The Marketplace is where people under 65 without employer coverage buy individual health insurance. This guide covers how it works in Florida specifically, what determines the price, and the gap that catches lower-income households in this state.
Where Floridians buy
Some states run their own exchange. Florida does not, so HealthCare.gov is the Marketplace here. That matters practically: the deadlines, the application and the plan categories are the federal ones, and a comparison site that is not HealthCare.gov is not the Marketplace, whatever it looks like.
Plans are sold by private insurers but must meet federal rules on what they cover, and all Marketplace plans cover the same set of essential health benefits and cannot refuse you or charge more for a pre-existing condition.
When you can enroll
Open Enrollment runs November 1 to January 15. Outside that window you can only enroll or change plans if you qualify for a Special Enrollment Period, which is triggered by a life event — see Special Enrollment Periods.
Medicaid and CHIP are different: there is no open enrollment window for them, and you can apply at any time of year.
What determines what you pay
Three things, in roughly this order of impact.
- The premium tax credit. Based on household size and estimated income, it is paid to the insurer each month so you pay less. See premium tax credits.
- The metal level you choose. Bronze through Platinum describes how costs are split between you and the plan, not the quality of care. See metal levels.
- Cost-sharing reductions. An extra discount on deductibles and copayments for lower-income households — but only on a Silver plan. Choosing Bronze instead of Silver can forfeit it entirely.
The Florida coverage gap
Florida has not expanded Medicaid. The result is a group of people whose income is too high for Florida Medicaid as an adult and too low to qualify for a premium tax credit, and who therefore have no affordable route to coverage. This is not a quirk of the application; it is a structural gap, and it is specific to non-expansion states.
If you have been told you do not qualify for either, that is the likely reason, and it is worth having the income estimate checked rather than accepting the result. Where a household’s expected income for the coming year is genuinely higher than the past year — variable hours, seasonal work, self-employment — the estimate on the application is what the subsidy is based on, not last year’s return.
If you are self-employed
The Marketplace is the main route to individual coverage for self-employed people, and there is a tax dimension: premiums may be deductible, which changes the real cost. That is a question for the tax return as much as the enrollment, and the two decisions interact.
Also on this site
Dated coverage of this topic, where the figures move year to year:
Frequently asked questions
Does Florida have its own health insurance exchange?
No. Florida uses the federal Marketplace, so coverage here is bought through HealthCare.gov. The deadlines and plan categories are the federal ones.
When is ACA open enrollment?
November 1 to January 15 each year. Outside that window you need a Special Enrollment Period triggered by a qualifying life event. Medicaid and CHIP have no enrollment window and can be applied for at any time.
Can I be refused for a pre-existing condition?
No. Marketplace plans cannot refuse you coverage or charge you more because of a pre-existing condition, and all of them cover the same set of essential health benefits.
What is the Florida coverage gap?
Because Florida has not expanded Medicaid, some people earn too much for Florida Medicaid as an adult and too little to qualify for a premium tax credit. They fall between the two and have no subsidised route to coverage. It is a feature of non-expansion states rather than a mistake on the application.
Sources
- HealthCare.gov — Centers for Medicare & Medicaid Services · read 2026-10-19
- Medicaid & CHIP coverage — HealthCare.gov · read 2026-10-19
- Health plan categories: Bronze, Silver, Gold & Platinum — HealthCare.gov · read 2026-10-19
This guide explains published rules and figures, with the source for each one. It is not advice about your own situation.