Florida ACA marketplace enrollees face significant premium increases as enhanced premium tax credits are set to expire at the end of 2025. The state leads the nation in Affordable Care Act (ACA) marketplace participation, making these changes especially impactful for millions of residents.

Florida ACA Marketplace Coverage and Enrollment

Florida has the highest number of ACA marketplace enrollees in the United States. According to data from federal agencies, more than 4.7 million Floridians rely on ACA coverage, while over 4.3 million are covered by Medicaid. Combined, about two out of every five residents in the state depend on one of these programs for health insurance.

The ACA marketplace provides coverage options for individuals who do not qualify for Medicaid and do not have employer-sponsored insurance. This makes the program a critical resource for many families, small business owners, and self-employed individuals throughout Florida.

Impact of Expiring ACA Premium Tax Credits in Florida

The enhanced ACA premium tax credits were introduced in 2021 as part of pandemic relief measures. These credits lowered the cost of marketplace plans, especially for those just above Medicaid eligibility. The credits were originally set to expire in 2022 but were extended through 2025.

Unless Congress acts, the enhanced credits will end on December 31, 2025. Insurers in Florida have already set 2026 premium rates based on the expectation that these credits will not be renewed. According to federal projections, premium payments for marketplace coverage are expected to rise by an average of 114%, or about $1,016 per year for many Floridians.

Who Will Be Most Affected?

Nearly 30% of Floridians with ACA marketplace coverage—over 1 million people—could be priced out of health insurance if the credits expire. Small-business owners are also expected to face average premium increases of $1,500 in 2026. The expiration of credits is likely to hit those without employer-sponsored insurance and those just above Medicaid eligibility the hardest.

Projected Consequences for Florida Residents

The Congressional Budget Office estimates that, nationwide, 3 to 4 million more people could become uninsured in 2026 if the enhanced credits are not extended. In Florida, the impact is expected to be especially severe due to the state’s high reliance on the ACA marketplace and the fact that Florida has not expanded Medicaid eligibility.

Experts warn that higher premiums may force healthier individuals to drop coverage. This could leave a sicker, more expensive insurance pool, which would drive premiums even higher for those who remain insured.

Economic and Healthcare System Effects

The expiration of the tax credits is projected to lead to nearly 340,000 job losses across the United States in 2026, primarily in the healthcare sector. Florida’s healthcare system could experience increased strain as more residents become uninsured and delay or forgo preventive care. Hospitals and emergency services may see higher demand from uninsured patients, increasing costs for providers and taxpayers.

Broader Context: Healthcare Affordability in Florida

Florida’s reliance on ACA coverage makes the state particularly vulnerable to changes in federal subsidies. The expiration of enhanced tax credits comes at a time of broader inflation and rising healthcare costs, adding financial pressure to families and the healthcare system.

The issue is part of a larger national debate over healthcare affordability, the future of the ACA, and the role of federal subsidies in maintaining insurance coverage. Congressional negotiations to extend the credits have stalled, and there is currently no legislative solution in place as of late 2025.

Upcoming Changes to Medicaid and Insurance Markets

The expiration of enhanced ACA credits coincides with other healthcare funding changes, including significant Medicaid cuts scheduled to begin in 2027. Insurers in Florida have set premium rates for 2026 with the expectation of no further federal support, resulting in the largest single-year premium increases in years—between 20% and 40% in the state, according to industry filings.

Frequently Asked Questions About Florida ACA Marketplace

What is the Florida ACA marketplace?

The Florida ACA marketplace is a state-based health insurance exchange where residents can shop for and purchase health plans. It is designed for people who do not qualify for Medicaid and do not have employer-sponsored insurance.

How much will premiums increase if tax credits expire?

Premiums for ACA marketplace coverage in Florida are projected to increase by an average of 114%, or about $1,016 per year, if the enhanced tax credits expire at the end of 2025.

Are there alternatives for Floridians losing ACA coverage?

Some Floridians may qualify for Medicaid or other state programs, but many just above Medicaid eligibility may not have affordable options if ACA premium credits expire. Private insurance may be available but could be costly.

Can you still enroll in the Florida ACA marketplace for 2025?

Yes, Floridians can still enroll in ACA marketplace plans for 2025. The enhanced premium tax credits remain in effect through December 31, 2025, according to federal guidelines.

Where are most ACA marketplace enrollees in Florida located?

ACA marketplace enrollees are found throughout Florida, with large numbers in urban and suburban areas. The state as a whole has the highest enrollment in the country, reflecting widespread reliance on the program.