Open Enrollment Tips for Individuals and Families in Florida

Open enrollment is your annual opportunity to get health insurance right. For Florida individuals and families purchasing coverage through the ACA marketplace, the enrollment window runs from November 1 through January 15, with coverage starting as early as January 1 for those who enroll by December 15.

Whether you are enrolling for the first time, switching plans, or simply reviewing your current coverage, these tips will help you make a smarter, more informed decision.

Many people procrastinate on open enrollment and scramble to enroll in the final days of the window. Starting early gives you time to:

• Gather the documents you need (income information, Social Security numbers, current insurance cards)
• Compare multiple plans carefully rather than rushing a decision
• Enroll by December 15 if you want coverage starting January 1
• Ask questions and get guidance from a licensed broker without time pressure

The plans available to you, and the tax credits you qualify for, are the same whether you enroll on November 1 or January 14. The only difference is how much time you have to make a thoughtful decision.

Your ACA premium tax credit is based on your projected household income for the upcoming year. Getting this estimate right matters — a lot.

If you underestimate your income: Your tax credit will be larger than you are entitled to. When you file your taxes, you will have to repay the excess — sometimes a significant amount.

If you overestimate your income: Your tax credit will be smaller than it could be, meaning you pay more each month than necessary. You will receive the difference as a refund when you file your taxes, but you will have overpaid throughout the year.

For most people, the best approach is to use your best estimate of what you expect to earn in the coming year, based on your current situation. If your income is variable — as it is for many self-employed individuals, freelancers, and seasonal workers — err slightly on the side of overestimating to avoid a tax bill.

The monthly premium is the most visible cost of a health insurance plan, but it is far from the only one. Before choosing a plan, understand the full cost picture:

Deductible: The amount you pay out of pocket before your insurance begins covering most services. A plan with a $0 premium and a $7,000 deductible may cost far more than a plan with a $150 premium and a $1,500 deductible — especially if you use medical care regularly.

Copays and coinsurance: After meeting your deductible, you typically pay a flat copay or a percentage of costs. Review these for the services you use most — primary care visits, specialist visits, urgent care, and prescriptions.

Out-of-pocket maximum: This is the most you will pay in a single year. Once you hit this limit, your insurance covers 100% of covered services. A lower out-of-pocket maximum provides stronger financial protection.

Prescription drug costs: If you take regular medications, check each plan's drug formulary to see how your prescriptions are covered and at what cost tier.

Before enrolling in any plan, verify that your preferred primary care physician, specialists, and hospitals are in the plan's network. Out-of-network care can be extremely expensive — sometimes not covered at all outside of emergencies.

Do not assume your current doctors are in-network for a new plan. Provider networks change each year, and a doctor who was in-network last year may not be this year. Always verify directly with the plan or your provider's office before enrolling.

ACA marketplace plans are organized into four metal tiers — Bronze, Silver, Gold, and Platinum — each representing a different balance between monthly premium and out-of-pocket costs.

Bronze: Lowest premium, highest out-of-pocket costs. Best for healthy individuals who rarely need care.

Silver: Middle ground on premium and costs. The only tier eligible for cost-sharing reductions (CSRs), which can dramatically lower your deductible and copays if your income qualifies.

Gold: Higher premium, lower out-of-pocket costs. Good for people with regular medical needs.

Platinum: Highest premium, lowest out-of-pocket costs. Best for those with significant, predictable health care expenses.

If your income falls between 100% and 250% of the federal poverty level, a Silver plan with cost-sharing reductions is almost always the best value — the enhanced coverage can make a Silver plan perform like a Gold or Platinum plan at a Silver premium.

If you are generally healthy and want to reduce your tax burden, consider enrolling in a High Deductible Health Plan (HDHP) paired with a Health Savings Account (HSA). HSAs offer a triple tax advantage:

• Contributions are tax-deductible
• Growth is tax-free
• Withdrawals for qualified medical expenses are tax-free

In 2026, you can contribute up to $4,300 as an individual or $8,550 as a family to an HSA. Unused funds roll over year to year and can be invested for long-term growth — making an HSA a powerful tool for both current medical expenses and retirement health care costs.

Note: HSA-eligible plans must meet minimum deductible requirements and are not compatible with cost-sharing reductions. If you qualify for CSRs, a Silver plan with CSRs will typically provide better value than an HSA-eligible plan.

Many people re-enroll in their current plan by default each year without reviewing their options. This is a costly mistake. Plans change their premiums, networks, and drug formularies annually, and new plans enter the market each year.

Even if your current plan was the best option last year, it may not be this year. Taking 30 minutes to compare your options during open enrollment can save you hundreds of dollars.

If your income, household size, or other circumstances change during the year, update your marketplace application promptly. Changes that affect your tax credit eligibility include:

• A significant increase or decrease in income
• Getting married or divorced
• Having or adopting a child
• A family member gaining or losing other coverage

Updating your application ensures your tax credit is adjusted in real time, preventing a large reconciliation at tax time.

If you miss open enrollment, you can only enroll or make changes during a Special Enrollment Period (SEP) triggered by a qualifying life event. Common qualifying events include:

• Losing job-based health coverage
• Getting married or divorced
• Having or adopting a child
• Moving to a new coverage area
• Turning 26 and aging off a parent's plan

You generally have 60 days from the qualifying event to enroll. Do not wait — missing this window means waiting until the next open enrollment period.

Navigating the ACA marketplace on your own is possible, but working with a licensed insurance broker makes the process faster, easier, and often results in better coverage at a lower cost. A broker can:

• Compare every available plan in your area side by side
• Estimate your tax credit and cost-sharing reduction eligibility
• Verify your doctors and medications are covered
• Help you enroll in the right plan for your family's needs

Brokers are compensated by the insurance carriers — their services cost you nothing.

At All Horizon Financial Services, we help West Palm Beach and South Florida individuals and families navigate open enrollment every year. Our licensed advisors are available to answer your questions, compare your options, and help you enroll in coverage that truly fits your life.

Call us at 561-688-7300 or 561-301-5274 to schedule a free consultation, or get a quote online today. Open enrollment comes once a year — make it count.