ACA Changes for 2026: What You Need to Know Before Open Enrollment

Aug 14 2025 16:05

Robert Routt

ACA Changes for 2026: Florida Marketplace Health Insurance Updates You Need to Know

 

If you live in Florida and get your health insurance through the Affordable Care Act (ACA) Marketplace, major rule changes are coming in 2026 that could impact your coverage, enrollment period, and monthly costs.

As your local Clearwater health insurance agent, I want to make sure you understand these ACA 2026 changes so you can plan ahead and avoid losing benefits.

1. Special Enrollment Period (SEP) Rules Are Changing

Starting August 25, 2025, the year-round SEP for low-income individuals (150% of the Federal Poverty Level or less) will end. You’ll only qualify for a Special Enrollment Period if you have a Qualifying Life Event like:

  • Losing health insurance

  • Getting married or divorced

  • Moving to a new coverage area

  • Having a baby

This is a major change for Florida Marketplace enrollees who used to apply anytime.

2. Income Verification Will Be Stricter

Your reported income must match IRS data. If there’s a mismatch, you’ll need to submit proof before you can get subsidies. This will affect many Florida ACA applicants who estimate their income.

3. New $5 Monthly Fee for Some $0 Premium Plans

If you’re auto-renewed into a $0-premium Marketplace plan and don’t verify your eligibility, you’ll now be charged $5 per month starting in 2026.

4. Filing Your Taxes Is Now Required for Subsidies

If you get Advance Premium Tax Credits (APTC), you must file taxes and reconcile your credits every year. Missing just one year can now end your subsidy eligibility.

5. Open Enrollment Dates for Florida in 2026

The Open Enrollment Period will still run from November 1 to January 15 for 2026. However, starting in 2027, enrollment will shorten to November 1 – December 15.

6. Pandemic-Relief Subsidies Are Ending

The extra ACA subsidies created during the pandemic will expire December 31, 2025. This could mean higher premiums for many Florida Marketplace members.

7. No Cap on Subsidy Repayments

If you underestimated your income, you’ll now repay the full amount of excess subsidies—there will be no repayment cap starting in 2026.

8. Reduced Subsidy Eligibility for Recent Immigrants

Lawfully present immigrants in their first 5 years in the U.S. will no longer qualify for Marketplace subsidies if their income is below the poverty line.

9. More ACA Plans Eligible for HSAs

Starting in 2026, some Bronze and Catastrophic Florida Marketplace plans will qualify for Health Savings Account (HSA) contributions.

10. Florida ACA Premiums Will Increase

Insurance carriers are requesting average premium increases of 18–20% for the 2026 plan year. With subsidies dropping, many Floridians could see higher out-of-pocket costs.

11. Coverage Changes

Certain benefits, like gender-affirming care, may no longer be required under ACA essential health benefits starting in 2026. DACA recipients will also lose Marketplace eligibility.

12. Shorter Enrollment Windows Coming

In 2027, Florida ACA Open Enrollment will be about two weeks shorter —so be ready to act faster.

13. Fraud Prevention Measures

The government expects these changes to reduce average premiums by about 5% and save billions in federal spending by limiting ineligible enrollments.

✅ What Florida Residents Should Do Now

  • Mark Open Enrollment dates: Nov 1 – Jan 15 for 2026

  • Update your income estimates: Avoid subsidy repayment surprises

  • Check your email & mail: Don’t miss important Marketplace notices

  • Work with a licensed agent: I can help you compare Florida Marketplace plans and make sure you keep your coverage and subsidies

 

💬 Need Help With Your 2026 ACA Plan in Florida?
I’ve been helping Florida families get the best Marketplace coverage for over 30 years. Let me guide you through these changes and find the right plan for your needs.

📞 Call or text me at 727-513-8338
🌐 Visit RouttInsurance.com to request a free ACA quote