Florida Health Insurance Plans: Complete 2025 Guide
Compare plan types (HMO, PPO, EPO), coverage levels (Bronze, Silver, Gold, Platinum), top carriers, and costs. Expert guidance to help you choose the right coverage for your needs.
🏥 Plan Types Explained
HMO, PPO, EPO, and POS plans compared with detailed pros and cons for each network structure
💰 Metal Tiers Breakdown
Bronze, Silver, Gold, and Platinum coverage levels—understand cost vs. coverage trade-offs
🏢 Top Florida Carriers
Compare Florida Blue, Ambetter, Oscar, Molina, and other major insurance companies in your area
🎯 Expert Guidance
Independent broker help choosing the right plan type, coverage level, and carrier for your situation
Understanding Florida Health Insurance Plans in 2026
Health insurance in Florida comes with important decisions that affect your healthcare access, costs, and flexibility. This guide helps Florida residents understand the landscape of coverage options available throughout the state.
Florida residents can approach health plan selection from two complementary angles. First, you choose a plan type (HMO, PPO, EPO, or POS)—this determines how you access care, which doctors you can see, and how much flexibility you have. Second, you select a metal tier (Bronze, Silver, Gold, or Platinum)—this determines how costs are shared between you and the insurance company.
This comprehensive guide walks you through both aspects of Florida health insurance plans, helping you understand plan types, metal tiers, carrier options, costs, and how to choose what’s right for your specific needs and budget.
⚠️ Important 2026 Change: Enhanced premium tax credits from the Inflation Reduction Act expired December 31, 2025. The “subsidy cliff” at 400% FPL has returned. Many Floridians will see significant premium increases for 2026 coverage—sometimes $400-800/month more for the same plan. If you received subsidies in 2025, review your 2026 options carefully.
Florida Health Insurance Marketplace: How It Works
The Florida Health Insurance Marketplace, accessed through HealthCare.gov, is the primary way most Florida residents shop for individual and family health coverage. The marketplace offers plans from multiple insurance companies, allows you to compare options side-by-side, and is where you apply for premium tax credits and cost-sharing reductions.
During Open Enrollment (November 1, 2025 – January 15, 2026), Florida residents can enroll in marketplace plans or change existing coverage. Special Enrollment Periods are available for those who experience qualifying life events like marriage, birth of a child, loss of other coverage, or moving to Florida from another state.
All marketplace plans must cover the ten essential health benefits required by the Affordable Care Act: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehabilitative services, laboratory services, preventive care, and pediatric services including dental and vision.
Financial Assistance for 2026
Premium Tax Credits: Available for individuals and families with incomes between 100% and 400% of the Federal Poverty Level:
- Individual: $15,650 to $62,600 annual income
- Family of 4: $32,150 to $128,600 annual income
- Note: The subsidy cliff has returned—earn $1 over 400% FPL and you lose ALL subsidies
Cost-Sharing Reductions (CSRs): Lower your deductibles (what you pay before insurance kicks in) and copays (fixed fees per visit). CSRs are only available with Silver plans if your income is under 250% FPL ($39,125 for individuals, $80,375 for a family of four).
For more details on saving money, see the affordable health insurance Florida guide.
Florida Health Plan Types: HMO, PPO, EPO, and POS Explained
The four main plan types available in Florida are HMO, PPO, EPO, and POS. Each has distinct advantages and limitations. Your choice affects your premiums, provider access, referral requirements, and out-of-network coverage options.
🏥 HMO Plans
Health Maintenance Organization
How It Works: Choose primary care doctor (PCP) who coordinates all care and provides referrals to specialists
Network: Must use in-network providers only (except emergencies)
Referrals: Required for specialists
Best For: Lower premiums, willing to coordinate through PCP, stay in network
🌐 PPO Plans
Preferred Provider Organization
How It Works: See any provider without referrals, though in-network costs less than out-of-network
Network: Can use out-of-network providers at higher cost
Referrals: Not required
Best For: Maximum flexibility, willing to pay higher premiums, see specialists directly
🎯 EPO Plans
Exclusive Provider Organization
How It Works: See any in-network provider without referrals, no out-of-network coverage
Network: In-network only (except emergencies)
Referrals: Not required
Best For: Lower cost than PPO, no referral hassles, comfortable staying in network
🔄 POS Plans
Point of Service
How It Works: Hybrid of HMO and PPO—choose PCP, can go out-of-network at higher cost
Network: Primarily in-network, some out-of-network coverage
Referrals: Required for in-network specialists
Best For: Want PCP coordination but occasional out-of-network flexibility
📱 Narrow Network Plans
Limited Provider Networks
How It Works: Smaller network of providers in exchange for lower premiums
Network: Smaller than standard HMO/PPO networks
Referrals: Depends on specific plan structure
Best For: Your doctors are included, want lowest possible premiums
💡 Choosing Your Plan Type
Key Considerations
• How often you see specialists
• If you want to choose doctors freely
• Your budget for premiums
• Whether you travel frequently
• Importance of out-of-network access
Expert Tip: Most Florida residents choose HMO or EPO plans because they offer the best value—lower premiums while maintaining good provider networks. PPO plans cost 20-40% more but provide flexibility rarely used by most people. Consider whether that flexibility is worth the extra cost for YOUR situation. For those who need maximum provider choice, explore the PPO health insurance Florida guide.
See What Coverage Fits Your Situation
Different plans are designed for different situations. Comparing options helps you choose coverage that aligns with your needs and budget.
Check your Options Call 888-215-4045
Florida Health Plan Metal Tiers: Coverage Levels Explained
All marketplace health plans are classified into four metal tiers—Bronze, Silver, Gold, and Platinum—based on how costs are shared between you and the insurance company. These tiers don’t reflect the quality of care, only how much of your healthcare costs the plan pays versus what you pay out-of-pocket.
Important Note: These percentages are averages. The “60%” in Bronze doesn’t mean you pay 40% of every bill—it means across all plan members, the insurance company covers 60% of total costs while members collectively pay 40%. Your individual costs depend on how much care you use. With high-deductible Bronze plans, you might pay 100% until reaching your deductible.
Top Health Insurance Companies Offering Florida Plans in 2026
Florida’s health insurance market includes several major carriers, each offering different plan options, provider networks, and coverage areas. Independent agencies provide access to all major carriers, ensuring the most competitive rates and comprehensive coverage options.
| Feature | Flexible Network Plans | HMO Plans |
|---|---|---|
| Monthly Premium | Higher ($50-150 more typically) | Lower |
| Referrals for Specialists | Not required | Required for most specialists |
| Out-of-Network Coverage | Yes, at higher cost | Usually none except emergencies |
| Primary Care Doctor Required | Optional | Yes, must select one |
| Network Size | Typically larger | More limited |
| Best For | Flexibility seekers, frequent travelers, those with multiple specialists | Budget-conscious, healthy individuals, those who prefer coordinated care |
⚠️ 2026 Carrier Changes: Aetna exited the Florida marketplace at the end of 2025. If you had Aetna coverage, you must choose a new carrier. Additionally, 22 Health (Community Care Network) is new for 2026 but only serves Broward County.
Carrier availability varies by county. Not all carriers offer plans in all areas, and plan type availability can differ even within the same carrier. Verify which carriers and plan types are available in your specific Florida county before enrolling. For a detailed analysis of Florida’s largest carrier, see the Florida Blue review. Comprehensive rankings are also available in the best health insurance Florida guide.
Understanding Health Insurance Costs in Florida for 2026
Health insurance Florida plans costs vary significantly based on your age, plan type, coverage level, and household income. Understanding both premiums and out-of-pocket costs is essential for budgeting healthcare expenses.
Average Premium Costs by Plan Type and Metal Tier
Here’s how monthly premiums typically compare across plan types and metal tiers for a 40-year-old individual in Florida:
Sample Monthly Premiums (40-Year-Old, Before Subsidies)
| Plan Type | Example Carrier | Monthly Premium | Deductible | Out-of-Pocket Max |
|---|---|---|---|---|
| HMO (Silver) | Health First | $645 | $3,100 | $5,011 |
| EPO (Silver) | Cigna | $911 | $2,208 | $5,476 |
| PPO (Silver) | Florida Blue | $1,510 | $2,505 | $5,475 |
Note: These are sample rates for 2026. Actual costs vary by age, location, carrier, and specific plan. Subsidies can significantly reduce these amounts for qualifying households.
Maria’s Situation: A 40-year-old self-employed graphic designer in Miami-Dade County earning $22,590/year paid $0/month for her Silver plan in 2025 thanks to enhanced subsidies. For 2026, her same plan costs $81/month—still affordable, but $972/year more than before.
Roberto’s Situation: Her neighbor Roberto, age 60 earning $35,000/year, faces a bigger hit. His 2025 plan cost $85/month. For 2026, similar coverage runs $485/month—an increase of $4,800/year. Working with an independent agency helped him find a different plan that reduced this impact significantly.
Ready to Compare Florida Health Insurance Plans?
Compare ALL available plans based on your doctors, budget, health needs, and medications.
Compare All Plan Options Online Call 888-215-4045Comparing Plan Types Side-by-Side
This detailed comparison helps you understand the key differences between Florida health plan types:
| Feature | HMO | EPO | PPO | POS |
|---|---|---|---|---|
| Primary Care Doctor | Required | Not required | Not required | Required |
| Specialist Referrals | Required | Not required | Not required | Required (in-network) |
| Out-of-Network Coverage | No (except emergency) | No (except emergency) | Yes (higher cost) | Limited (higher cost) |
| Relative Premiums | Lowest | Low-Moderate | Highest | Moderate |
| Administrative Hassle | Moderate (referrals) | Low | Low | Moderate (referrals) |
| Best For | Budget-conscious, local care | Balance of cost and flexibility | Maximum freedom, frequent travel | Want coordination with flexibility |
How to Choose the Right Florida Health Insurance Plan
Selecting the optimal health plan requires balancing several factors. Use this decision-making framework:
💰 Step 1: Determine Your Budget
Monthly vs. Out-of-Pocket Costs
Understand what you can afford for premiums AND unexpected costs (deductibles, out-of-pocket max).
Tight budget: Bronze HMO
Moderate budget: Silver plans
Higher budget: Gold/Platinum
🏥 Step 2: Assess Healthcare Needs
Current Health & Expected Care
Consider how often you need medical care and any ongoing conditions.
Healthy: Bronze or Silver
Chronic conditions: Silver CSR or Gold
Frequent specialists: EPO or PPO
👨⚕️ Step 3: Check Provider Networks
Verify Your Doctors Are Covered
Critical: Confirm your doctors, specialists, and hospitals are in-network BEFORE enrolling.
• Current doctors in-network?
• Specialists you see regularly?
• Which hospitals covered?
💊 Step 4: Review Drug Coverage
Check the Formulary
Ensure your prescriptions are covered and calculate total annual drug costs.
• Medications on formulary?
• What tier? (affects copays)
• Prior authorization needed?
📊 Step 5: Plan for Financial Risk
Assess Your Risk Tolerance
Honestly evaluate your ability to handle unexpected medical costs.
Limited savings: Silver or Gold for predictability
Substantial savings: Bronze may work
✅ Step 6: Compare & Enroll
Make Your Decision
Calculate total annual costs (premiums + expected out-of-pocket) across 2-3 top options.
Don’t just pick lowest premium—the cheapest plan often costs more overall.
Call 888-215-4045 for help comparing.
Compare Coverage Options Before You Decide
Coverage types vary in benefits, eligibility, and limitations. Comparing options side by side helps you understand the differences and choose what fits your needs.
Compare Options Online Call 888-215-4045Frequently Asked Questions About Florida Health Insurance Plans
What’s the difference between HMO and PPO plans?
HMO requires you to choose a primary care doctor who coordinates care and provides referrals to specialists. You must use in-network providers only (except emergencies). PPO lets you see any doctor without referrals and covers out-of-network care, though at higher cost. HMO plans cost 20-40% less than PPO but offer less flexibility. Most Florida residents find HMO networks adequate and prefer the cost savings.
Which metal tier should I choose?
Bronze if you’re healthy and want lowest premiums (accepting high deductible risk). Silver if you’re average health with moderate care needs—best value for most people. Gold if you have chronic conditions or expect regular healthcare expenses. Platinum if you have significant ongoing medical needs. Also consider: Silver plans qualify for Cost-Sharing Reductions if income is under $39,125 (individual), making them exceptional value.
Can I get health insurance in Florida if I have a pre-existing condition?
Yes, under the Affordable Care Act, insurance companies cannot deny coverage or charge higher premiums based on pre-existing medical conditions. All qualified health insurance Florida plans must accept all applicants regardless of health status. This protection applies to all marketplace plans and ACA-compliant coverage.
What is the deadline to enroll in Florida health insurance plans for 2026?
The Open Enrollment Period runs from November 1, 2025 through January 15, 2026. You must enroll during this time unless you qualify for a Special Enrollment Period due to life events like marriage, birth of a child, loss of other coverage, or moving to Florida from another state.
How do I know if I qualify for financial assistance with my premiums?
Premium tax credits are available for individuals and families with incomes between 100% and 400% of the Federal Poverty Level. For 2026, this means individuals earning between $15,650 and $62,600, or families of four earning between $32,150 and $128,600. Cost-sharing reductions are available up to 250% of FPL ($39,125 individual, $80,375 family of four) with Silver plans only. Call 888-215-4045 to calculate exact eligibility.
Can I change plan types or metal tiers during the year?
No, except with a Qualifying Life Event (job loss, marriage, birth, moving to a new area). You’re locked into your plan type and metal tier for the full year unless circumstances change significantly. This makes choosing correctly the first time critical—proper guidance helps ensure the right plan is selected upfront so you’re not stuck with wrong coverage for 12 months.
Are EPO plans a good compromise between HMO and PPO?
Often yes! EPO plans offer HMO-like pricing without referral requirements—you can see specialists directly like a PPO. The trade-off is no out-of-network coverage (except emergencies). For most people who stay in-network anyway, EPO provides the best of both worlds: lower cost plus flexibility to see specialists without PCP gatekeeping.
How do I know which plans cover my doctors?
NEVER assume—always verify before enrolling. Each carrier maintains different provider networks, and these vary by plan type within the same carrier. During the comparison process, specific doctors should be checked against each plan’s network to avoid accidentally choosing a plan where preferred doctors are out-of-network. This verification prevents the #1 complaint from people who enrolled without proper guidance.
Additional Florida Health Insurance Resources
Learn how subsidies, premium tax credits, and cost-sharing reductions make Florida health coverage more affordable.
Compare Florida’s top health insurance carriers by cost, provider networks, customer service, and overall value.
In-depth review of Florida Blue plans, pricing, network size, and how they compare with other insurers.
Explore private medical insurance options with flexible benefits and coverage beyond the ACA marketplace.
Understand temporary health insurance for coverage gaps, including costs, limits, and eligibility rules.
Explore Florida PPO health insurance plans offering flexible provider access and nationwide doctor networks.
Get Started With Your Florida Health Insurance Plan Today
This guide covered Florida health plan types (HMO, PPO, EPO, POS), metal tiers (Bronze, Silver, Gold, Platinum), major carriers, and how to evaluate options. The next step is comparing specific plans based on your doctors, prescriptions, budget, and healthcare needs.
Get Free Quotes Now Call 888-215-4045Independent Broker Notice
ForHealthInsurance.com is an independent health insurance agency serving Florida residents. We are not affiliated with any carrier or government agency. We help you compare plans and enroll in coverage that meets your needs at no extra cost to you.