To get health insurance in Florida, most residents enroll through HealthCare.gov, get coverage through a job, or qualify for a government program like Medicaid, Florida KidCare, or Medicare. Florida does not run its own exchange, so all individual and family Marketplace plans go through the federal site. One thing to know before you start shopping for 2026: the enhanced premium subsidies that made Marketplace coverage unusually cheap from 2021 through 2025 expired on January 1, 2026, so many people will pay more this year, and some higher earners no longer qualify for any subsidy.
Buying a Plan Through HealthCare.gov
Every individual and family Marketplace plan in Florida is sold through HealthCare.gov. You can shop and enroll online, call 1-800-318-2596, or work with a Navigator. Florida has roughly 150 Navigators statewide. They are federally trained, state-licensed, and paid through federal grants rather than by insurance companies, so their help is free and their advice isn’t tied to any one insurer.
When you apply, you’ll enter household income, family size, and whether anyone in the household has access to employer coverage. The application will tell you if you qualify for premium tax credits, cost-sharing reductions, Medicaid, or the Children’s Health Insurance Program. You can enroll directly through an insurer’s website instead, but you’ll forfeit any subsidy by skipping HealthCare.gov.
When You Can Enroll
Open Enrollment runs November 1 through January 15. Enroll by December 15 and coverage starts January 1. Enroll between December 16 and January 15 and coverage starts February 1. Miss January 15 and you’re generally locked out until the next November.
The main exception is a Special Enrollment Period. Qualifying life events give you 60 days to sign up, and they include losing employer coverage, getting married, having a baby, or moving to Florida from another state. You’ll need documentation of the event, and applications get denied when the paperwork isn’t there. Losing coverage because you didn’t pay premiums or didn’t submit required paperwork to a prior insurer does not qualify as an event.
Medicaid and Florida KidCare take applications year-round with no enrollment window.
What You’ll Pay in 2026
The enhanced premium tax credits from the American Rescue Plan and Inflation Reduction Act expired on January 1, 2026. Two changes matter for what you’ll pay.
First, the income cap for premium tax credits is back at 400% of the federal poverty level. A single person earning above roughly $62,400 or a family of four above about $132,000 no longer qualifies for any premium subsidy. From 2021 through 2025 there was no upper cap.
Second, even people who still qualify below 400% FPL get smaller subsidies. The “applicable percentages” that determine how much of your income goes to premiums have reverted to their original, less generous levels. Some lower-income enrollees who had $0-premium plans will now owe a monthly premium.
Premium Tax Credits
If your household income is between 100% and 400% of the federal poverty level, you can receive advance premium tax credits that lower your monthly premium. For 2026, the poverty level for a single person is $15,960, putting the 400% cutoff around $63,840. For a family of four, the poverty level is $33,000, with the cutoff near $132,000. The credit is calculated from the cost of the second-lowest-cost Silver plan in your area, measured against your income.
If you take advance credits, you have to reconcile them on your federal tax return using IRS Form 8962. The Marketplace will send you Form 1095-A to complete it. If your actual income came in higher than you estimated, you may owe money back; if it came in lower, you’ll pick up an additional credit. Skip the reconciliation and you lose eligibility for advance credits and cost-sharing reductions the next year.
Cost-Sharing Reductions
Cost-sharing reductions lower your deductibles, copays, and out-of-pocket maximums, but only on Silver plans bought through HealthCare.gov. Eligibility runs up to 250% of the federal poverty level. Below 150% FPL, a Silver plan’s actuarial value jumps from 70% to 94%. Between 150% and 200% FPL it rises to 87%, and between 200% and 250% FPL it reaches 73%. Pick a Bronze or Gold plan and you give up the reduction even if your income qualifies.
If You Have a Low Income
Medicaid
Florida has not expanded Medicaid under the ACA, which narrows eligibility sharply. Non-disabled adults without children generally do not qualify, regardless of income. Parents and caretaker relatives can qualify only if income is below roughly 26% of the federal poverty level, about $598 per month for a family of three. Pregnant women qualify with income up to about $4,355 per month for a family of three. Children qualify at much higher income levels through Medicaid and Florida KidCare.
Because premium tax credits start at 100% FPL, adults who earn too much for Florida Medicaid but less than 100% of the poverty level ($15,960 for a single person) fall into a coverage gap. Neither program is available to them.
Florida does run a Medically Needy program, sometimes called Share of Cost, for people whose income exceeds standard Medicaid limits. It works like a monthly deductible: you accumulate qualifying medical expenses until they reach your share-of-cost amount, and Medicaid covers the rest of that month’s care. Qualifying expenses include unpaid medical bills, insurance premiums, copays, prescriptions, and ambulance transportation. Over-the-counter supplies do not count. You submit documentation through the MyACCESS portal, by fax, or in person. Not every provider accepts Medically Needy patients, so confirm before scheduling.
Florida KidCare
Florida KidCare covers children from birth through age 18 in families that earn too much for Medicaid but can’t easily afford private insurance. It includes Medicaid for children, MediKids for ages 1 through 4, Florida Healthy Kids for ages 5 through 18, and the Children’s Medical Services plan for children with special health needs. Premiums are tied to family income:
- Up to 133% FPL: free coverage through Medicaid
- 133% to 158% FPL: $15 per month per family
- 158% to 200% FPL: $20 per month per family
- Above 200% FPL: full-pay plans ranging from roughly $248 to $276 per month per child, depending on the program
Applications run year-round. Eligibility depends on factors beyond income, so applying is worthwhile even if you aren’t sure.
If You’re 65 or Older
Medicare covers Floridians aged 65 and older, along with some younger people with disabilities. Part A handles hospital stays, Part B covers outpatient services and preventive care, and Part D covers prescription drugs. Medicare Advantage (Part C) bundles Parts A and B through a private insurer and often adds dental, vision, and drug coverage. Florida has one of the highest concentrations of Medicare Advantage plans in the country.
Timing matters. Your Initial Enrollment Period is a seven-month window around your 65th birthday: the three months before, your birthday month, and the three months after. Miss it without qualifying employer coverage and you face permanent late-enrollment penalties added to your Part B and Part D premiums for as long as you have coverage. The Part B penalty alone adds 10% of the standard premium for each full 12-month period you were eligible but didn’t enroll.
Through a Job
Employers with 50 or more full-time employees must offer coverage that meets ACA minimum value and affordability standards or pay penalties. Minimum value means the plan covers at least 60% of expected healthcare costs. The affordability threshold, adjusted yearly by the IRS, has hovered near 9% of household income for the employee’s share of premiums.
Most employer plans fall into three types. HMOs keep premiums low but require you to use a tight network and get referrals for specialists. PPOs let you see out-of-network providers at higher cost. High-deductible health plans pair lower premiums with higher deductibles and let you open a Health Savings Account. For 2026, HSA contribution limits are $4,400 for individual coverage and $8,750 for family coverage.
You’ll typically enroll when hired or during your employer’s annual open enrollment. Premiums come out of your paycheck pre-tax, lowering your taxable income. Employers usually pay a significant share of the premium, though the split varies.
Small Employer Options
Small employers don’t have to offer coverage. Those with fewer than 25 full-time equivalent employees, paying average annual wages below an inflation-adjusted threshold, may qualify for the Small Business Health Care Tax Credit if they cover at least 50% of employee premiums and buy through the SHOP Marketplace. The credit can cover up to 50% of the employer’s premium contributions.
Some employers now use an Individual Coverage Health Reimbursement Arrangement instead of a group plan. With an ICHRA, the employer gives you a tax-free allowance to buy your own individual policy and submit receipts for reimbursement. You have to be enrolled in an individual plan to participate, and the employer must give you at least 90 days’ notice before each plan year. If the ICHRA is considered “affordable” under ACA rules, you can’t take Marketplace premium tax credits, so check the math before choosing.
After You Lose Job-Based Coverage
Losing employer coverage is one of the most common reasons Floridians need new insurance quickly. COBRA lets you keep the employer’s group plan for up to 18 months, or 36 months in certain cases like divorce or a dependent aging out. The catch is cost: you pay the full premium, up to 102% of what the plan costs, because the employer’s share is gone. A family plan that ran $1,800 a month with a $500 employee contribution could bill over $1,800 under COBRA.
You have 60 days from your qualifying event to elect COBRA, and coverage is retroactive to the date you lost the employer plan, so there’s no gap even if you take a few weeks to decide. You will owe premiums for the entire retroactive period.
Before defaulting to COBRA, compare it with a Marketplace plan. Losing employer coverage triggers a 60-day Special Enrollment Period on HealthCare.gov, and depending on your income, subsidies can make a Marketplace plan far cheaper. COBRA tends to make sense when you’re mid-treatment with providers who aren’t in any Marketplace plan’s network, or when the COBRA premium happens to be competitive.
Short-Term and Catastrophic Plans
Short-term plans are worth knowing about mostly so you know what they aren’t. Florida allows initial terms of up to 12 months and a total duration, including renewals, of up to 36 months. These plans are not ACA-compliant. They can deny coverage for pre-existing conditions, impose annual or lifetime benefit caps, and skip essential health benefits like maternity care and mental health services. They don’t count toward ACA coverage requirements for premium tax credit purposes. Federal regulations issued in 2024 tried to limit short-term plans to three months initially and four months total, but enforcement has been deprioritized at the federal level, and Florida’s more permissive state law effectively governs. Use them to bridge a temporary gap between jobs, not as ongoing coverage.
Catastrophic plans are ACA-compliant but built as a safety net. Premiums are the lowest on the Marketplace, and deductibles are very high. Eligibility is limited to people under 30 or those who qualify for a hardship or affordability exemption. Catastrophic plans cover three primary care visits per year and preventive services before the deductible, but little else until you hit that threshold. They aren’t sold in every Florida county.
Who Can Enroll
You have to live in Florida with the intent to remain in order to enroll in a Marketplace plan. Proof usually means a Florida driver’s license, a utility bill, or a lease. Seasonal residents and students can qualify if Florida is their primary residence during the coverage period.
Lawfully present immigrants, including green card holders, refugees, asylees, and certain visa holders, can buy Marketplace plans and may qualify for premium tax credits based on income. DACA recipients are not eligible for Marketplace coverage. Undocumented immigrants cannot enroll in Marketplace plans or receive federal subsidies, though they can buy insurance directly from an insurer outside the exchange. Community health centers provide care regardless of immigration status, and emergency Medicaid covers life-threatening conditions and childbirth for people who would otherwise qualify for Medicaid but for their immigration status.
If a Claim or Plan Decision Is Denied
ACA-compliant plans in Florida must cover ten categories of essential health benefits, including outpatient care, emergency services, hospitalization, maternity and newborn care, mental health and substance use treatment, prescription drugs, rehabilitation, lab services, preventive care, and pediatric services, with no annual or lifetime dollar limits and no exclusions or surcharges for pre-existing conditions. If your insurer denies a claim, cancels your policy, or refuses to authorize a treatment you believe is covered, you can challenge the decision.
The insurer must explain the denial in writing and tell you how to appeal. You have 180 days from the denial notice to file an internal appeal. The insurer must respond within 30 days for services not yet received and 60 days for services already provided.
If the internal appeal fails, you can request an external review by an independent review organization with no ties to your insurer. That organization must issue a decision within 45 days. For urgent situations, such as an ongoing hospitalization or a condition where delay could seriously harm your health, the external review must be completed within 72 hours.
For broader complaints about insurer conduct, including cancellations, misrepresented coverage, or billing disputes, the Florida Department of Financial Services investigates through its Division of Consumer Services. Keep copies of every denial letter, appeal submission, and piece of correspondence. The paper trail is what separates disputes that get resolved from ones that stall.