The Affordable Care Act (ACA), or “Obamacare,” is a law that has dramatically changed how health insurance works in America. Millions upon millions of people now have access to health insurance coverage as a result of the ACA. Additionally, the ACA has changed the affordability of health insurance for Americans.
Overview
Many Florida residents are feeling the impact of rising health care costs—especially adults under 65 who buy their coverage through the Affordable Care Act (ACA) marketplace. Premiums, deductibles, and out-of-pocket costs have increased steadily, and those who don’t qualify for subsidies often feel priced out altogether.
This guide breaks down why ACA plans in Florida have become so expensive, who is most affected, and how to evaluate alternative coverage options, including private plans that may offer more predictable costs depending on your situation.
Why Florida ACA Premiums Keep Rising
ACA premiums rise due to several key factors—some national and some unique to Florida.
1. Medical Costs Continue to Increase
Like the rest of the country, Florida faces higher medical costs due to:
- Rising hospital and provider prices
- Increased demand for care
- Higher prescription drug and medication costs
- More chronic conditions in the population, with many individuals requiring ongoing medications, which contributes to higher costs
When healthcare costs rise, premiums follow.
2. Florida’s Demographics Drive Higher Utilization
Compared to other states, Florida has a higher percentage of its population who are older or retired before age 65. This group typically uses:
- Use more medical services on average compared to younger populations.
- Require more specialist visits.
- Face more chronic health issues.
The average healthcare costs and utilization for these individuals are higher than for other age groups.
Higher utilization → higher claims → higher premiums for ACA insurers.
3. A Large Portion of Floridians Are Uninsured
Many Floridians have a household income just above the subsidy cliff or experience income fluctuations that cause them to lose eligibility for subsidies.
These individuals pay:
- Full price for premiums
- Full deductibles
- Higher out-of-pocket expenses
For this group, ACA plans can become cost-prohibitive.
4. Narrow Networks Can Limit Value for Some Buyers
To control costs, many ACA insurers introduce limited networks:
- Fewer doctors
- Fewer hospitals
- More HMO-style plans
For people whose providers aren’t included, the perceived value drops—even as premiums rise.
5. Plan Structures Have Trended Toward Higher Deductibles
It’s common to see:
- $9,000+ deductibles
- High out-of-pocket maximums
- Specialist visit restrictions
- Tiered drug formularies
These designs help control premiums, but they also shift more of the cost burden to consumers. In many cases, high-deductible plans can still come with a significant monthly premium, further increasing the overall cost burden.
Who Is Most Impacted by Rising ACA Costs
Not everyone feels the premium increases equally. Some groups experience much bigger price shocks.
1. People Who Don’t Qualify for Subsidies
If your income is:
- Above ~400% of the Federal Poverty Level
- Irregular (self-employed, commission-based)
- Not calculated correctly using marketplace rules
…you may get little or no financial assistance, which means:
- Monthly premiums may be high, especially if you lose eligibility for a tax credit
- Deductibles may be difficult to meet
- Budgeting becomes unpredictable
These individuals often explore alternative health insurance options.
2. Adults Ages 50 to 64
ACA pricing allows age-rating—meaning premiums rise as you get older.
A 62-year-old often pays:
- 2–3× more than a 25-year-old on the same plan
- Even more if unsubsidized, with expected higher costs for adults ages 50 to 64 if ACA tax credits expire
For many in this age group, ACA costs feel especially heavy.
3. Self-Employed Floridians
People who are self-employed frequently:
- Earn variable income.
- Fall in and out of eligibility for subsidies.
- Face large tax-time adjustments when income doesn’t match estimates.
- Rely on tax deductions for health insurance premiums, but unpredictable income can complicate these deductions.
This makes ACA budgeting extremely difficult year-round.
4. Early Retirees Under 65
Until they become eligible for Medicare at 65, retirees must find their own coverage. Those who do not qualify for Medicaid may face particularly high ACA premiums until they become eligible for Medicare. Without subsidies, ACA options can be one of their biggest expenses.
When an ACA Plan Is Still the Best Fit
Despite rising costs, ACA plans remain the right choice for many Florida residents.
You may want to stay with an ACA plan if:
- You qualify for significant subsidies.
- You have chronic health conditions requiring broad health coverage.
- You need access to specific providers only in ACA networks.
- You expect high medical usage and want to ensure continuous health coverage.
- You prefer standardized protections (pre-existing conditions, essential benefits, etc.)
ACA plans are especially valuable for:
- Lower-income households
- Individuals with ongoing medical needs who cannot risk gaps in health coverage
- Families with children and maternity needs
When It Makes Sense to Explore Private Health Insurance Options
There could be other individuals that live in Florida that might choose to obtain their private health insurance plan as an alternative (this option might provide them with a better mix between premium costs, benefits, and provider selections), while many employers will also provide hefty employer-subsidized health insurance benefits (which often means lower premiums for the employee and/or greater coverage because of the employer’s contribution and tax benefits associated with it).
To better understand the importance of the role an employer plays in obtaining health insurance, individuals who do not receive employer-sponsored health insurance should consider purchasing a private plan, enrolling through the ACA, or both.
Private plans may be worth comparing if:
- If you are not eligible for ACA subsidies.
- If you would like a monthly cost that is easier to estimate.
- If you want a more PPO-type of access to providers.
- If you want wider access to healthcare providers, i.e., greater access to hospitals.
- You want options outside the ACA open enrollment period.
- You’re relatively healthy and want coverage for larger medical events, not day-to-day usage.
Important Note
Private plans vary widely in structure and eligibility. They are not ACA plans and do not replace ACA protections. A licensed agent can explain the differences so you can make an informed decision.
Key Differences Between ACA Plans and Private Health Plans
Below is an educational comparison—not a recommendation. The best option depends on income, household size, health needs, and subsidy eligibility.
| Feature | ACA Marketplace Plans | Private (Non-Marketplace) Plans |
|---|---|---|
| Subsidies | Premium tax credits, ACA tax credits, enhanced premium tax credits, and marketplace subsidies available based on income | Not available |
| Enrollment Period | Limited (mostly Nov–Jan) | Year-round options |
| Network Type | Often HMO/EPO | Often PPO or broader networks |
| Premiums | Premiums set by insurers and influenced by policy changes and subsidy availability; can be high without subsidies | May be lower depending on profile |
| Deductibles | Always covered | Varies by plan |
| Who Benefits Most | Subsidy-eligible & high users | Unsubsidized & low–moderate users |
Employer-sponsored coverage offers opportunities for Group Pricing, Employee Contributions, and different Tax Benefits compared to Marketplace and Private Non-Marketplace Plans.
This chart should help consumers see why some individuals consider Private Coverage Options when faced with the high costs of ACA coverage.
How to Compare ACA and Private Plans Responsibly
When reviewing your plan options, be aware that you can use enrollment assistance and/or financial counseling services, as both will help you base your decision on more complete information rather than emotion or guesswork. Things to consider are:
1. Your Annual Healthcare Usage
- How many times in the last 12 months have you visited your doctor(s)?
- Do you use branded prescription medications?
- Need to see specialists for your health care needs?
2. Your Monthly Budget Tolerance
- Do you want to pay higher premiums and lower costs when you see the doctor(s)?
- Or, would you rather pay lower premiums and higher deductibles?
3. Income qualifications for subsidies
A small income difference can dramatically change ACA pricing. Crossing a certain income line can affect your eligibility for subsidies. Taxes and your tax filing status also play a key role in determining whether you qualify for government assistance with your health insurance plan.
4. Your Preferred Providers
With Private plans, you will have access to providers that you do not have through Marketplace Networks.
5. You Risk Tolerance
ACA has standard requirements for health plans, whereas private plans can vary by company, plan design, etc.
An agent can assist you with a balanced view of your situation and determine the best option for you.
Frequently Asked Questions (FAQs)
Are ACA plans more expensive in Florida than in other states?
Florida is among the states where ACA premiums have risen consistently, partly due to demographics and provider pricing. Orlando residents, for example, have seen significant increases, and major insurers like Florida Blue have responded to federal and state regulatory changes affecting premiums.
Are private health insurance plans cheaper than ACA?
They can be—in certain situations, especially for people who don’t qualify for subsidies. But private plans vary widely, and eligibility requirements differ. In most cases, if your employer offers affordable coverage that meets minimum value, you are not eligible for ACA subsidies and would pay full price for marketplace plans.
Can you switch from an ACA plan to a private plan at any time?
Private plans typically offer year-round enrollment. ACA plans require a qualifying life event outside Open Enrollment. If you are already enrolled in an ACA plan, you may need a qualifying event to change your coverage outside the official period.
Do private plans cover pre-existing conditions?
Coverage depends on the plan type. A licensed agent can explain what’s covered and where limitations apply.
Who should stay on an ACA plan?
Anyone who receives meaningful subsidies or is insured and has high medical usage usually benefits most from remaining on ACA coverage, especially those managing chronic conditions like diabetes.
When is Open Enrollment, and how do I enroll?
The time frame designated for Open Enrollment for ACA plans is from November through mid-January each year. Consumers can apply for health coverage during this time or qualify for a Special Enrollment Period due to a qualifying life event.
What details affect my eligibility for ACA subsidies?
Your eligibility for financial assistance through ACA subsidies to help lower your monthly premiums will be determined by your household size, income, and information on whether you are covered by your spouse or dependents, among other factors. It is very important to provide accurate and complete information so that the correct subsidy amount can be calculated.
What are the expected cost changes if subsidies expire?
If ACA subsidies expire, expected premium increases could impact thousands of Floridians, making coverage less affordable for many.
How do state regulators influence health insurance premiums?
State regulators oversee premium adjustments and ensure that insurers like Florida Blue comply with state and federal laws regarding rate changes and consumer protections.
Have there been recent press conferences on ACA costs?
Yes, recent press conference events in Florida have featured residents from cities like Orlando voicing concerns about rising health care costs and the potential loss of ACA tax credits.
How do organizations connect consumers to health insurance resources?
Health care organizations and community organisations link consumers with enrollment assistance and resources to support smooth transitions during open enrollment.
How do law and government decisions affect ACA costs?
The Government creates or modifies laws that provide a framework for who is eligible to receive benefits through the ACA and which services are eligible. These changes affect the cost of health insurance premiums and the amount of subsidies available to people through the ACA, thereby influencing the overall cost of health insurance (healthcare affordability).
How are people with diabetes affected by rising healthcare costs?
Individuals with diabetes often face higher medical expenses and are particularly vulnerable to premium increases and changes in insurance coverage.
Why is money and financial planning important for health insurance?
Healthcare costs can be a significant financial burden. Careful money management and understanding available subsidies or financial aid are crucial for maintaining affordable coverage.
How have tariffs contributed to rising healthcare costs?
Recent tariffs on imported medical supplies have increased costs for insurers and consumers, contributing to higher premiums and out-of-pocket expenses.
How does Florida lead the nation in ACA enrollment?
Florida leads the nation in ACA enrollment, with more residents enrolled and receiving subsidies than in any other state. Changes to subsidies would have a major impact on the state’s healthcare landscape.
In most cases, who is not eligible for ACA subsidies?
In most cases, individuals with access to affordable employer-sponsored insurance that meets minimum value standards are not eligible for ACA subsidies and would pay full price for marketplace plans.
Final Thoughts
ACA plans remain an essential part of Florida’s healthcare system, but they can become expensive for residents who don’t receive subsidies. For those exploring alternatives, private health insurance may offer different structures, networks, and pricing that better suit income and medical needs.
Whether you stay on the marketplace or compare other options, understanding the differences allows you to make informed, confident decisions about your coverage.
Not sure whether an ACA plan or a private plan is the better fit?
A quick conversation with a licensed Florida advisor can help you understand the differences, confirm your subsidy eligibility, and explore any private options that may align with your needs.
Find Out If a Private Plan Fits You
