Florida Health Insurance Answers: 30 Questions, Straight Answers, Real Sources

When is open enrollment for 2027 health insurance in Florida?

November 1, 2026 through January 15, 2027 on HealthCare.gov, which is the exchange Florida uses. To have coverage start January 1, 2027, enroll by December 15, 2026. These dates come from a CMS operational statement dated July 31, 2026.

One caveat worth knowing: a 2025 CMS rule would have shortened the window, a federal judge vacated that provision in June 2026, and HHS appealed with argument expected in late October 2026. The CFR text still reads the other way. CMS's operational statement is what governs what actually happens, and it says January 15.

What happens if I miss open enrollment?

You generally cannot buy an individual marketplace plan until the next open enrollment unless you have a qualifying life event. Qualifying events include losing other coverage, marriage, divorce, birth or adoption, a permanent move to a new coverage area, and certain income changes affecting subsidy eligibility. Most special enrollment periods run 60 days from the event. Medicaid and CHIP enrollment is open year-round for those who qualify.

Can a small business buy group coverage any time of year?

Usually yes. Group coverage is not tied to individual open enrollment. However, if you cannot meet a carrier's minimum participation or contribution requirement, federal rule 45 CFR 147.104(b)(1)(i)(B) permits the carrier to restrict you to an annual window running November 15 through December 15. Separately, Fla. Stat. § 627.6699(5)(e)(7) requires carriers to offer a 30-day annual open enrollment period to each small employer's eligible employees.

How long does it take to get a group plan in place?

Most carriers work on roughly a 30-day implementation window, but that is the minimum, not the target. Start shopping 90 to 120 days before your renewal date. Waiting until 30 days out eliminates most of your options — particularly level-funded quotes, which require underwriting time.

Are ACA subsidies still available in 2027?

Yes, but at pre-2021 levels. The enhanced premium tax credits created in 2021 expired December 31, 2025 and have not been restored as of August 2026. The 400% federal poverty level subsidy cliff is back: above 400% FPL there is no credit at all. The IRS applicable percentage table for 2027, published in Rev. Proc. 2026-26, runs from 2.15% at the low end to 10.22% at 300–400% FPL, then stops.

H.R. 1834, a three-year extension, passed the House 230–196 on January 8, 2026. Senate compromise talks were reported stalled as of mid-January 2026. Nothing has been enacted. We are not going to predict what Congress does.

How much are Florida health insurance premiums going up for 2027?

Florida carriers filed proposed 2027 increases averaging around 15.9%, but read that number carefully — it is a straight unweighted average of filed rates rather than an enrollment-weighted average, because several Florida filings were heavily redacted. Individual carrier requests ranged from under 5% to over 39%. Nationally the median proposed increase across 276 insurers was about 15%. All of these are proposals pending regulatory approval, not final rates.

Why are premiums rising so much?

Analysts attribute roughly 10 percentage points to underlying medical and prescription cost trend, and about 4 percentage points to risk-pool deterioration following the expiration of enhanced subsidies — healthier people dropping coverage when it stopped being cheap leaves a sicker pool behind. Specialty drug costs, particularly GLP-1 medications, are a named driver in multiple filings.

What if I make too much for a subsidy?

Above 400% FPL you pay full price on the marketplace, and this is the group hurt most by the enhanced credits expiring. Options worth examining: an HSA-qualified high-deductible plan to capture the triple tax advantage; buying off-exchange, where some carriers offer different plan designs; if you are self-employed, the IRC § 162(l) above-the-line deduction; and if you are an employer, an ICHRA — since you are not giving up a credit you were not receiving.

Does Florida have Medicaid expansion?

No. Florida is one of ten states that have not expanded Medicaid. Parents and caretaker adults qualify only up to roughly 26% of the federal poverty level, and childless non-disabled adults are not eligible at any income. Approximately 388,000 Floridians fall in the resulting coverage gap — earning too much for Medicaid but too little for marketplace subsidies. A Medicaid expansion ballot initiative did not qualify for the November 2026 ballot and organizers are targeting 2028.

How many Floridians are on marketplace coverage?

Florida recorded 4,538,772 plan selections for 2026 — more than any other state — down about 4% from 4,735,415 for 2025. Note that plan selections are not the same as effectuated enrollment; KFF has projected national effectuated enrollment could fall substantially below plan selections for 2026.

Does Florida require employers to offer health insurance?

No. Florida has no state employer mandate. Chapter 627 of the Florida Statutes imposes obligations on insurance carriers, not employers. The only mandate that may apply is federal, and it begins at 50 full-time equivalent employees.

At what size do I have to offer coverage?

50 full-time equivalent employees, averaged across the prior calendar year. A full-time employee averages at least 30 hours per week or 130 hours per month. Part-time hours convert to equivalents: total monthly hours of non-full-time employees, cap each at 120, divide by 120. Full walkthrough here.

What is the penalty for not offering coverage?

For 2027, $3,780 per full-time employee per year excluding the first 30, if you offer nothing and at least one employee receives a premium tax credit. If you offer coverage that is unaffordable or lacks minimum value, $5,670 per affected employee, capped at what the no-offer penalty would have been. Assessed monthly at one twelfth. Neither penalty is tax-deductible, which materially changes the math versus paying deductible premiums.

What is Florida's small employer definition?

At least one and not more than 50 eligible employees on average during the preceding calendar year, per Fla. Stat. § 627.6699(3)(v). Note it starts at one, not two — the statute expressly includes self-employed individuals. Carriers must offer small employer plans on a guaranteed-issue basis under § 627.6699(5)(b).

Does Florida law require me to pay a percentage of premiums?

No. Fla. Stat. § 627.6699(5)(e)(2) requires only that carriers apply participation and contribution requirements uniformly among groups of the same size. The commonly cited 50% employer contribution and 70–75% participation figures are carrier underwriting rules that vary between carriers. Do not treat them as legal requirements.

What is the Small Business Health Care Tax Credit worth?

Up to 50% of your premium contributions for taxable employers, 35% for tax-exempt organizations, available for two consecutive tax years. You need fewer than 25 full-time equivalents, average annual wages below a threshold — for tax year 2025, phase-down begins above $33,000 per FTE and eligibility ends at $67,000 — and you must pay at least 50% of employee-only coverage and buy through SHOP. The 2026 wage figures had not been published as of August 2026.

What is Florida mini-COBRA?

Fla. Stat. § 627.6692, the Florida Health Insurance Coverage Continuation Act, extends continuation rights to employees of employers with fewer than 20 employees — below the federal COBRA threshold. Premium is capped at 115% of the applicable premium versus 102% for federal COBRA, for up to 18 months, extendable to 29 months on a Social Security disability determination filed within 60 days.

How much does group coverage cost per employee?

KFF's 2025 survey put the average annual premium at firms with 10 to 199 workers at $9,211 for single coverage and $26,054 for family. Employees at those firms contributed 36% of the family premium, versus 23% at firms with 200 or more workers, and faced average single deductibles of $2,631 versus $1,670. Your actual cost depends on your census and, for level-funded quotes, your claims history.

What is an ICHRA?

An Individual Coverage HRA lets an employer reimburse employees tax-free for individual health insurance premiums instead of offering a group plan. No minimum company size, no minimum participation, no contribution cap. Created by 2019 federal regulation at 26 CFR § 54.9802-4. Full guide here.

Can employees keep their subsidy with an ICHRA?

Only by opting out, and only if the ICHRA is unaffordable for them. An employee who accepts an ICHRA cannot claim a premium tax credit for any month covered. This is the single most important design consideration and it is why ICHRA suits some workforces and harms others.

What are the 2026 QSEHRA limits?

$6,450 for self-only coverage and $13,100 for family coverage, per IRS Rev. Proc. 2025-32. That is $537.50 and $1,091.66 per month. QSEHRA requires fewer than 50 full-time equivalents and no other group health plan, and it reduces the premium tax credit dollar-for-dollar rather than eliminating it.

What is a level-funded plan?

A self-funded plan wrapped in stop-loss insurance so the employer pays a fixed monthly amount. It splits into a claims fund, a stop-loss premium and an administrative fee. Surplus may be partially refunded if claims come in low. Medically underwritten, unlike guaranteed-issue ACA small group coverage. 37% of covered workers at firms with 10 to 199 employees are on one. Full guide here.

What is a Section 125 plan worth to an employer?

Running employee premium contributions through a Section 125 cafeteria plan removes those dollars from the FICA wage base. Employers save 7.65% on those dollars up to the Social Security wage base of $184,500 in 2026; above that, savings drop to the 1.45% Medicare portion. Employees save income tax withholding plus their own 7.65%. It requires a written plan document adopted before the plan year begins and annual nondiscrimination testing. More-than-2% S-corporation shareholders cannot participate on a tax-favored basis.

Does occupational accident insurance count as health insurance?

No. It is an accident-only product covering on-duty injury and it explicitly excludes sickness. No coverage for cancer, diabetes, heart disease, prescriptions or preventive care, and it is not minimum essential coverage under the ACA. Full comparison here.

Is there an FMCSA sleep apnea regulation?

No. There is no FMCSA rule requiring obstructive sleep apnea screening, testing or treatment. A joint rulemaking was withdrawn in August 2017. Examiners evaluate drivers under the general respiratory standard at 49 CFR § 391.41(b)(5). The BMI and neck-circumference thresholds drivers hear about came from 2016 advisory committee recommendations that were never adopted as regulation. Referral decisions are examiner discretion.

Does health insurance cover a CPAP machine?

Generally yes, as durable medical equipment, subject to your deductible and coinsurance. DME is not itself one of the ten essential health benefit categories but is covered through the rehabilitative and habilitative services and devices category and Florida's benchmark plan, which covers DME without a quantitative limit for plan years 2025 through 2027. Sleep studies are covered as medically necessary diagnostic services, typically with prior authorization. Without insurance, a CPAP machine commonly runs $400 to $1,600 plus ongoing supplies.

Is the DOT physical covered by insurance?

Generally not — it is an occupational examination rather than preventive care. Cash cost typically runs $50 to $150. HSA and FSA funds are commonly usable. Certification is valid for a maximum of 24 months under 49 CFR § 391.45(b), with 12-month maximums for insulin-treated diabetes and for drivers certified under the alternative vision standard.

How do I estimate income for a marketplace application as an owner-operator?

Use net self-employment income — your Schedule C profit — not gross revenue or settlement totals. Underestimating means repaying advance credits at tax time; overestimating means leaving savings on the table until you file. Start with last year's Schedule C and adjust for known changes in rates, miles or equipment. If your income genuinely swings, report changes to the marketplace during the year rather than waiting for reconciliation.

Can I deduct my health insurance as an owner-operator?

Generally yes, under IRC § 162(l) on Form 7206. Three limits: it cannot exceed net earnings from the business, it is unavailable for any month you were eligible for a subsidized plan through your own or a spouse's employer, and it does not reduce self-employment tax.

Do owner-operators in Florida need workers' comp?

Fla. Stat. § 440.02(18)(d)4 excludes owner-operators transporting property under written contract with a motor carrier, where the owner-operator furnishes the vehicle and principal operating costs and is not paid hourly. Non-construction employers need coverage at four or more employees. Corporate officers and LLC members may file a Notice of Election to be Exempt. Confirm your specific structure with the Florida Division of Workers' Compensation.

What is the difference between Bronze, Silver, Gold and Platinum?

Metal tiers describe how costs split between you and the plan, not the quality of care. Bronze plans have the lowest premiums and highest out-of-pocket costs; Platinum reverses that. Silver matters for a specific reason: cost-sharing reductions, which lower your deductible and copays, are only available on Silver plans and only below 250% of the federal poverty level. If you qualify, Silver frequently beats Gold on total cost. More detail here.

What is the difference between an HMO and a PPO?

An HMO generally requires you to stay in network and to get a referral from a primary care physician to see a specialist, in exchange for lower premiums. A PPO lets you see out-of-network providers at higher cost and usually does not require referrals. In Florida, HMO products dominate the individual marketplace and PPO options are more limited than they were a decade ago. Full comparison here.

I'm turning 26 and coming off my parents' plan. What do I do?

Losing coverage at 26 is a qualifying life event, giving you a 60-day special enrollment period. You can generally apply up to 60 days before the loss as well, which is the better approach — it avoids a gap. Compare your employer's plan, if you have one, against a subsidized marketplace plan; at entry-level wages the marketplace is sometimes cheaper.

I just lost my job. What are my options?

Four, roughly in order of how often they are the right answer: a subsidized marketplace plan through your special enrollment period, since unemployment usually lowers your income and raises your subsidy; a spouse's plan, if the job loss triggers their special enrollment period; COBRA or Florida mini-COBRA, which keeps your exact plan and doctors but at full cost plus an administrative percentage; and Medicaid, though Florida's eligibility is restrictive for adults. Do not let the 60-day window lapse.

Are health care sharing ministries insurance?

No. Fla. Stat. § 624.1265 exempts qualifying religious organizations from the Insurance Code specifically on the condition that there is no assumption of risk and no promise to pay, and requires a disclaimer stating you are personally responsible for your own medical bills. No guaranteed payment, no state solvency oversight, no guaranty association, no ACA protections, and not minimum essential coverage.

What does it cost to use a health insurance broker?

Nothing to you. Licensed brokers are compensated by the insurance carriers, and the premium you pay is the same whether you buy through a broker, buy direct from the carrier, or enroll yourself on HealthCare.gov. There is no broker markup on health insurance premiums in Florida. What you get for free is someone who shops multiple carriers, handles the paperwork, and is reachable when a claim goes wrong.

Do I have to use a broker in my own city?

No. Health insurance is licensed at the state level, so a broker licensed in Florida can serve you anywhere in Florida. A local broker is useful for provider network knowledge — knowing which plans include which hospital systems in Miami-Dade versus Hillsborough versus Duval — and for being in your time zone when something goes wrong. VS Health Benefits is based in Miami and licensed in 40+ states.

What should I have ready before I call a broker?

For individual coverage: dates of birth for everyone to be covered, your ZIP code, an estimate of household income for the coverage year, and a list of any doctors or prescriptions you want to keep. For a business: a census with age, ZIP code and dependent count for each employee, your current plan and rates if you have one, and how much you can contribute per employee per month. That is enough to start quoting.

Can a broker help if I already have a plan I'm unhappy with?

Yes, though timing matters. Individual plans can generally only be changed during open enrollment or after a qualifying life event. Group plans can be changed at renewal or, in some circumstances, mid-year. If your issue is a claim denial or a billing error rather than the plan itself, a broker can often help you resolve it directly with the carrier — that is part of what the commission pays for.