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HMO Health Insurance Florida

Within the managed care health insurance industry, health maintenance organizations---also known as HMOs---are one of three types of health-care plans that operate through a network of service providers. Service provider networks deliver a wide range of health-care services to plan participants. Within Florida, state and federal regulatory agencies monitor HMO networks, all of which are located throughout the state's southeast region.

  1. Health Maintenance Organizations

    • A health maintenance organization consists of a network of doctors, hospitals, clinics and related facilities that each contract with an insurance carrier to provide health-care services to plan members at reduced rates. Compared to other types of managed care networks, such as Preferred Provider Organizations (PPO) and Point-of-Service (POS) networks, HMOs offer the lowest rates, but are the least flexible in terms of choice of providers, according to Insure.com, an insurance plan reference site. Unlike PPO and POS networks, HMO plan benefits only apply when members receive services from in-network providers. Members must also select a primary care physician within the network who coordinates all aspects of patient care, including referrals to specialists.

    Regulatory Agencies

    • Within Florida, HMO plans are only available within the southeast region of the state in the counties of Broward, Palm Beach, Miami-Dade, St. Lucie and Martin. The Agency for Health Care Administration and the Department of Financial Services act as regulatory agencies that oversee quality-of-care and contractual issues for HMO networks within these areas. Florida also administers the Subscriber Assistance program, an agency that helps consumers settle disputes with managed care organizations and insurance providers. Disputes can arise in cases where a plan refuses to pay for services received. Plan members must go through their plan's official grievance process before submitting their case to the Subscriber Assistance Program for review.

    Out-of-Pocket Costs

    • Besides the required monthly premium payment amount, HMO plan members pay minimal out-of-pocket costs for services provided within their assigned networks. Most Florida HMO health insurance plans require no deductible amount before coverage becomes active. Any services received, either through a primary care physician or authorized by a primary care physician, require a co-pay amount at the time of service. Co-pay amounts cover any costs related to testing and office-based procedures. HMO plans typically include some degree of dental and vision coverage with the option to purchase maternity coverage. Co-pay and deductible guidelines also apply for emergency room visits and well-care examinations.

    Medicare HMO Insurance

    • Medicare HMO insurance coverage is one of the plan types available under Medicare Advantage plans. Plan participants receive the same comprehensive healthcare coverage as offered through standard HMO plans. Medicare HMO plans are offered by insurance carriers who've contracted with Medicare to offer reduced health-care rates to plan participants. As a result, plan participants pay the usual monthly premium amount for Medicare Part B and no monthly premium payment to the insurance company. In effect, Medicare reimburses insurance companies for services provided through HMO plans. Areas such as South Florida have a large number of senior citizens, which makes for a variety of choices in terms of companies offering Medicare HMO insurance plans.

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