Floridians shopping for their own coverage usually end up choosing between two very different kinds of plan: an ACA marketplace plan bought through HealthCare.gov, or a private plan bought directly from an insurance company. Both can be good choices. The right one depends on your health, your income and the doctors you want to keep.
The short version
| ACA marketplace plan | Private (medically underwritten) plan | |
|---|---|---|
| Who can enroll | Anyone, during open enrollment or a special enrollment period | Based on your health history; many accept applications year-round |
| Price based on | Age, ZIP code, tobacco use | Age, ZIP code, tobacco use and health history |
| Income | Determines eligibility for premium tax credits | Not considered |
| Pre-existing conditions | Must be covered | May be limited or excluded |
| Networks | Often HMO or EPO in many Florida counties | Often PPO networks |
When an ACA plan usually makes more sense
- You have an ongoing or serious health condition. Marketplace plans can't deny coverage or charge more for health history.
- Your income qualifies for meaningful tax credits. For some households, credits bring the premium well below a comparable private plan.
- You're planning a pregnancy. Maternity care is an essential health benefit on ACA plans and may be limited on private plans.
When a private plan may be the better value
- You're healthy and rarely use care. Underwritten plans price your actual health profile, so healthy applicants who qualify may pay significantly less.
- Your income is too high for tax credits. Without credits, a marketplace plan is full price, and private options deserve a look.
- You want a PPO network. If your doctors aren't in the local marketplace HMOs, a private PPO plan may keep them in network.
- You missed open enrollment. Many private plans don't follow the open enrollment calendar.
Timing in Florida
Florida uses HealthCare.gov. For 2027 coverage, open enrollment runs November 1, 2026 to January 15, 2027; choose a plan by December 15 for a January 1 start. Outside that window you generally need a qualifying life event. Private plans set their own start dates after approval.
Questions to ask before you decide
- Are my doctors, specialists and hospital in this plan's network?
- What would I pay in a quiet year, and in a bad year, once the deductible and out-of-pocket maximum are included?
- For a private plan: how is any pre-existing condition treated, and is the plan renewable?
- For a marketplace plan: what tax credit am I likely to qualify for, and what happens if my income changes?
We compare both side by side, using your real doctors and budget. Read more about private PPO health insurance, ACA marketplace plans, or options if you have a pre-existing condition.
Sources
General information only, not tax, legal or medical advice. Plan availability, benefits, networks and pricing vary by carrier, state, county and eligibility. Stratton Advisory Group is an independent agency and is not affiliated with any insurance carrier or government agency.