Florida Health Insurance Consumer Guide

To qualify for Florida Health Insurance Marketplace coverage, you must:¹

• Live in Florida
• Be a U.S. citizen, national, or lawfully present in the U.S.
• Not be incarcerated
• Not be enrolled in Medicare

But those rules just allow a person to enroll in coverage through the exchange. Eligibility for financial assistance (premium subsidies and/or cost-sharing reductions) through the Health Insurance Marketplace depends on how your household income compares with the cost of the second-lowest-cost Silver plan in your area.

In addition, to qualify for financial assistance with your Marketplace plan you must:

• Not be eligible for Medicaid or CHIP (Florida KidCare), or premium-free Medicare Part A.⁴
• Not have access to affordable employer-sponsored health coverage. If your employer (or your spouse’s employer) offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to learn whether you might be eligible for premium subsidies in the Florida Marketplace.
• If married, file a tax return jointly with your spouse.⁵
• Not be able to be claimed by someone else as a tax dependent.⁵

The open enrollment period to sign up for ACA-compliant individual and family health insurance in Florida runs from November 1 to January 15.⁶ 

• Enroll by December 15 for coverage to start January 1.
• If you enroll between December 16 and January 15, coverage will begin on February 1.

If you miss open enrollment, you can still enroll or switch plans if you meet the special enrollment period (SEP) requirements. Most SEPs require a qualifying life event like losing coverage, getting married, or permanently moving.

But some SEPs don’t require a qualifying life event.⁷ For example:

• Native Americans can enroll year-round.⁸
• People who are subsidy-eligible and earn no more than 150% of the poverty level can enroll anytime.

People who lose Medicaid or CHIP between March 2023 and November 2024 may qualify for a temporary extended SEP.⁹

To sign up for a Florida Health Insurance Marketplace plan, you have several enrollment options:

1. Online through HealthCare.gov.
2. By calling the Marketplace Call Center at (800) 318-2596.
3. With the help of licensed agents, navigators, or certified application counselors or an approved enhanced direct enrollment entity.¹⁰
4. Mailing in a paper application

Go to localhelp.HealthCare.gov to find a navigator, certified application counselor, or agent in your area.

You can find affordable individual and family health insurance in Florida through HealthCare.gov, which is Florida’s ACA exchange/Marketplace.

During 2023 open enrollment, more than 90% of Florida’s Health Insurance Marketplace enrollees qualified for subsidies.¹¹ These subsidies, called Advance Premium Tax Credits (APTC), lower your monthly premiums.

As of early 2024, nearly all — 98% — of Florida’s Marketplace enrollees were receiving premium subsidies. The subsidies averaged $567/month, and the average enrollee was paying about $60/month for their coverage after the subsidies were applied.²

(The numbers above are based on effectuated enrollment in early 2024; the chart below is different because it illustrates some different metrics and uses data from all enrollments submitted during the open enrollment period for 2024.)

If your household income is between 100% and 250% of the federal poverty level and you select a Silver plan through the Florida Health Insurance Marketplace, you will also receive cost-sharing reductions (CSR).¹² 63% of Florida’s Marketplace enrollees were receiving CSR benefits as of early 2024.²

While APTCs help reduce health insurance costs, CSRs reduce out-of-pocket costs like deductibles, copayments, or coinsurance.

Source: CMS.gov ¹³

Medicaid and Florida KidCare (CHIP) are options for affordable health insurance in Florida if you qualify for either program.

Alternatively, short-term plans offer low-cost health coverage, for people who aren’t eligible for Medicaid or a Marketplace subsidy. These plans can also be used by people who missed the annual enrollment period for ACA-compliant coverage (short-term health insurance is much less robust than ACA-compliant coverage, and should not be considered an adequate substitute).

Fourteen insurers offer plans on Florida’s Marketplace for 2024.¹⁴ 

Two additional insurers, Wellpoint and Simply Healthcare Plans, Inc, are joining Florida’s Marketplace for 2025.¹⁵¹⁶¹⁷

In 2024, the average Florida Health Insurance Marketplace enrollee was paying about $60/month in premiums, after premium subsidies (premium tax credits) were applied.²

The following average rate changes have been approved (before subsidies are applied) for 2025 for individual/family plans sold through Florida’s Health Insurance Marketplace. They amount to an overall weighted average rate increase of 7.5%,¹⁷ but that’s calculated before any subsidies are applied, and most enrollees get subsidies that change each year to keep pace with the cost of the benchmark plan.

Source: FLOIR (Florida Office of Insurance Regulation)¹⁷

Remember that these rate changes are calculated before subsidies are applied. Most Florida exchange enrollees receive subsidies, so they may find coverage more affordable than expected.²

For perspective, here’s a summary of how full price premiums in Florida’s ACA-compliant market have changed over the years:

• 2015: Average increase of 7%¹⁸
• 2016: Average increase of 9.5%¹⁹
• 2017: Average increase of 19.1%²⁰
• 2018: Average increase of 44.7%²¹ (federal funding for cost-sharing reductions was eliminated)
• 2019: Average increase of 5.2%²²
• 2020: Average increase of 0%²³
• 2021: Average increase of 3.1%²⁴
• 2022: Average increase of 6.6%²⁵
• 2023: Average increase of 7.2%²⁶
• 2024: Average increase of 5.3%²⁷

During the open enrollment period for 2024 coverage, a significant new record high of 4,211,902 people enrolled in health insurance through Florida’s Marketplace.²⁸

The previous record high, in 2023, had been 3,225,435,²⁹ so the increase for 2024 was substantial. (See chart below for a comparison of year-by-year enrollment.)

This surge in enrollment in recent years is due in part to the American Rescue Plan, which improved affordability starting in 2021. The Inflation Reduction Act then extended these improvements until 2025, ensuring coverage remains more affordable than it was before the ARP became law.³⁰

The 2024 enrollment spike is also due to the “unwinding” of the pandemic-era Medicaid continuous coverage rule. Medicaid disenrollments resumed in 2023 after a three-year pause, and some people who previously had Medicaid have transitioned to Marketplace coverage instead.

Source: 2014,³¹ 2015,³² 2016,³³ 2017,³⁴ 2018,³⁵ 2019,³⁶ 2020,³⁷ 2021,³⁸ 2022,³⁹ 2023,⁴⁰ 2024⁴¹

Healthcare.gov
This is the ACA Marketplace, where you can enroll in a health insurance plan online. You may also get help by calling (800) 318-2596. 

Florida Consumer Action Network (FCAN)
Nonprofit consumer advocacy group that helps Floridians understand their health insurance options.

Florida KidCare
Florida’s health insurance program for children.

FloridaHealthFinder.gov
State-run site to compare and enroll in health plans.

Federally funded Navigator organizations:

• University of Florida/Florida Covering Kids & Families – Helps people enroll in and understand health coverage.
• Urban League of Broward County – Helps underserved and vulnerable populations.
  

Florida Office of Insurance Regulation
Licenses and oversees health insurers, brokers, and agents. Helps consumers with complaints. Reviews annual health insurance rate changes. 

Medicare Rights Center
National service with a call center providing advice and information for people with Medicare.