You can still get a nationwide PPO in Florida. Here is how self-employed tax preparers and bookkeepers are buying coverage when most of the year's income lands between January and April.
Hi, I'm Sam Jaber, a licensed health insurance broker based in Tampa. I'm licensed in 36 states and do everything over the phone, and with Florida tax pros I'm happy to wait until the season is behind you.
You already know half of this subject better than my average client. You've reconciled premium tax credits on other people's returns and you know what net self-employment income means. What tends to be new is the Florida insurance side: the price jump this year, what the marketplace PPO actually costs, and a gap at the low end that Florida has and many states don't. That's what this page covers.
Put this at the top of your notes: you can still get a nationwide PPO in Florida, and a preparer in good health above the credit range should run that comparison.
On the marketplace, the numbers aren't kind to PPOs. Only 14 of the 410 marketplace medical plans in Florida's file are PPOs, all from one insurer. Next to the lowest-priced plan on any other network in the same county, the PPO costs 85% more in St. Lucie, 110% more in Martin and 120% more in Flagler. The median county is about two times the price.
Off the marketplace, medically underwritten private plans use PPO networks that reach nationwide and set their price from your health. That's the other column in the comparison.
Does your household's income for the coverage year qualify for the premium tax credit through HealthCare.gov? The cutoff is near four times the poverty level, rising with household size, and the marketplace works from your estimate of net self-employment income.
The answer weighs more in Florida this year than usual. Approved 2026 rates for individual plans increased 34.1% on average, according to the state's insurance regulator, with enrollment weighting and no subsidies applied. You know how that plays out: the credit absorbs a lot of it for people under the line, and the people above it pay the whole increase.
Then a HealthCare.gov plan is usually your most affordable option, since the credit only attaches to marketplace plans.
The estimate is where a seasonal business gets caught. You'll be enrolling before you know how the next filing season goes. If it runs stronger than you projected, some of the advance credit comes back on your own return. The practical answer is the one you'd give a client: estimate honestly, then update HealthCare.gov after April when you know the real number.
Most of Florida's marketplace plans are HMOs, so we'll confirm your doctors are in the network rather than chasing the lowest premium alone.
Next step: Send me your projection for the year and I'll help you pick a marketplace plan that leaves room for a strong season.
A one-person shop in a slow year, or a first year after leaving a firm, can come in very low. In most states that would mean more help. In Florida it can mean less. Florida has not adopted the Medicaid expansion, and the premium credit usually requires income of at least the poverty line. Fall short of that and a household can be shut out of both programs.
You'll recognize the planning problem: the estimate and the timing of enrollment both matter when income sits near a threshold.
Next step: If your projection is close to that floor, call me before you enroll and we'll work through what you qualify for.
Above the line, you pay full Florida price, increase included. For a healthy household, I'd price a medically underwritten nationwide PPO next to it.
You answer health questions on the application, and the insurer either accepts, declines, or accepts with a specific condition excluded. Being healthy is what allows the price to land below the full marketplace rate. Each plan sets its own benefits, so I'll go through what any plan pays before you commit.
Next step: Call me once the season wraps and we'll compare a nationwide PPO price with what your county's marketplace charges.
If you or a family member has a chronic diagnosis or a medication you can't skip, the marketplace is usually the right home, even above the line. Marketplace plans can't turn anyone away or charge more for health. An underwritten plan can.
Then the Florida choice is between the less expensive HMO and EPO plans and the higher-priced marketplace PPO, depending on where your doctors are.
Next step: Give me your doctors and prescriptions and I'll check them against the plans in your county with you.
Straight answers, no sales pitch.
Your best estimate of the full year's net income, updated on HealthCare.gov once the season shows you the real figure.
Individual plan rates approved for 2026 were up 34.1% on average, per the state's regulator, before subsidies. Above the credit range, that full increase is yours.
Yes, one insurer sells it in every county. In the median county it costs about twice the lowest-priced plan on another network.
You may be in the coverage gap. Florida skipped the Medicaid expansion, and the premium credit normally requires income at or above the poverty line, so a sub-poverty year can leave you with no help from either side. Talk to me first.
Your county, who's on the plan, and the net you're projecting for the year. I'll show you which side of the line you're on and what each path costs, and if your current plan is already the better deal, I'll say that too.
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