Florida ACA premiums rise again as residents call for relief

Florida’s Affordable Care Act Marketplace plans are set to cost more again.

As open enrollment approaches, customers and health advocates are urging policymakers to step in and address rising, and in some cases unsustainable, healthcare expenses.

Florida Voices for Health, a healthcare advocacy organization, held a meeting to press elected leaders to do more.

“We're also calling on our state and federal lawmakers after November 3 to take this seriously and to pursue the needed reforms to lower costs and improve coverage and give Floridians a chance to live full and healthy lives,” said Scott Darius, executive director of Florida Voices for Health.

How much are plans increasing?

On average, ACA premiums in Florida will rise 10.4% next year, following a 34% increase in the previous year, according to the Florida Office of Insurance Regulation.

UnitedHealthcare of Florida Inc. is seeing one of the largest increases for its marketplace plans, with a 25% jump. The year before, its Florida customers saw monthly premiums climb 32%.

Dave Waalewyn, 64, of Leesburg, worked as a pilot for Spirit Airlines. After the company shut down, he lost his health insurance. He later applied for a marketplace plan that would have cost him $800 a month, but the insurer raised concerns after learning about a stress test he took while flying and possible heart issues.

“(The test) proved that there was a trivial amount of plaque,” he said.

He is now facing a premium of $1,500 a month.

“For me, to look at it, $1,500 a month means $18,000 a year,” Waalewyn said. “I do find it frustrating… I was hoping to possibly retire, but that is too wide of a gap for me.”

Waalewyn described his situation at the meeting, where he and other insurance customers pressed lawmakers to take stronger action as healthcare costs keep rising.

The ripple effect

Darius said next year’s increases are still being driven “by the rippling effects of the non-extension of the enhanced premium tax credits last year.”

The enhanced premium tax credit, expanded during the Biden administration, made Marketplace coverage more affordable. Last year, the Trump administration and congressional Republicans did not renew the ACA enhanced premium tax credit as part of the One Big Beautiful Bill. That mattered especially in Florida, which had the largest share of Marketplace customers. About 97% of Florida customers used the tax credit, according to research from KFF, a nonpartisan health policy organization.

Losing the enhanced credit has also pushed private insurance premiums higher.

“I feel like folks like us are at the mercy of these greedy giants who simply see us as profit,” said Emily Bellairs-Romero of Geneva.

Bellairs-Romero also spoke at the Florida Voices for Health meeting. She said she was diagnosed with Crohn’s disease 16 years ago. “It can cause catastrophic damage to the intestines, and it can even cause life-threatening conditions like sepsis.”

She once paid $5 a month for her medication through her husband’s employer-sponsored insurance, until the company stopped covering the drug. Her doctor found a biosimilar alternative, but it would cost her $3,400 a year. She cannot enroll in Medicare for years.

With costs climbing, she said she fears what lies ahead medically and financially.

“I have no idea how I am going to pay in January,” she said. “I only know that the cost of this medication and the cost of my insurance is becoming unsustainable.”

What to know about open enrollment

Even with higher prices, the Marketplace can still offer meaningful help, said Katie Roders Turner, executive director of the Family Healthcare Foundation.

“Don't assume you don't qualify for assistance on the health insurance marketplace this year. There have been a lot of changes, but it's still worth taking a look,” she said.

In some situations, paying a little more in monthly premiums may save money overall by reducing out-of-pocket costs, Roders Turner said.

“Spending a little bit more each month might help reduce your out-of-pocket expenses,” she said.

Open enrollment begins soon and runs through Jan. 15.

Those wanting coverage to start at the beginning of 2027 must enroll by Dec. 15. Enrolling later will delay coverage until Feb. 1.

Anyone needing help choosing a plan can speak with a Florida healthcare navigator at CoveringFlorida.org or call 877-813-9115.