Many people may get less financial help in 2026
Unless Congress renews the enhanced subsidies, they will expire at the end of 2025. If this happens, monthly insurance costs will be much higher for almost all Floridians who buy health insurance on the Marketplace.
For some, their monthly costs will more than double, and they may need to look at a different health insurance plan for next year.
For example, a 40-year-old man in Miami-Dade County making $22,590 could see his payment go from $0 per month in 2025 to $81 in 2026 for the same plan.1
Frequently asked questions
Changes to enrollment and financial help
Centers for Medicare & Medicaid Services (CMS), which is part of the federal government, determines who is eligible for financial assistance, how much they qualify for, what they must provide to prove they are eligible, and when they can enroll. The changes they make affect all insurance companies.
Yes. The federal government oversees the Health Insurance Marketplace (HealthCare.gov), and they determine who qualifies for financial assistance and how much, what paperwork is required to enroll or renew, and when people can enroll. The changes they’re making, including the possible expiration of the enhanced tax credits, will apply to every insurance company in Florida.
Monthly premiums for the upcoming year are released on November 1, and because of the changes in the market and some of the new guidelines, premiums are expected to go up across the country. Setting up an appointment with a licensed Florida Blue agent is one of the best ways to learn how your monthly costs could change. Even if you typically don’t work with an agent and choose to purchase insurance on your own, consulting with an agent is free and will be helpful when making choices about your health care coverage this year.
No, the subsidies for plans sold on the Health Insurance Marketplace are not going away totally.
Unless Congress renews the enhanced subsidies, they will expire at the end of 2025. That means, in January 2026, they will go back to their pre-2021 American Rescue Plan Act amounts. Subsidies have always been available for plans that are sold on the Marketplace.
The 2021 American Rescue Plan Act increased the amount of financial help that some people received, and it allowed others over a certain annual income to get subsidies for the first time. These enhanced subsidy levels were planned to be in place for two years, but The Inflation Reduction Act later extended them for another two years. The enhanced subsidies are set to expire at the end of 2025 and, unless Congress acts, they will return to the pre-2021 American Rescue Plan Act amounts.
With this change, millions of Americans would lose some portion or all their financial help, making their monthly insurance costs more expensive.
Marketplace rules and filing your taxes
You must file your taxes every year that you received a subsidy. When you enroll in or renew your insurance and apply for financial help, you estimate how much money you’ll make that year. When the year is over, you’ll need to confirm whether your estimate was correct.
You do this by filing your taxes and comparing your actual income to what you predicted. This is referred to as IRS form 8962. If you got more of a subsidy than you should have, you’ll have to pay back some of the financial assistance. On the other hand, if you got less of a subsidy than you should have, you could get some money back. The Marketplace will look at your taxes up to 2024 when you apply for a tax credit for plan year 2026.
When you enroll in or renew your insurance and apply for financial help, you estimate how much money you’ll make that year. When the year is over, you’ll need to confirm whether your estimate was correct. You do this by filing your taxes and comparing your actual income to what you predicted. If you got more of a subsidy than you should have, you’ll have to repay 100% of the extra amount. In the past, there was a limit on what you’d have to repay.
So, if your income fluctuates, you will need to update your eligibility in your Florida Blue account during the year to avoid owing anything back.
If your current plan is still being offered next year, and you don’t qualify for a subsidy, the answer is yes.
If you qualify for a subsidy, you can passively renew, but your subsidy amount may change, and you could have a higher monthly cost. Specifically, those whose subsidy covers 100% of their monthly premium (so they pay $0 per month for their premium), will be assessed $5 per month until they verify their income. So, after November 1, to avoid having to pay $5 per month, you should work with an agent to validate your income and renew your coverage by December 15.
When, how, and why to enroll
When you’re with Florida Blue, you’re never alone. Our agents are licensed and specially trained to explain all the changes and find the best plan for your family’s needs. And there’s never an extra cost to work with them. We have a wide range of plans to fit many budgets, and our agents know how to help you get the most subsidy you can qualify for. Plus, all our plans include personalized care programs, special discounts, and more at $0 extra cost. We’ll do everything we can to help you find a plan that fits your needs and your budget.
We have knowledgeable agents standing by to answer your questions at no extra cost and there’s no obligation to buy a plan from them. Our agents are licensed and specially trained to explain all the changes and find the best plan for your family’s needs. Having this expert guidance at no extra cost is a perk of working with Florida Blue. It’s easy to find an agent near you, connect with an agent at a local Florida Blue Center in person or through a virtual chat, or call us at 1-844-396-2595.
No one plans to get sick or hurt, but most people will need medical care at some point. Having insurance means you won’t have to pay expensive medical bills on your own, whether you have a simple stomach bug or a serious accident or illness. For example, without health insurance, here are some common out-of-pocket costs:
- Average ER visit at a Florida hospital: $3,1002
- To fix a broken leg: $7,5003
- Average three-day hospital stay: $30,0003
- Cost of comprehensive cancer care: More than $100,0003
A recent report shows that 40% of adults in the United States have some type of health care debt.4 Medical debt shows up on your credit report, and medical bills contribute to nearly 70% of bankruptcies in the U.S.2 Having health insurance helps protect you and your loved ones from potentially huge health care expenses.
Health insurance is more than just a financial safety net — it can be a tool for getting healthier. Many insurance plans offer added personalized services, like help managing ongoing health conditions, for no extra cost. This can help you get the quality care you need for the least out of your pocket. Plus, with insurance, your checkups, vaccinations, yearly bloodwork, and annual cancer screenings are covered at no extra cost.
The annual Open Enrollment Period is a time when individuals and families can enroll in a health insurance plan or renew their current plan for the upcoming year. In 2025, Open Enrollment runs from November 1 through January 15. Those who enroll by December 15 will have coverage starting on January 1. Those who enroll between December 16 and January 15 will have coverage starting February 1.
If it’s outside of the Open Enrollment Period, you would have to have a qualifying life event, which includes situations like losing your existing health insurance, getting married, having a baby, or moving to a new ZIP code. If you miss Open Enrollment and do not qualify for a Special Enrollment Period, you may have to wait until the next Open Enrollment to get coverage. A Florida Blue agent can help determine if your life change qualifies you for an SEP.
