Florida Health Insurance Marketplace — FAQ
Plain-English answers to the most common questions about the ACA Marketplace, subsidies, enrollment windows, and what changed in 2026.
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Key Points
- The ACA Marketplace (HealthCare.gov) is the only place you can access premium tax credits that lower your monthly premium — these subsidies are only available to households earning between 100% and 400% of the Federal Poverty Level in 2026.
- Important 2026 change: The enhanced subsidies that were in place from 2021–2025 expired at the end of 2025. Subsidies are now smaller, and the “subsidy cliff” has returned — households above 400% FPL no longer qualify for any subsidy.
- Florida has the highest ACA Marketplace enrollment of any state — nearly 1 in 5 U.S. Marketplace enrollees is in Florida. Working with a local independent advisor is the best way to navigate your options and avoid costly mistakes.
What Is the Florida Health Insurance Marketplace?
The Health Insurance Marketplace (also called “the exchange” or “Obamacare”) is a government-organized system created to provide a competitive, organized platform for purchasing ACA-compliant health insurance. Florida uses the federal Marketplace at HealthCare.gov — not a state-run exchange.
The Marketplace offers plans from multiple private insurers, allows you to compare plans side-by-side, and — most importantly — is the only place you can access premium tax credits (subsidies) based on your income. Sixteen private insurance companies offered coverage through the Florida Marketplace for 2026.
~1 in 5
U.S. Marketplace enrollees are in Florida — highest of any state
$740/mo
Average subsidy amount for eligible Florida enrollees in 2026
$62/mo
Average premium paid by subsidy-eligible Florida enrollees after subsidies
⚠ Important 2026 Changes You Need to Know
2026 brought significant changes to the Marketplace that affect what you pay and whether you qualify for help. If you enrolled in 2025 without reviewing your plan for 2026, you may be paying significantly more than you realize.
Enhanced Subsidies Expired
The enhanced premium tax credits that were in place from 2021 through 2025 (under the American Rescue Plan and Inflation Reduction Act) expired at the end of 2025. Congress did not extend them. As a result, subsidies in 2026 are smaller than they were in recent years — and some people who had subsidized coverage in 2025 now pay significantly more.
The “Subsidy Cliff” Has Returned
From 2021–2025, there was no upper income limit for subsidy eligibility. Starting in 2026, households earning above 400% of the Federal Poverty Level (approximately $58,320 for an individual or $120,000 for a family of four) no longer qualify for any premium tax credits.
Full Repayment of Excess Tax Credits Required
Starting with 2026 coverage, the cap on excess premium tax credit repayment has been eliminated. If you receive more in subsidies than you’re entitled to (because your actual income was higher than estimated), you must repay the full amount when filing your taxes — with no limit. If your income is variable or uncertain, report changes to HealthCare.gov promptly to minimize repayment risk.
Premiums Increased
In addition to smaller subsidies, insurers raised pre-subsidy premiums by a weighted average of more than 23% nationwide for 2026 — the largest increases since 2018. This makes comparing plans carefully more important than ever, and working with an independent advisor can help you find the best value.
Who Can Buy Coverage in the Marketplace?
Most U.S. citizens and legal residents can purchase coverage through the Marketplace. To be eligible you must:
✓ You ARE eligible if you…
- Are a U.S. citizen or lawfully present resident
- Reside in the state where you’re applying
- Are not currently incarcerated
- Are not enrolled in Medicare
✗ You cannot get subsidies if you…
- Have access to affordable employer-sponsored coverage
- Are enrolled in Medicare, Medicaid, or CHIP
- Earn above 400% of the Federal Poverty Level
- File taxes as “Married Filing Separately” (in most cases)
Immigrants: Many lawfully present immigrants qualify for Marketplace coverage, including green card holders, refugees, asylees, those with work visas, and others. Note: Starting in 2026, lawfully present immigrants not eligible for Medicaid due to their immigration status with incomes below 100% FPL are no longer eligible for subsidized Marketplace coverage.
Premium Tax Credits & Subsidies in 2026
Premium tax credits are federal subsidies that reduce your monthly health insurance premium. In 2026, the rules changed significantly from the previous five years.
Who Qualifies for Subsidies in 2026
| Annual Household Income (Individual) | % of FPL (approx.) | 2026 Subsidy Eligibility |
|---|---|---|
| $15,650–$21,000 | 100%–134% FPL | Premium credit + CSR (Silver plan) |
| $21,000–$39,000 | 134%–250% FPL | Premium credit + possible CSR on Silver |
| $39,000–$58,320 | 250%–400% FPL | Premium credit (no CSR) |
| Above $58,320 | Above 400% FPL | No subsidy (subsidy cliff in effect) |
FPL = Federal Poverty Level. 2026 FPL: $15,650 for an individual, $32,150 for a family of four. Income thresholds are approximate.
How Premium Tax Credits Work
The subsidy is calculated based on your estimated household income and the cost of the benchmark Silver plan (second-lowest-cost Silver plan) in your area. The government determines what percentage of your income you should pay for the benchmark plan — anything above that cap is subsidized.
You can apply the credit in advance to lower your monthly premium, or claim it as a lump sum when you file your taxes. If you take it in advance and your actual income turns out to be higher than estimated, you must repay the difference in full when you file your 2026 taxes — there is no longer a repayment cap.
Cost-Sharing Reductions (CSR)
If your income is between 100% and 250% of the FPL and you choose a Silver plan on the Marketplace, you may also qualify for Cost-Sharing Reductions — which lower your deductible, copays, and out-of-pocket maximum significantly. CSR is only available on Silver plans, only on-exchange.
Silver plan strategy: If you qualify for CSR, a Silver plan can have a deductible as low as $0–$500 instead of the standard $3,000–$4,000. Don’t automatically choose Bronze just because the premium looks lower — the total cost of a CSR Silver plan is often much better for those who qualify.
What Health Plans Are Offered Through the Marketplace?
Marketplace plans are organized into four metal tiers based on how costs are split between you and the insurer.
| BRONZE You pay 40% |
Lowest monthly premium, highest out-of-pocket costs. Best for healthy people who want protection against catastrophic events. Deductibles typically $5,000–$9,200. |
| SILVER You pay 30% |
The benchmark tier — and the only tier where Cost-Sharing Reductions apply. If you earn under 250% FPL, a Silver plan with CSR can dramatically lower your deductible and out-of-pocket costs. Don’t overlook this before choosing Bronze. |
| GOLD You pay 20% |
Higher monthly premium, lower out-of-pocket costs when you use care. Best for people with ongoing medical needs or regular prescriptions. |
| PLATINUM You pay 10% |
Highest monthly premium, lowest out-of-pocket costs. Best for people with significant ongoing medical needs who want maximum predictability. |
Enrollment Windows
Health insurance has specific enrollment windows. Outside of these periods, you generally cannot enroll in or change a Marketplace plan unless you have a qualifying life event.
Open Enrollment — 2026 Coverage
November 1, 2025 – January 15, 2026 (already passed). Coverage began January 1, 2026 if enrolled by December 15; February 1 if enrolled by January 15.
Open Enrollment — 2027 Coverage
November 1 – December 15, 2026 (coming up). Note the shorter window compared to previous years — enroll by December 15 for January 1, 2027 coverage.
Special Enrollment Period (SEP)
A 60-day window triggered by a qualifying life event — job loss, marriage, birth, divorce, moving, or loss of other coverage. You must act within 60 days of the triggering event.
Medicaid / CHIP — Year Round
If you qualify for Medicaid or CHIP (Florida KidCare), you can apply any time of year. Apply through ACCESS Florida at myflorida.com.
Qualifying Life Events for Special Enrollment
If you miss Open Enrollment, you can still enroll in a Marketplace plan if you experience one of the following qualifying life events — but you must act within 60 days.
Loss of Coverage
- Losing job-based coverage (laid off, quit, reduced hours)
- COBRA coverage exhausted
- Aging off a parent’s plan
- Loss of student health plan coverage
- Loss of Medicaid or CHIP eligibility
Household & Life Changes
- Getting married
- Having a baby or adopting a child
- Getting divorced or legally separated
- Moving to a new coverage area or state
- Changes in immigration status
Important: Loss of coverage because you failed to pay your premiums does NOT qualify as a life event triggering a Special Enrollment Period. Also note that pregnancy alone is not a qualifying event — but having a baby is.
More Frequently Asked Questions
My employer offers coverage — can I still buy from the Marketplace?
You can always shop the Marketplace, but if your employer’s plan is considered “affordable” under ACA rules (generally, if your share of the premium for employee-only coverage doesn’t exceed a certain percentage of your household income), you won’t qualify for premium tax credits on a Marketplace plan. This makes the Marketplace plan more expensive in most cases.
Is there a penalty for not having health insurance?
There is no federal tax penalty for being uninsured as of 2019. However, going without coverage means paying 100% of all medical costs yourself, which can be financially devastating in the event of a serious illness or accident.
Can I buy coverage outside the Marketplace?
Yes — you can buy ACA-compliant plans directly from insurers (“off-exchange”). The plans are similar, but you cannot receive premium tax credits on off-exchange plans. Only buy off-exchange if you’ve confirmed you don’t qualify for any subsidy. A NISONA advisor can check this for you in minutes.
I’m self-employed. How do I estimate my income for subsidy purposes?
Use your best estimate of your net profit for the year (after business expenses). If your income is variable, estimate conservatively — because if your actual income is higher than estimated and you received subsidies in advance, you must now repay the full difference when you file your taxes (the repayment cap was eliminated in 2026). Report mid-year income changes to HealthCare.gov promptly.
What happened to the year-round SEP for people under 150% FPL?
CMS discontinued the Special Enrollment Period for individuals at or below 150% of the Federal Poverty Level in August 2025. This year-round enrollment window is no longer available — those at low income levels now need to enroll during Open Enrollment or qualify for a traditional qualifying life event SEP.
Get Help Navigating the Marketplace
With 2026 bringing significant changes to subsidies and premiums, working with an independent local advisor is more important than ever. NISONA can check your subsidy eligibility, compare every plan available in your Florida county, and help you avoid costly enrollment mistakes — at no cost to you.
Our service is completely free and 100% unbiased. Discover the difference of having NISONA on your side.
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