Open enrollment in Florida runs from November 1 through January 15 each year. Most people spend more time picking a streaming service than a health plan — and then spend the rest of the year paying for it. This checklist gives you every comparison that matters, in the order that matters, so you can enroll with confidence.
Your 10-Step Florida ACA Plan Shopping Checklist
List Your Current Doctors and Specialists
Write down every provider you've seen in the past year — primary care doctor, OB-GYN, cardiologist, dermatologist, mental health provider, and anyone else you expect to see in the coming year. For each plan you consider, run their name through the carrier's provider directory. If a key provider is out-of-network, the plan may not be the right fit regardless of price.
List Every Prescription You Take
Pull your current prescriptions — name, dose, and frequency. Look each one up in the formulary for each plan you're comparing. Note the tier: Tier 1 generics are cheapest; Tier 3–4 brand and specialty drugs carry much higher cost-sharing. A plan with a $30/month lower premium that puts your $200/month medication on Tier 4 with 30% coinsurance costs more overall.
Estimate Your Annual Medical Usage
Be honest about how much care you typically use. Three common profiles: Low-user — preventive visits only, generally healthy; Moderate-user — a few sick visits per year, one or two specialist visits, ongoing prescriptions; High-user — chronic condition management, regular specialist care, possible procedures or hospitalizations. Your profile should drive which tier makes financial sense.
Calculate Total Annual Cost — Not Just Monthly Premium
Annual premium × 12 is not your full cost. Add your estimated out-of-pocket spending based on your usage profile: copays for expected visits + expected drug costs + any procedures. Compare this total number across 2–3 plans. A plan with a $100/month lower premium and a $3,000 higher deductible only wins if you use less than $1,200 in non-preventive care per year.
Check the Out-of-Pocket Maximum
The out-of-pocket maximum (OOPM) is your worst-case scenario for the year. If you get seriously ill or injured, this is the most you'll pay before insurance covers 100%. In 2026, the federal ACA OOPM cap is $9,450 for an individual. Gold plans typically offer lower OOPMs — $3,000–$5,000 — which matters significantly if you have a chronic condition or expect a procedure.
Consider HSA Eligibility If You're Healthy
Only High Deductible Health Plans (HDHPs) — typically Bronze plans meeting IRS minimum deductible thresholds — qualify for a Health Savings Account (HSA). If you're generally healthy, an HDHP + HSA combination can be a smart financial move: you save on premiums and contribute pre-tax dollars to the HSA to cover out-of-pocket costs if needed. Unused HSA funds roll over and can grow tax-free for decades. The 2026 HSA contribution limit is $4,300 for an individual.
Check the Carrier's Quality and Star Ratings
CMS rates ACA marketplace plans on a 1–5 star scale based on member outcomes, care management, and member experience. In Florida, most established carriers (Florida Blue, Ambetter, Molina) have 3–4 star ratings. A plan with a significantly lower star rating may save money upfront but deliver worse service — longer preauth delays, harder claim disputes, narrower networks.
Understand the Network Type: HMO vs PPO
Most Florida ACA plans are HMOs — you choose a primary care physician, get referrals for specialists, and stay within a defined network. HMOs are typically less expensive. PPOs offer more flexibility: you can see any provider in or out of network without a referral, but you'll pay more for that flexibility. Florida also has EPO plans (no referrals but still network-restricted) and rare POS plans. Know what you're buying before you enroll.
Review the Drug Formulary for Your Specific Medications Again
Don't assume Step 2 covered this fully. Also check: are your drugs available via mail order for a 90-day supply at a discount? Does the plan require step therapy or prior authorization for any of your medications? Are specialty drugs on a separate specialty pharmacy benefit with different rules? These details don't appear in the summary — you need the full formulary document or a direct call to the plan's pharmacy line.
Consider Working with a Licensed Broker
A licensed Florida health insurance broker costs you nothing — they are compensated by the carrier at the same premium you'd pay if you enrolled directly on Healthcare.gov. They can compare all plans available in your county, run the total cost analysis, verify your doctors and drugs against each plan's network, explain subsidy implications, and help you enroll. They also assist throughout the year if you have billing issues or need to make a mid-year change.
Metal Tier Comparison: When Each Makes Sense in Florida
| Metal Tier | Premium | Deductible | Best For |
|---|---|---|---|
| Bronze / HDHP | Lowest | $5,000–$8,000 | Healthy, low-utilization; HSA eligible |
| Silver | Moderate | $500–$2,500 | Most Floridians; required for CSR subsidies |
| Gold | Higher | $0–$1,000 | Regular care users, chronic conditions |
| Platinum | Highest | $0 | Very high utilizers; lowest OOPM |
Don't Overlook Silver Plan Cost-Sharing Reductions
The Benchmark Silver Plan and Your Subsidy
The benchmark plan is the second-lowest-cost Silver plan in your area. The ACA premium tax credit is calculated based on this benchmark — your subsidy equals the benchmark premium minus the maximum contribution expected at your income level. This means:
- If you pick a plan cheaper than the benchmark, your subsidy covers some of the remaining premium — potentially bringing your cost to $0/month
- If you pick a more expensive plan, you pay the difference
- Always compare your after-subsidy cost, not the sticker price
Florida Plan Finder and Healthcare.gov both display your estimated subsidy and after-tax-credit premium for each plan once you enter your household income and size.
Frequently Asked Questions
Licensed Florida Health Insurance Producer
This resource is maintained by a licensed Florida health insurance producer (NPN #21249133). We help Florida residents find ACA marketplace plans, compare coverage options, and enroll in health insurance.
Sources & Further Reading
- Healthcare.gov — ACA Plan Comparison and Enrollment
- CMS — 2026 Federal Poverty Level Guidelines
- IRS — HSA Contribution Limits 2026
- CMS — Quality Rating System for Marketplace Plans
- Florida Office of Insurance Regulation — Consumer Resources