Florida HMO Rates and Plans

HMO plan descriptions and rates are available for download.
Click Here.

Health Maintenance Organizations (HMO)

Health Maintenance Organizations (HMO) in Florida are health care management plans that stress preventative healthcare, early diagnosis, and treatment on an outpatient basis. These plans are typically characterized as having lower insurance costs (premiums) as well low cost usage (co-payments instead of deductibles) particularly when it comes to the medical expenses associated with doctor visits, lab exams, and emergency room. 

You should expect co-payments to be associated with most services, unless otherwise noted.  Co-payments will vary depending on the service, and of course, the carrier.  Most plans will have out-of-pocket limits that will limit your risk exposure.  For example:  If a plan has an out-of-pocket maximum of $2,000 then that is the most you will have to pay in any given calendar year for the covered services and subject to the benefit limits (should also be stated in the benefit summary).

Florida HMO's also require that you use network providers.  Some HMO's have larger networks than others, so be sure you check these out before you purchase. If you go out of the network for services the plan is not required to cover you.  Usually, the only exception to this rule is in regards to "Emergency" coverage.  The variation is in what the HMO defines as an "Emergency".

All your medical care is channeled through your Primary Care Physician (PCP).  They are your first step in seeking medical attention.  They will then refer you to the appropriate providers depending on what is needed.  This gives HMO's maximum control over their costs and is what allows them to offer lower premiums.  This lack of control or choice is why some people may prefer to opt for a PPO (Preferred Provider Organization).

HMO's are a good choice when:

  • You want to cover children.  We don't take the same risks with kids that we do with ourselves.  HMO's provide low cost access to medical attention increasing your peace of mind.
  • Your are not particular about who your doctor is and are more concerned with the potential cost of your medical needs.
  • You are looking for the lowest possible cost for your necessary health insurance coverage.  HMO's cost less to use since they typically have low co-payments.
  • You do not like the idea of having a calendar year deductible and co-insurance.