The Health Maintenance Organization (HMO) require members to select a primary care physician (PCP), a doctor who acts as a "gatekeeper" to direct access to medical services. PCPs are usually internists, pediatricians, family doctors, or general practitioners (GPs). Members need a referral from the PCP in order to see a specialist or other doctor, and the gatekeeper cannot authorize that referral unless the HMO guidelines deem it necessary. Unless there is an emergency.

"Open access" HMOs do not use gatekeepers - there is no requirement to obtain a referral before seeing a specialist. The co-payment or coinsurance will be higher for specialist care.

An HMO is able to offer cheaper health care by contracting with specific providers of health care and dealing with large quantities of patients, therefore the HMO is able to negotiate for more affordable health care than the patients would otherwise receive. The HMO also lowers costs by controlling treatments that the HMO views as necessary, and by focusing on preventative health care with an eye toward the long-term health of their members.HMOs monitor doctors to see if they are performing more services for their patients than other doctors, or fewer. HMOs often provide preventive care for a lower copayment or for free, in order to keep members from developing a preventable condition that would require a great deal of medical services. Experimental treatments and elective services that are not medically necessary e.g. elective plastic surgery are normally not covered. HMO patients with catastrophic cases or certain chronic diseases like diabetes, asthma, or some forms of cancer are identified; and the HMO takes a greater level of involvement in the patient's care, assigning a case manager to the patient or a group of patients to ensure that no two providers provide overlapping care, and to ensure that the patient is receiving appropriate treatment, so that the condition does not worsen beyond what can be helped.

HMOs are regulated at both the state and federal levels. They are licensed by the states, under a license that is known as a certificate of authority (COA) rather than under an insurance license. In 1972 the National Association of Insurance Commissioners adopted the HMO Model Act, which was intended to provide a model regulatory structure for states to use in authorizing the establishment of HMOs and in monitoring their operation.

The advantage of an HMO includes slightly lower annual premiums, because the cost of care is spread out among the members. In addition, there is little paperwork dealing with insurance forms for the patients. And there is an influence of prevention at an HMO, whereby programs are provided to its members which promote healthier life choices and better health.The disadvantages include fewer choices for medical care outside of the HMO, since referrals to specialists are sometimes limited. If a specialist is needed for an unusual medical condition, the person may want to see someone outside of the system and that will be at a greater cost. The requirement to pick a primary care physician at the HMO may seem inflexible.

Providers of HMOs in Florida:

Aetna

Blue Cross

Humana

HMO- Health Maintenance Organization

There are two types of HMO. Many people think that with an HMO they must name a primary physician and get referrals to specialists. This is call a “gate keeper” HMO. The other type of HMO which is very common is the “open access” HMO. With this plan, the insured does not have to name a primary physician. They are required to stay in-network if they want the insurance company to assist in the claim.