Some services need no referral even in an HMO; Medicare.gov gives the yearly screening mammogram as an example. Emergency care, urgent care when you are out of the area and temporary dialysis out of the area are covered without staying in the network. Each plan sets its own list of services that need a referral, so read it in the plan’s 2027 Evidence of Coverage before you enroll. A referral is also different from prior authorization: a plan can require approval in advance for a service whether or not you needed a referral to see the doctor who ordered it.
| Plan type | Plans | Referral to see a specialist |
|---|---|---|
| HMO | 23 | Yes, in most cases |
| HMO-POS | 4 | Yes, in most cases |
| PPO | 12 | No |
| Regional PPO | 5 | No |
| Special Needs Plans, counted separately | 62 | Varies by plan |
How an HMO referral works
In most HMOs you choose a primary care doctor, who manages your care and refers you to a specialist in the plan’s network when you need one. If you get care outside the network that is not an emergency or urgent care away from home, you may have to pay the full cost. An HMO-POS plan is an HMO that may let you get some services out of network for a higher copay or coinsurance, so check which services that covers and whether they still need a referral.
Why so many Broward plans are HMOs
HMOs make up 23 of the 44 plans, down from 30 in 2026, and with the 4 HMO-POS plans they come to 27. All 27 have a $0 monthly premium for 2027. The 17 PPO and regional PPO plans let you see specialists without a referral and use providers out of network at a higher cost; 11 of the 17 have a $0 premium. Among the 62 Special Needs Plans, which are counted separately, 56 are HMOs or HMO-POS plans, and Medicare.gov says referral rules for those vary by plan.
What to do next
If you see specialists regularly, list them and check that each one is in the network of every plan you are considering, then read each plan’s referral rules in its 2027 Evidence of Coverage. If you would rather not need referrals at all, a PPO is the plan type built for that. In Broward, all 6 Medicare Advantage plans that charge a monthly premium for 2027 are PPOs, so weigh that cost against the freedom. Annual Enrollment for 2027 coverage ends December 7, 2026.
Read the full guide: Every 2027 Medicare plan in Broward County
Related questions
Do I need a referral for a mammogram in an HMO?
Not for a yearly screening mammogram, which Medicare.gov gives as an example of a service that needs no referral in an HMO.
Do PPOs in Broward need referrals?
No. Medicare.gov says you do not need a referral to see a specialist in a PPO, and you do not need to choose a primary care doctor.
Is a referral the same as prior authorization?
No. A referral is your primary care doctor sending you to a specialist. Prior authorization is the plan approving a specific service in advance, and an HMO or a PPO can require it.
Sources
- Health Maintenance Organizations (HMOs) — Medicare.gov (CMS) · read 2026-10-30
- Preferred Provider Organizations (PPOs) — Medicare.gov (CMS) · read 2026-10-30
- Special Needs Plans (SNP) — Medicare.gov (CMS) · read 2026-10-30
- CY2027 Medicare Advantage / Part D Landscape Source Files — Centers for Medicare & Medicaid Services · 2026-09-28 · read 2026-10-30
- CY2026 Medicare Advantage / Part D Landscape Source Files — Centers for Medicare & Medicaid Services · 2026-03 · read 2026-10-12
- Joining a plan — enrollment periods — Medicare.gov (CMS) · read 2026-10-13
This page explains published rules and figures, with the source for each one. It is not advice about your own situation.