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For Florida individuals and families · Licensed in 20 U.S. states

HMO health insurance,
explained.

An HMO, or health maintenance organization, keeps your care inside a group of doctors and hospitals it works with, and a primary doctor often steers you to everyone else. If you buy your own plan in Florida, you'll meet a lot of them: in the state's 2027 individual ACA filings, 13 of the 15 companies list an HMO network. Here's what that means when you pick one.

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How an HMO works

Three rules that shape
every HMO.

HealthCare.gov describes an HMO by a few features. Each plan's own contract sets the details:

A network you stay inside.

The plan pays for care from its own doctors, hospitals, and other contracted providers. Routine visits outside that group are generally not covered, so the provider directory is the first thing to read.

A primary doctor at the center.

Many HMOs want a referral, a written order from your primary care doctor, before you see a specialist or get certain services. Skip it and the plan may not pay. HMOs often focus on prevention and wellness and coordinate your care through that doctor.

A service area tied to your address.

An HMO may require you to live or work in its service area to join. That area is also generally where you get routine, non-emergency care, and the plan may end your coverage if you move out of it.

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Florida HMO rules

Protections Florida law writes into HMO contracts.

These points summarize Florida Statutes s. 641.19, Florida Statutes s. 641.31, and Florida Statutes s. 641.51, read October 29, 2026. Federal rules and each plan's contract add more.

A woman can choose an in-network OB-GYN as her primary physician, as long as that doctor has agreed to serve as one.
If an HMO offers dermatology, it must let you see a contracted dermatologist for office visits and minor procedures without a referral. The plan may limit that to five visits in 12 months for a skin problem.
You have a right to a second medical opinion when you dispute whether surgery is reasonable or necessary, or when you face a serious injury or illness. If you pick a non-contract doctor in the service area, the HMO may make you pay up to 40% of the usual and customary charge for that opinion.
The contract must say that emergency care is provided without prior approval when the emergency doesn't allow treatment through the HMO's own providers.

HMOs in Florida

HMOs in Florida's
2027 individual filings.

13 of 15

Companies in the state's 2027 individual ACA rate table that list an HMO network.

567

Plans offered by those 13 companies, out of 647 individual ACA plans in the state's 2027 plan count.

HMO companies listed as selling both on and off the federal exchange. Two more sell off the exchange only.

Figures come from two state documents dated October 16, 2026: the Florida Office of Insurance Regulation, Individual PPACA Market Monthly Premiums for Plan Year 2027 (rate table) and the Florida Office of Insurance Regulation, Individual Market Health Insurance Plan Distribution by Company (2027) (plan count). We added up the plans of each company that lists an HMO network. Florida notes these 2027 rates were not yet reviewed or finalized by HHS, so treat the numbers as preliminary.

Paul DanielsLicensed health advisor · NPN 20986580

Working with Paul

Help choosing the HMO
and the doctor in it.

Daniels Health Advisors is the independent brokerage Paul Daniels founded, licensed in 20 U.S. states. With an HMO, the doctor list decides almost everything. We search your current doctors, the hospital you would want, and your pharmacy in each HMO sold for your ZIP code, and we note which plans ask for referrals before specialist visits. When an HMO's network is too tight for you, we also show the other network types sold where you live, and private PPO options outside the Marketplace. Some private plans ask health questions, and approval is not guaranteed. Some may not cover care for health problems you had before you enrolled.

Bring the names of your doctors and specialists, any referral you already have, and the county where you live and the one where you work.

Your doctors searched in every HMO we compare
Licensed in 20 U.S. states · Paul Daniels, NPN 20986580 · FL license G065122
You do not pay us for our help. We are paid by the insurance companies when you enroll. Your price for a plan is the same whether you use us or sign up on your own. Commissions can differ by company.

Your first call

Choosing an HMO in three steps.

Name your doctors

Primary care, specialists, and the hospital you trust.

We check each HMO

Network, referral rules, and service area for your ZIP code.

Weigh the trade-off

Premiums after any tax credit next to the doctors you keep.

Book a 15-minute call

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Before you need a specialist

Pick your primary doctor
before you need one.

In an HMO, your primary care doctor is usually the route to everyone else. Choose one who is taking new patients, and ask how the office handles referrals before you need a specialist. If you split time between two counties, check that the service area covers where you actually get care. And if a specialist is part of your routine, ask the plan how long a referral stays valid. After the call you will have:

A short list of HMOs that include your doctors
The referral rule for each plan
A service area check for home and work
Premiums after any tax credit

A checklist for

Comparing HMO plans.

Search each doctor and hospital in the HMO's provider directory, then call the office to confirm.
Find out which specialists need a referral and which don't.
Check that the service area covers where you live and work.
Look up your prescriptions on the plan's drug list.

HMO questions

HMO health insurance FAQ.

What is an HMO in health insurance?

It stands for health maintenance organization: a plan that mostly pays only for care from providers employed by or under contract with it. Outside that network it generally pays only for emergencies, and it can require members to live or work in the area it serves.

Do I need a referral to see a specialist in an HMO?

Often, yes. Many HMOs won't pay for a specialist visit unless your primary care doctor wrote a referral first. In Florida, an HMO that offers dermatology must let you see a contracted dermatologist without one, and a woman can choose an in-network OB-GYN who agrees to serve as her primary physician.

Are HMO plans cheaper?

Not always. The monthly price depends on the company, the metal level, your age, and your ZIP code. Compare the premium after any tax credit along with the deductible and the doctors each plan includes.

Does an HMO cover emergencies?

Yes. Emergencies are the exception to the network rule, and Florida law requires HMO contracts to state that emergency care is provided without prior approval when you can't be treated through the plan's own providers. The plan may still charge its usual cost sharing.

Can I keep my doctor with an HMO?

Only if your doctor is in that HMO's network. Search the provider directory for each doctor before you enroll and again before a planned procedure, because networks can change.

Do I have to wait for open enrollment?

Not for every plan. A private plan (not from the Marketplace) can often be bought any time of year. Some private plans ask health questions, and approval is not guaranteed. Some may not cover care for health problems you had before you enrolled. Marketplace plans, and other plans that follow ACA rules, work differently. As of October 29, 2026, under current law, open enrollment for 2027 plans on HealthCare.gov runs from November 1, 2026, to January 15, 2027. To start coverage January 1, pick a plan by December 15. States that run their own Marketplace may set different dates, so check with your state's Marketplace. A federal appeal about these rules is pending (City of Columbus v. Kennedy, 4th Cir. No. 26-1938), with oral argument set for October 30, 2026, so confirm the dates before you enroll. Outside open enrollment, you need a special enrollment period, such as one after losing job-based coverage.

Find an HMO that
includes your doctors.

Book a 15-minute call to check your doctors in each HMO, or see quotes online.

Book a 15-minute call Get a quote online

By Paul Daniels, licensed insurance agent (NPN 20986580).

Disclaimer

Daniels Health Advisors LLC is an independent brokerage, not a carrier, HealthCare.gov, or CMS. Agent: Paul Daniels, NPN 20986580, Florida license G065122. This page explains HMO plans in general. Networks, referral rules, and service areas vary by plan, so read the plan documents. The Florida figures describe 2027 filings, not the plans offered to you. Tax credits, plans, networks, and prices depend on your state, zip code, income, and household. We never guarantee approval, a doctor, or a price. Not medical, legal, or tax advice.

HMO health insurance,explained.

Three rules that shapeevery HMO.