Florida Maintains Nation’s Highest ACA Enrollment Despite 202,000-Person Drop in 2026

Facing rising costs of insurance premiums, about 202,000 fewer Floridians purchased insurance from the Affordable Care Act Marketplace during the 2026 enrollment period. It was one of the starkest declines in ACA enrollment across the nation, just behind Georgia, which had a decline of 206,000, according to new data released by the Centers for Medicare and Medicaid Services.

Despite the decline, Florida still has more ACA enrollees than any other state. During this year’s coverage period, total customer enrollment fell to 4.5 million. Since that time, ACA enrollment saw sharp increases in Florida from a total enrollment of 2.7 million customers in 2022 to 4.7 million in 2025.

Enhanced Tax Credits Expiration Drives Premium Increases

According to KFF estimates, premiums were expected to increase by 114% on average nationwide. That’s because the federal government didn’t renew the “enhanced premium tax credit,” which kept monthly premiums down. In Florida, about 97% of customers used the tax credit, KFF research shows.

The enhanced premium tax credit became most effective in 2021 during the COVID-19 pandemic when the American Rescue Plan Act increased subsidized payments and removed the income limits, so a household with an income above 400% of the federal poverty line could qualify.

Consumer Behavior Shifts Toward Lower-Cost Plans

“While we do recognize that costs have increased, there still is a demand for coverage and a demand for work,” said Xonjenese Jacobs, director of the Covering Florida Navigator Program, which assists ACA customers in choosing a plan. She says navigators experienced a lot of customer frustration over the jump in premium prices.

Jacobs says the types of plans consumers typically buy also shifted. Consumers focused more on cheaper monthly premiums in exchange for a higher out-of-pocket deductible. In some instances, consumers decided to forego “silver plans,” where they might have had an additional savings, but it cost them more money each month – for example, in some cases the premium jumped from $0.00 to $20 a month, Jacobs said. Many instead decided to go with a plan that was $0.00 in a “gold plan” category, but has a higher max out of pocket.

Business and Financial Implications for Healthcare Organizations

The enrollment decline and premium increases create significant operational challenges for healthcare providers. With fewer insured patients and higher deductibles becoming more common, healthcare organizations may face increased bad debt and collection challenges. The shift toward higher-deductible plans means patients are responsible for more out-of-pocket costs before insurance coverage begins, potentially affecting payment patterns and cash flow.

Healthcare providers should prepare for potential increases in uncompensated care and may need to adjust financial assistance programs and payment plan offerings. Revenue cycle management becomes increasingly critical as more patients struggle with affordability and may delay or forego care entirely.

Regulatory and Accounting Considerations

The changing landscape of ACA enrollment requires healthcare organizations to carefully monitor patient mix and payor composition. Financial reporting and budgeting processes must account for potential shifts in insurance coverage types and collection rates. Organizations may need to reassess their provision for bad debt and evaluate the adequacy of their charity care policies.

Healthcare entities should also consider the impact on compliance requirements, as changes in patient insurance status may affect various regulatory reporting obligations and quality metrics tied to federal programs.

“When we’re looking at the numbers, it just tells me that Floridians want access to affordable, quality health care, and they’re willing to ensure that this is one of those priorities for themselves and their family,” she said. Despite the challenges, the continued high enrollment numbers demonstrate ongoing demand for healthcare coverage in Florida’s market.

Healthcare organizations navigating ACA enrollment changes and premium increases can benefit from specialized guidance. Contact James Moore’s healthcare practice team to discuss how these developments may impact your organization.

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