more even split than the national trend, where HMOs make up 57% of plans offered.
• PPOs actually average a lower monthly premium in Brooklyn ($22.99) than HMOs ($37.68) — the opposite of the common national assumption.
• Star ratings are nearly identical between the two: HMO plans average 3.54 stars, PPO plans average 3.57 stars, in Kings County for 2026.
• By enrollment, HMO-type plans (standard HMO + HMO-POS) still cover about 70% of Brooklyn’s traditional Medicare Advantage members, even though plan counts are close to even.
• Nationally, insurers are shifting new plan designs from PPO toward narrow-network HMO for 2026 due to cost pressures — a trend worth watching if you’re considering a PPO for the long term.

HMO AND PPO: WHAT ACTUALLY SEPARATES THEM

Before the numbers, the plain-English version, because this is where most of the confusion starts.

HMO (Health Maintenance Organization): You pick a network, and you generally stay in it. Most HMOs require a referral from your primary care doctor to see a specialist, and out-of-network care typically isn’t covered except in a real emergency. In exchange, HMOs are usually designed to run leaner and, in theory, cost less.

PPO (Preferred Provider Organization): You still have a network, but you’re not locked into it. You can see specialists without a referral, and you can go out-of-network for care — it’ll just cost more out of pocket when you do. That flexibility is the whole selling point.

HMO-POS (HMO Point-of-Service): A hybrid. It runs like an HMO day-to-day, but gives you a limited option to step outside the network for certain services at a higher cost. Brooklyn has 11 of these in 2026, and two of them happen to be the highest-rated plans in the entire county.

The theory says HMO = cheaper and more restrictive, PPO = pricier and more flexible. Brooklyn’s actual numbers only agree with half of that.

BROOKLYN HMO vs. PPO: FAST FACTS COMPARISON (2026)

Figures reflect Kings County, NY 2026 CMS-backed plan data (traditional/non-SNP Medicare Advantage). Confirm current details for your exact ZIP code at Medicare.gov’s Plan Finder before enrolling.

The premium surprise

Look at that table again. PPO plans in Brooklyn average $22.99 a month — over $14 cheaper than the average HMO. That runs counter to what most people expect walking in, and counter to the national pattern, where HMOs are generally the budget option. It’s not universal — you’ll still find $0 HMOs and pricier PPOs in the mix — but as a category average, PPO wins on price here.

Why? A lot of it comes down to which carriers are competing hardest for Brooklyn business and how they’ve priced their local networks against Manhattan’s major hospital systems. Aetna alone runs five of Brooklyn’s PPO plans, several at $0 or near-$0 premium, and that volume pulls the PPO average down.

The star rating surprise

The “HMOs sacrifice quality for savings” narrative doesn’t hold up here either. HMO plans average 3.54 stars, PPOs average 3.57 — essentially a tie. The two 5-star plans in Brooklyn are actually HMO-POS plans (Anthem Veteran 2 and Anthem Medicare Advantage 2), and the next tier of 4.5-star plans is a mix of both Healthfirst HMOs and Aetna PPOs.

ENROLLMENT: WHERE BROOKLYN RESIDENTS ARE ACTUALLY CHOOSING

Plan count is close to even. Plan enrollment is not.

• HMO + HMO-POS combined: 46,707 members (70.4%)
• PPO: 19,631 members (29.6%)

Even though Brooklyn offers roughly the same number of HMO and PPO plans, people are enrolling in HMO-type plans at more than double the rate of PPOs. Some of that is inertia — Healthfirst’s 65 Plus Plan alone (HMO) has over 13,000 members, more than every PPO plan in the county combined except Aetna Medicare Elite. Some of it reflects that several of Brooklyn’s most heavily marketed $0-premium plans happen to be HMOs.

THE NATIONAL TREND: WHY HMOs ARE GAINING GROUND EVERYWHERE

Here’s the piece that matters if you’re thinking long-term, not just about this year’s enrollment.

<cite index=”7-1″>HMOs still make up the majority — 57% — of plan offerings in the non-SNP Medicare Advantage market nationally</cite>, and <cite index=”10-1″>CMS enrollment data through mid-2026 shows HMO enrollment growing roughly 4.8% year-over-year while PPO enrollment has actually declined slightly over the same period</cite>. Industry analysts point to a straightforward reason: <cite index=”3-1″>insurers are shifting plan designs from PPOs toward narrower-network HMOs for 2026, since HMOs are considered better positioned to absorb the cost pressures the industry is currently facing</cite>.

At the same time, it’s not a total abandonment of PPOs. <cite index=”7-1″>PPO plan offerings have contracted meaningfully in 2026, but PPO enrollment itself has remained relatively stable</cite> — <cite index=”7-1″>it seems many seniors still prefer the broader networks and fewer restrictions that come with a PPO, even as insurers try to steer the market toward HMOs</cite>.

What this means for Brooklyn specifically: the county’s current near-even HMO/PPO split shouldn’t be taken for granted going forward. If national carrier strategy continues favoring HMO plan designs, Brooklyn’s PPO options could shrink in future plan years the way they already have in some other markets. If having a PPO’s flexibility matters to you — especially if you split time between Brooklyn and another state, or want the freedom to see specialists at Manhattan academic medical centers without a referral — it’s worth locking that in sooner rather than later, and revisiting it every Annual Enrollment Period rather than assuming it’ll still be there.

WHY YOUR NETWORK CHOICE MATTERS MORE IN BROOKLYN RIGHT NOW

Brooklyn residents currently have a couple of live, real reasons to think carefully about network flexibility instead of defaulting to whichever plan has the lowest premium:

• UnitedHealthcare and NewYork-Presbyterian are in an active contract dispute, with in-network access extended only through July 31, 2026. This directly touches Brooklyn: NewYork-Presbyterian Brooklyn Methodist Hospital and its Brooklyn Medical Group practices are named among the facilities that would go out-of-network — not just Manhattan campuses. If no new agreement is reached, all of these become out-of-network for most UHC Medicare Advantage members starting August 1, 2026. An HMO member in that situation loses access outright; a PPO member can still go out-of-network at a higher cost.
• Anthem and Mount Sinai already went through exactly this in 2026, and it shows how fast it can happen. When their contract lapsed, Mount Sinai’s entire system — including Mount Sinai Brooklyn — went out-of-network for all Anthem Blue Cross Blue Shield members starting March 4, 2026. A new three-year agreement was reached about six weeks later, restoring in-network access retroactively effective April 13, 2026. The dispute is resolved now, but for those six weeks, Anthem members with Mount Sinai doctors lived the exact scenario this section is warning about.
• HealthSpring terminated its Northwell Health network relationship on Long Island effective December 31, 2025 — a reminder that a carrier’s network relationship with a specific hospital system can change with little warning, even mid-plan-year.

This is exactly the kind of situation where the HMO-vs-PPO decision stops being theoretical. An HMO can lock in a lower premium and work perfectly well for years — until the one specialist or hospital system you rely on falls out of network, and you have no fallback option built into the plan itself. A PPO member in the Anthem/Mount Sinai situation could have kept seeing their doctor out-of-network at a higher cost during those six weeks; an HMO member generally could not have, outside of emergency care.

WHO ACTUALLY FITS EACH PLAN TYPE

An HMO tends to make sense if:

• You have a primary care doctor and specialists already within one of Brooklyn’s major networks (Maimonides, NYU Langone Brooklyn, Mount Sinai Brooklyn, SUNY Downstate) and don’t anticipate needing care outside it.
• Lower monthly cost matters more than out-of-network flexibility.
• You’re comfortable getting referrals before seeing specialists.

A PPO tends to make sense if:

• You split time between Brooklyn and another location — a second home, snowbird arrangement, or family elsewhere in the country — and want coverage that travels with you at a predictable (if higher) out-of-network cost.
• You want direct access to specialists without waiting on a referral.
• You’re currently affected by, or want to hedge against, a network dispute like the UnitedHealthcare/NewYork-Presbyterian situation above.
• You have a specific specialist or academic medical center relationship you’re not willing to risk losing to a network change.

HMO-POS is worth a look if: you like the lower typical cost structure of an HMO but want a limited safety valve for occasional out-of-network care, rather than an all-or-nothing network commitment. Two of Brooklyn’s three 5-star-caliber plans are HMO-POS, which is worth knowing if star rating is a priority for you.

PAUL’S HONEST TAKE

I’ll be straight with you: the “HMO is always cheaper” line people repeat isn’t true in Brooklyn right now, and I think that surprises even some agents. What I actually care about when I sit down with someone isn’t the plan type in the abstract — it’s whether their specific doctors and hospital are solidly in-network, and whether that network relationship looks stable for the year ahead. A $0 HMO premium doesn’t mean much if the hospital you count on falls out of network next year and you have zero flexibility to go around it. That’s the conversation worth having before you enroll in either type.