2027 enrollment: the dates to use
Florida uses HealthCare.gov. Open enrollment for 2027 coverage runs November 1, 2026, through January 15, 2027. It does not begin November 15. CMS expressly confirmed this window in its August 4, 2026 statement following court orders affecting Marketplace rules.[14]
- November 1, 2026: enrollment opens. Compare your current plan with the options for next year.
- December 15, 2026: enroll for coverage starting January 1, 2027.
- January 15, 2027: the final open-enrollment deadline, for coverage starting February 1.
- Pay the first premium: choosing a plan alone does not activate coverage. Confirm the insurer's payment deadline and that your payment was received.[15]
If you need coverage before January: ask whether you qualify for a Special Enrollment Period, such as after losing qualifying coverage. Eligibility and deadlines depend on your circumstances. Do not cancel existing coverage until you understand when the replacement starts.[15]
Florida ADAP: prescription help is not premium help
Florida ADAP currently lists eligibility up to 400% of the federal poverty level, subject to other requirements. Eligible uninsured people can receive covered medicines directly. Eligible people with insurance may receive help with covered medication copays and deductibles. Biktarvy and Descovy returned July 1, 2026, but insurance premium assistance has not been restored.[16]
That distinction matters when comparing plans: a premium is the monthly bill that keeps insurance active. Assistance at the pharmacy does not automatically pay that bill, a doctor's bill, or every medical deductible. Before enrolling, ask ADAP to confirm your eligibility, covered medicine, participating pharmacy, and exact assistance.[16]
Call the Florida ADAP Help Desk at 1-844-381-2327. The Florida ADAP guide explains current benefits, the enacted budget, advocates' work, and the January 2027 program review. A future review is not a promise that premium assistance will return.
Read at your own pace: about 15 minutes for the full guide. For a shorter path, start with the enrollment dates, Florida ADAP, and the plan checklist. You do not need to read everything at once.
Your Case Manager Can Help You Through This
Comparing Marketplace plans is complicated — especially when medication tiers, provider networks, and deductibles all affect your care. You do not have to figure this out on your own. Your HIV case manager can review your options with you, help you compare plans, and help check medication coverage and provider networks before you enroll. This is exactly what they are there for.
If you are not currently connected to a case manager or HIV care team, our Florida Care Resource Guide can help you find one near you.
Find HIV Care & Case Management in Florida →Why This Guide Exists
For many people living with HIV in Florida, health insurance is not abstract policy. It is medication refills, lab monitoring, and appointments that keep viral loads suppressed and long-term health stable. Staying in regular HIV care and taking treatment as prescribed is what allows most people living with HIV to reach and maintain an undetectable viral load — even short coverage gaps can interrupt that continuity.[1]
If a Marketplace transition becomes necessary, this resource provides a clear framework to evaluate your options without risking continuity. It is designed for individuals navigating this on their own, case managers supporting clients, and clinics helping people make informed enrollment decisions.
Florida Marketplace Realities to Understand First
Florida uses the federal Marketplace at healthcare.gov. Plan availability, pricing, and provider networks vary by county. Check whether a plan is an HMO, EPO, or PPO, whether referrals are required, and what it covers outside its network. Do not assume that an insurer’s name means your particular doctor or hospital participates in every plan it sells.[2]
Before enrolling in any plan, confirm:
- Your HIV provider is in network
- Specialists and hospitals you use are in network
- Your HIV medication is on the formulary
- The medication's tier placement and cost-sharing structure
- Whether a specialty pharmacy is required for your medication
Being in network at enrollment does not guarantee a provider stays in network all year. Outside of Open Enrollment or a qualifying life event, you generally cannot switch plans mid-year.
If you rely on mental health or substance use services, confirm those providers are in network. If you are aging with HIV, review how the plan handles ongoing specialist care — cardiology, endocrinology, oncology, or other chronic condition management.
Florida's 2027 plans: proposed rates are not your final bill
WLRN reported on September 11 that Florida insurers were seeking premium increases for 2027. Those were proposed rates, not a personalized final price. Your cost depends on the available plan, county, household, and any financial assistance you qualify for.[19]
Florida's Office of Insurance Regulation publishes 2027 individual-market filing information. Use it for the state-level picture, then use HealthCare.gov to compare the actual plans and prices offered to you. Check your plan's 2027 formulary and network even if you want to stay with the same insurer.[18][15]
Understanding Tiers and Cost Sharing
When you enroll in a Marketplace plan, your medication is placed on a formulary tier. That tier, along with the deductible, copay or coinsurance, and plan rules, affects what you pay at the pharmacy.
Key TermsCopay — a fixed dollar amount per prescription refill or office visit.
Coinsurance — a percentage of the covered medication cost. Check the percentage and whether a deductible applies first.
Deductible — the amount you must pay before certain coverage kicks in. Some plans apply a separate deductible to prescriptions.
Out-of-pocket maximum — the annual limit on your share of covered in-network care. Monthly premiums, noncovered services, and out-of-network costs generally do not count toward this limit. Once reached, the plan pays 100% of covered in-network benefits for the rest of the plan year.[21]
Drug tiers and charges vary by plan. Check your exact medication, dose, pharmacy, and any prior-authorization requirement. As an illustration, 20% coinsurance on a covered medication cost of $2,000 would be $400 before considering a deductible, the out-of-pocket limit, or assistance. This is not a quote for any specific medication or plan.[12]
Why the Monthly Premium Is Not the Whole PictureA plan with a lower monthly premium might have a higher medication coinsurance that costs far more over the course of a year. A plan with a higher premium and a flat $100 copay could end up being significantly less expensive if you refill every month. Do the math before you decide.
+ expected medication, lab, and visit costs
= your true projected annual cost
A simple question to ask yourself: If I had to refill my medication tomorrow, would this plan feel financially stable? Prioritize the plan that protects uninterrupted access to your medication. Sustainability all year matters more than a lower number on the enrollment screen.
Understanding Metal Levels
Metal levels describe cost sharing structure — not the quality of care you receive. Marketplace plans cover the same broad categories of Essential Health Benefits, but their covered drugs, networks, and charges can differ.[20][11]
| Category | What to check for HIV care |
|---|---|
| Bronze | Often has greater cost sharing when you use care. A low premium is not enough: check whether medication and visit costs are manageable, with any confirmed assistance. |
| Silver | If you qualify for income-based cost-sharing reductions, you must choose Silver to receive them. That makes Silver an important starting point for those who qualify, not automatically the best plan for everyone.[4] |
| Gold | Usually covers a larger share of covered care than standard Silver or Bronze. Compare the actual premium, deductible, medication charges, and network; do not assume Gold always has a higher premium. |
These categories describe average cost sharing across a population, not the percentage of every bill you personally pay. Your own costs depend on the plan and the care you use.[20]
Marketplace plan-year deductibles and out-of-pocket limits start over each January. Before switching plans during the year, ask the insurer whether any amounts you have already paid will be credited to the replacement plan. Do not assume that those amounts carry over.
Income and tax credits: distinguish 2026 from 2027
A premium tax credit helps pay the monthly insurance bill. Under current rules, the general income range is 100% to 400% of the federal poverty level (FPL). Income alone does not establish eligibility: tax-household rules, immigration status, access to affordable employer coverage, and eligibility for Medicare or Medicaid also matter.[6]
Use expected income for the year you want coverage. A 2027 application asks about expected 2027 household income, not simply last year's wages. The poverty guideline used to compare that income comes from the prior year's published guideline. “Household” generally means your tax household, not everyone who shares your address.[5][6][15]
On a small screen, swipe or scroll the table sideways to see both income limits. You can also focus the table and use the left and right arrow keys.
| Coverage year | Guideline used | 100% FPL | 400% FPL |
|---|---|---|---|
| 2026 | 2025 guideline | $15,650 | $62,600 |
| 2027 | 2026 guideline | $15,960 | $63,840 |
These are income comparisons, not a guarantee of a tax credit. Larger households use different amounts. The 400% figures are four times the applicable one-person guideline. Do not use this Marketplace table to decide ADAP eligibility; ask ADAP which guideline and household calculation it uses.[5][6][16]
The temporary enhanced premium tax credits applied through 2025. They increased assistance and removed the usual 400% income ceiling for people who otherwise qualified; they did not make everyone eligible. Under current law, the general 400% ceiling applies again in 2026 and 2027. A proposal to extend assistance is not the same as an enacted change. Review your actual Marketplace eligibility result rather than assuming your old premium will continue.[6]
Florida's coverage gap: still get screened
Florida has not expanded Medicaid. Some adults with income below 100% FPL qualify for neither Marketplace financial assistance nor Medicaid under the state's existing rules. That does not mean everyone with low income is ineligible: children, pregnant people, some parents, older adults, and people qualifying through disability-related pathways can have different eligibility rules. Ask for an individual screening rather than ruling yourself out.[7]
If you cannot get affordable insurance, ask your HIV clinic or case manager about Ryan White services and Florida ADAP. These programs can support care and medications for eligible people, but they are not substitutes for comprehensive insurance and do not cover every health need.[8][16]
Tax-credit repayment: only the excess, but no cap
Advance premium tax credits are paid during the year using your estimated eligibility. At tax time, Form 8962 compares that advance help with the credit you actually qualify for. For tax years after 2025, there is no repayment cap on excess advance credits. If you received more than you qualified for, you must repay the excess, not automatically every dollar of assistance you received.[9]
For example, if $5,000 was paid in advance but your final credit is $4,000, the excess is $1,000. This is an illustration, not a personal tax estimate. Report income and household changes promptly, keep Form 1095-A, and get tax help with Form 8962 if you need it.[9]
Medicaid requirements beginning in 2027
A separate Medicaid change: CMS’s new work/community-engagement rules generally begin by January 1, 2027 for specified adult eligibility groups, with exemptions and exceptions. They are not a requirement for every Medicaid recipient or a Marketplace enrollment rule. Ask a navigator which rules apply to your eligibility group and what documentation you need.[22] Policy context and 2027 watch list →
Immigration-related eligibility needs a fresh check
The Congressional Budget Office confirms that section 71301 changes which immigration categories qualify for premium tax credits beginning in 2027. Eligibility to buy a plan and eligibility for financial assistance are different questions. Ask a certified Navigator to review your status and coverage year; eligibility in 2026 does not guarantee the same assistance in 2027.[17]
Court orders changed some enrollment rules, not your tax-filing duty
CMS's August 4 statement says a court order stopped several new 2027 provisions from taking effect as finalized, including specified income-verification changes and the Marketplace's “failure to file and reconcile” eligibility policy. Existing verification for a Special Enrollment Period based on loss of coverage is unaffected. Respond to the notices you actually receive rather than assuming that every verification requirement has disappeared.[14]
You still need to reconcile advance tax credits with the IRS. A court order affecting Marketplace eligibility enforcement does not remove the requirement to file Form 8962 when advance credits were paid on your behalf.[9][14]
Key ACA Protections to Know
- Marketplace plans cannot deny coverage, cancel coverage, or charge you higher premiums because of HIV or any other pre-existing condition[10]
- All Marketplace plans must cover the same 10 categories of Essential Health Benefits, including prescription drugs, laboratory services, hospitalization, preventive care, and mental health[11]
- The difference between plans is not whether HIV care is covered — it is how it is covered and what cost sharing applies to your specific medications and providers
- If a medication is not covered, you can ask about a medically necessary formulary exception and appeal a denial. Approval does not guarantee a lower drug tier or a lower copay[12]
- If you do not make changes during Open Enrollment, you may be automatically re-enrolled into the same or a similar plan — review your plan every year before accepting auto-renewal[13]
- Keep your address and contact information updated with the Marketplace to avoid missing important notices or facing unintended termination
If You Are Comparing Plans Yourself
When reviewing plans on healthcare.gov, go beyond the premium. Before deciding, look at:
- Deductible — and whether there is a separate prescription deductible
- Annual out-of-pocket maximum
- Your HIV medication's tier placement and coinsurance or copay structure
- Whether your HIV provider, specialists, and labs are in network
- Specialty pharmacy requirements for your medication
- Copays for office visits, urgent care, ER, and hospitalization
- Coverage effective date
+ expected medication and care costs
= projected annual cost
Save all documentation — your application confirmation, plan summary, premium amount, and medication cost information. If you have a case manager, bring this to them before finalizing. A second set of eyes on a plan decision can prevent a costly mistake.
If Someone Else Is Enrolling You
Enrollment should never feel rushed or unclear. Before finalizing coverage, confirm these details and ask for copies of everything:
For Case Managers and Community Partners
A few reminders before finalizing coverage for a client:
- Check the correct coverage-year income range, tax household, immigration-related rules, and other eligibility requirements. Do not rely only on last year’s determination
- Verify plan effective dates and enrollment confirmation before the client leaves
- Document clearly who is responsible for premium payments and what happens if assistance changes or ends
- Educate clients that the repayment caps protecting low-income individuals have been eliminated — income reporting during the year is more important than ever[9]
- Explain the January plan-year reset. Before a midyear plan change, ask whether any deductible or out-of-pocket credit can transfer
Ryan White HIV/AIDS Program funding and other assistance programs may help with medication costs, premiums, or cost sharing depending on eligibility and local program rules — Ryan White is designed to be the payer of last resort, filling gaps other coverage doesn't reach.[8] However, Florida ADAP currently does not pay insurance premiums. Do not describe prescription copay assistance as premium assistance. Confirm any other local funding separately before promising help.[16] Connect clients to your local Ryan White program or ADAP coordinator for coordination of benefits.
Preparation is not panic. It is protection. Consistent access to treatment supports viral suppression and protects both individual and community health. After 16 years of living with HIV, I have learned that acting early — asking the right questions, confirming your coverage before you need it — is what keeps care intact.
You do not have to navigate this alone. Your case manager, your HIV clinic, and your community are here. If you are not yet connected to care or a case manager, our Florida Care Resource Guide can help you find what you need.
Find Care & Support Resources in Florida →— RiseUpToHIV · Written by a person living with HIV · This guide is for general educational purposes. It is not affiliated with any government agency, insurance company, or healthcare provider, and does not replace advice from certified Navigators or licensed professionals.
This update was prepared with AI-assisted research and writing under RiseUpToHIV’s editorial direction. Program rules can change. Please contact RiseUpToHIV if you find an error or outdated information.
References & Sources
- HIV.gov. HIV Care Continuum. hiv.gov ↩
- KFF. How Narrow or Broad Are ACA Marketplace Physician Networks? kff.org ↩
- HealthCare.gov. Contact Us — Marketplace Call Center. healthcare.gov ↩
- HealthCare.gov. Cost-Sharing Reductions. healthcare.gov ↩
- HealthCare.gov. Federal Poverty Level (FPL). 2025 guidelines used for 2026 coverage; 2026 guidelines used for 2027 coverage. healthcare.gov; KFF, How Much Can I Earn and Qualify for Premium Tax Credits in the Marketplace? kff.org ↩
- IRS. Questions and Answers on the Premium Tax Credit. Income eligibility reverts to 100–400% FPL for tax years after 2025. irs.gov ↩
- KFF. How Many Uninsured Are in the Coverage Gap, and How Many Could Be Eligible If All States Adopted the Medicaid Expansion? Updated July 27, 2026; explains eligibility gaps in non-expansion states. kff.org ↩
- HRSA Ryan White HIV/AIDS Program. Part B: AIDS Drug Assistance Program (ADAP). ryanwhite.hrsa.gov ↩
- IRS. Questions and Answers on the Premium Tax Credit. No repayment cap applies for tax years after 2025. irs.gov ↩
- HealthCare.gov. Pre-Existing Conditions. healthcare.gov ↩
- HealthCare.gov. What Marketplace Health Insurance Plans Cover. healthcare.gov ↩
- KFF. How Can I Find Out If a Health Plan Covers the Prescription Drugs That I Take? kff.org ↩
- HealthCare.gov. Automatically Re-Enrolled in a Marketplace Plan. healthcare.gov ↩
- CMS. August 4, 2026 statement on City of Columbus v. Kennedy and the 2027 enrollment period. https://www.cms.gov/files/document/statement-re-city-columbus-080426.pdf ↩
- HealthCare.gov. Keep or change your insurance plan. Enrollment deadlines, start dates, and renewal steps. https://www.healthcare.gov/keep-or-change-plan/ ↩
- Florida Department of Health. HIV/AIDS Management. Current ADAP eligibility, medication assistance, and premium policy. https://www.floridahealth.gov/individual-family-health/injury-prevention-wellness/hiv-aids/hiv-aids-management/ ↩
- Congressional Budget Office. Answers to Questions for the Record: section 71301 and 2027 premium tax-credit immigration restrictions. Source. ↩
- Florida Office of Insurance Regulation. Federal Health Insurance. 2027 individual-market filing information. https://floir.gov/life-health/federal-health-insurance ↩
- WLRN. Up, up and away: Are double-digit health insurance rate increases ahead? September 11, 2026. Proposed, not final, rate increases. https://www.wlrn.org/light/health/2026-09-11/up-up-and-away-are-double-digit-health-insurance-rate-increases-ahead ↩
- HealthCare.gov. Health plan categories: Bronze, Silver, Gold, and Platinum. https://www.healthcare.gov/choose-a-plan/plans-categories/ ↩
- HealthCare.gov. Out-of-pocket maximum/limit. Included and excluded expenses. https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/ ↩
- CMS, Medicaid community engagement interim final rule fact sheet, June 1, 2026. Reviewed September 28, 2026. Source. ↩