Quick facts (bookmark this)
- Where to enroll: Florida stays on HealthCare.gov (the federal Marketplace).
- Open Enrollment window (for 2026 coverage): Nov 1, 2025 → Jan 15, 2026. Enroll by Dec 15 for a Jan 1start; enroll Dec 16–Jan 15 for a Feb 1 start. (Same timing Florida used last year.)
- Standardized plan designs updated for 2026: CMS fine-tuned copays/coinsurance and clarified how insurers can vary certain extras. Example: expanded bronze standardized plans use 50% coinsurance (down from 60%) with a $10,000 max out-of-pocket (MOOP); standardized silver MOOP is $8,900; gold is $7,400. (These are standardized plan design values, not universal caps.)
- Agent/broker safeguards: Stronger rules against unauthorized enrollments and clearer consent documentation requirements.
The big variable: Will 2026 subsidies be the same?
Right now, the enhanced premium tax credits (the expanded ACA subsidies many families have enjoyed since 2021 and extended through 2025) are scheduled to sunset after 2025 unless Congress extends them. CMS even set two possible user-fee scenarios depending on whether an extension happened by July 31, 2025—it didn’t. Bottom line: as of today, enhanced subsidies expire after 2025 unless lawmakers act later. If they lapse, net premiums will rise for many Floridians in 2026 and some people above 400% FPL may lose eligibility again.
Translation: build a Plan A and a Plan B. Compare options early (Nov 1) and be ready to switch to a different metal level or insurer if subsidies change.
What CMS changed for 2026 (and why it matters)
CMS finalized the 2026 Notice of Benefit & Payment Parameters (NBPP)—that’s the rulebook for Marketplace plans. Highlights for consumers:
- Small premium-payment shortfalls won’t trip you up as easily. Plans can choose thresholds (e.g., at least 95% of net premium paid, or up to $10 balance due, or 98% of gross) before starting a grace period. This helps prevent accidental terminations over tiny amounts.
- Cleaner, more comparable choices. Standardized plan options are updated so metal-level benefits line up better and duplicative look-alike plans are pared back. That means easier apples-to-apples comparisons.
- Network adequacy + equity nudges. CMS will review Essential Community Provider (ECP) inclusion more consistently and tweaked risk-adjustment (adding a factor for PrEP drugs) to discourage skimping on high-need populations.
Florida carriers and plan types (what to expect)
Florida’s Marketplace is competitive and county-specific. For 2025, the state’s official list shows a broad mix of companies—including Florida Blue/Health Options, Ambetter (Centene), Aetna, AvMed, Molina, Capital Health Plan, Health First, UnitedHealthcare, Oscar, Wellpoint/Simply, and others—though availability varies by ZIP code and some brands sell via HMO subsidiaries. Expect a similar lineup in 2026, with final county maps posted closer to Open Enrollment. Always check your ZIP on HealthCare.gov.
Pro tip: Florida leans heavily HMO/EPO on-exchange. If you need a particular hospital or doctor, filter by providerfirst, not just price.
How to pick the right 2026 plan (simple workflow)
- Lock your doctors & meds first. Use the plan’s directory and formulary filters on HealthCare.gov.
- Model total cost, not just premium. Deductibles, copays, coinsurance, and the MOOP matter—especially if you expect care. (Standardized 2026 designs make this a bit easier to compare.)
- Check Silver carefully. If enhanced subsidies aren’t extended, some households may get squeezed. Silver is still the only tier with cost-sharing reductions (CSR) for those who qualify; if you’re between 100%–250% FPL, CSR slashes your out-of-pocket costs.
- HSAs & Bronze/HDHPs. If you’re healthy and want to save pre-tax, consider an HSA-eligible Bronze HDHP—but verify coverage for must-have meds and visits.
- Apply early (Nov 1–Dec 15) and re-shop if Congress changes subsidies before your coverage starts.
Timeline for Florida shoppers
- Now → Oct: Watch subsidy news. If Congress acts, it’ll be all over the headlines and HealthCare.gov notices.
- Nov 1: Window opens. Update your application; preview 2026 plans.
- By Dec 15: Enroll for Jan 1 coverage.
- Dec 16–Jan 15: Still time—coverage begins Feb 1.
FAQs
Will my 2025 plan auto-renew into 2026?
Usually yes, but verify. If subsidies change, your net premium could jump even if the plan stays the same. Re-shop.
Are adult dental/vision included?
Not as essential health benefits. Some plans bundle extras or sell stand-alone options you can add.
Who qualifies for CSR (lower deductibles & copays)?
Households 100%–250% FPL and enrolled in a Silver plan. If you’re close to the cutoff, keep an eye on your projected 2026 income.
What if I miss Open Enrollment?
You’ll need a Special Enrollment Period (move, birth, loss of coverage, certain income changes, etc.) to sign up later.
Need 1-on-1 help in Florida?
My Easy Rate Insurance is here to walk you through plan comparisons, doctors in-network, and subsidy scenarios—in English o en Español. Call (305) 218-4460 or visit myeasyrate.com and we’ll make the paperwork painless so you don’t overpay for 2026.
Sources & policy notes
- CMS 2026 Final Rule (NBPP) Fact Sheet – payment thresholds, agent/broker protections, standardized plan updates, user fee scenarios tied to subsidy extension.
- Federal Register: 2026 NBPP Final Rule – standardized plan design tables showing 2026 cost-sharing/MOOP examples.
- HealthInsurance.org Florida Marketplace Guide – Florida uses HealthCare.gov; enrollment dates and eligibility basics.
- Florida Dept. of Financial Services (OIR/CFO) ACA Carrier List (2025) – who sold individual ACA plans; county availability varies. Useful proxy until 2026 filings publish.
- CRS & Commonwealth Fund explainers – enhanced ACA tax credits are scheduled to end after 2025 unless extended; potential impact if they lapse.
