Up, up, and away: 2026 health insurance premiums set to double for millions of Floridians

Health insurance rates will increase sharply for the 4 million-plus Floridians who rely on so-called Obamacare plans or small employer health insurance coverage in the coming weeks, according to data released by the Florida Office of Insurance Regulation.

The OIR reported late last month that, beginning Jan. 1, 2026, Florida health plans had been approved for double-digit increases in monthly premiums people pay for the individual policies sold on the federal health insurance exchange (healthcare.gov). Florida leads the nation in the number of people enrolled in the exchange.

A 28-year old adult living in Duval County earning $35,000 annually and enrolled in a silver-level individual health insurance plan may pay $281 a month starting Jan. 1, up from $149 now.

Premiums for a family of four earning $85,000 in Duval County will increase to $864 a month after tax credits in 2026, up from $558.

A 28-year-old- living in Miami-Dade County could pay a $322 monthly premium; premiums for such a person in Hillsborough County could total $298 a month. Family premiums in those counties will be $1,019 a month and $932 a month, respectively.

Rates in rural counties will be even higher. Okeechobee County has the dubious distinction of facing the highest premiums in the state: A family of four could The OIR posted the information "for illustrative purposes only" on Aug. 25 but did not otherwise publicly announce that it was available online for people to review in advance of open enrollment for 2026 coverage, which starts Nov. 1.

"Posting them on our website is making them public," OIR spokesperson Kylie Mason told the Florida Phoenix in an email.

The increases in the costs of coverage — coupled with reductions to Medicaid in the 2025 Budget Reconciliation Act (also known as the One Big Beautiful Bill) and programmatic changes to the ACA — could increase the number of uninsured residents in the state by as many as 730,000 in the next 10 years, a KFF analysis shows.

Most of those people, 500,000, could become uninsured because of changes to Obamacare — formally the Affordable Care Act (ACA) — and the elimination of enhanced advanced premiums tax credits first made available in 2021 to further lower out-of-pocket costs for people in "silver" level plans.

If the enhanced advance premium tax credits expire, the number of uninsured residents in Florida could increase by another 1.2 million people, the same KFF analysis indicates. Those additional tax payments for co-payments and deductibles are set to expire at the end of the year. The Florida Hospital Association and other organizations want Congress to extend them.

"We're approaching a healthcare cliff right now," Florida Decides Healthcare spokesperson Karol Molinares told the Florida Phoenix. The organization is pushing a ballot initiative to place Medicaid expansion before the voters.

"That means ERs being clogged up, people not being able to see their primary-care doctors, uncompensated care. Costs for hospitals are going to skyrocket, which the state is going to be on the hook for. You're also going to have 50,000 medical jobs that are going to be lost. It's a whole chain reaction."

More details

The rate increases affect small-employer coverage, too, because the ACA requires certain benefits and coverage to be included in the health plans small employers offer their staffs.

The rate increases for small businesses aren't as great as those for individuals and therefore the premium increases aren't as severe, but remain substantive. The OIR data show costs rising from an average $728 per individual in 2025 to $821 in 2026.

Although Republicans in Florida have not expanded Medicaid to lower-income childless adults, as the ACA allows, the federal health law is popular with residents who annually have flocked to the marketplace for health coverage.

The health exchanges represent a key component of the law, which changed how health insurance can be priced. The law bans insurance companies from medically underwriting the policies and allows rates to be based on four factors only: age, tobacco use, geographic location, and family size.

Eighteen companies write in the state's individual health insurance market, including the Community Care Network, a Department of Veterans Affairs health plan providing care outside of VA facilities that operates in Broward County only.

Blue Cross and Blue Shield of Florida, operating under the Florida Blue moniker, offer policies across Florida's 67 counties. Its affiliate, Health Options, provides HMO coverage in 64 counties. Centene Venture Co. Florida, meanwhile, is offered in 63 counties.

The OIR released 2026 county breakdowns of potential premiums for a 28-year-old individual earning $35,000 annually and potential premiums for a family of four earning $85,000. (Note: The 2025 county breakdowns showed premiums for individuals earning $34,000 and families of four earning $84,000.)

The OIR examples illustrate the costs of plans as well as costs after the advanced premium tax credits that reduce premiums. The numbers are based on the silver-level health insurance policy, the only plan that qualifies enrollees for additional credits to lower out-of-pocket costs.

Florida is not alone in these rate hikes — insurers nationwide are filing double-digit increases. A KFF review of marketplace plans submitted by 312 insurers in 50 states and the District of Columbia shows that the median proposed increase for 2026 is 18%, more than double last year's 7% median proposed increase.

Insurers cited rising costs, utilization of services, and the loss of enhanced advanced premium tax benefits as reasons behind the rate increases, according to KFF.

Medicaid expansion needed

According to the most recent OIR data, most people in Florida who purchased health insurance policies in 2023 bought individual coverage on the federal health insurance exchange.The 2023 data show that more than 5.8 million people maintained commercial health insurance policies, and most of those people, 3.6 million-plus, had individual health insurance.

Nearly 1.8 million people had large-group plans — those sold to businesses with more than 51 employees. Small group policies insured another 400,164 lives in 2023.

The soaring rates, Molinares said, underscore the need for Florida to expand Medicaid to low-income, childless adults, Molinares said.

"I think Medicaid expansion is the last tool in the tool box to avoid a healthcare cliff that we are barrelling toward if the ACA tax credits don't get renewed," she said.