If you live in Clearwater, Tampa, Palm Harbor, Dunedin, Tarpon Springs, or anywhere else around the Tampa Bay area and you need health insurance, the ACA Marketplace is one of the biggest resources available to you. We will walk you through exactly how to get ACA insurance. From figuring out whether you’re eligible, to gathering what you need, to choosing the right plan. If you’d rather have someone walk you through it in person, Martindale Insurance Services is right here in Tarpon Springs and serves clients across Pinellas and Hillsborough counties at no cost to you.
Before diving into plans, it helps to know whether the ACA Marketplace is the right route for you.
You’re eligible to enroll in a Marketplace plan if you’ve met the following. A U.S. citizen or lawfully present resident, you live in the United States, and you’re not currently incarcerated. There is no income limit to enroll. However, your income does affect whether you qualify for financial help in the form of premium tax credits.
You generally should not use the Marketplace if you already have Medicare coverage. Once you’re enrolled in Medicare, Marketplace plans are off the table.
If you have access to health insurance through your employer, you may still be able to use the Marketplace. Whether you qualify for subsidies depends on whether your employer’s plan meets affordability and minimum value standards. We covered that in detail in a previous blog post here, but the short version is: talk to an independent agent before assuming employer coverage is automatically your best option.
Timing matters with ACA insurance. You can’t simply sign up any time you feel like it. There are specific windows when enrollment is open.
Open Enrollment runs from November 1 through January 15 each year in Florida and most other states. This is the primary window when anyone who is eligible can shop for plans, make changes to existing coverage, or enroll for the first time. If you enroll by December 15, your coverage starts January 1. If you enroll between December 16 and January 15, your coverage starts February 1.
Outside of open enrollment, you can only get coverage if you qualify for a Special Enrollment Period. These are triggered by qualifying life events, which include losing health coverage (through job loss, aging off a parent’s plan, losing Medicaid eligibility, or other reasons), getting married or divorced, having or adopting a child, moving to a new coverage area, and a few other circumstances. If you’ve recently experienced any of these, you likely have a 60-day window from the event date to enroll.
For residents of Clearwater, Dunedin, Palm Harbor, Safety Harbor, Oldsmar, and surrounding Pinellas County communities, the federal Marketplace at HealthCare.gov is where you’ll shop. Florida does not run its own state exchange, so all enrollment goes through the federal platform.
Having the right information ready before you sit down to apply makes the process significantly smoother.
Personal information for everyone in your household who needs coverage, including full legal names, dates of birth, and Social Security numbers.
Income information for your household. This includes wages, self-employment income, Social Security benefits, pension or retirement income, rental income, and any other sources. The Marketplace uses your projected income for the coming year, not last year’s actual income, so you’ll need to estimate if your earnings vary.
Current coverage information, if applicable. If you’re losing employer coverage or another type of insurance, you may need the date your coverage ends.
Your doctors and medications. You don’t technically need this to apply, but you’ll need it to choose the right plan. Knowing which doctors you want to keep in-network and which prescriptions you take regularly will help you compare plans effectively once you see your options.
This is where a lot of people get tripped up, especially given the changes heading into 2026.
If your household income falls between 100% and 400% of the federal poverty level, you may qualify for premium tax credits that lower your monthly cost. For a single person, that range runs from roughly $15,650 to $62,600 per year. For a family of four, it runs from about $32,150 to $106,000.
It’s important to know that the enhanced premium tax credits that were in place from 2021 through 2025 have expired. During those years, subsidies were available at virtually any income level. That’s no longer the case in 2026. Premiums on the Marketplace have increased substantially as a result, and the income cap for subsidies is back in effect. If your income is above the threshold for premium tax credits, you’ll be paying the full unsubsidized premium. Many people in the Tampa Bay area make a careful comparison against employer plans or other options more important than ever.
If your income qualifies, subsidies can be applied directly to your monthly premium. So you pay less each month rather than waiting for tax time. The credit is reconciled when you file your federal taxes for the year, so it’s important to update your income estimate on the Marketplace if your earnings change significantly during the year.
Also worth knowing: Silver plans are the only tier that comes with cost-sharing reductions, an additional form of financial help that lowers your deductible, copays, and out-of-pocket maximum if your income falls below certain thresholds. If you qualify for cost-sharing reductions, enrolling in a Silver plan is almost always the right call.
Once you’ve submitted your application and the Marketplace has determined your eligibility and any subsidies you qualify for, you’ll be presented with available plans in your area.
Plans are organized into metal tiers: Bronze, Silver, Gold, and Platinum. Bronze plans have the lowest premiums and the highest out-of-pocket costs. Platinum plans have the highest premiums and the lowest out-of-pocket costs. Silver and Gold fall in the middle, each with different tradeoffs depending on how much care you expect to use.
When comparing plans, don’t just look at the monthly premium. Look at the deductible, which is what you pay before insurance kicks in. Look at the out-of-pocket maximum, which caps your total exposure for the year. Check whether your doctors are in-network. Verify that your prescriptions are on the plan’s formulary and at a cost tier that works for your budget.
For people in the Tampa, Clearwater, St. Petersburg, and surrounding areas, provider network availability can vary meaningfully from one plan to another. A plan that includes Tampa General Hospital and major Pinellas health systems may be worth a higher premium if those are the providers you rely on.
Once you’ve chosen a plan, the enrollment process on HealthCare.gov is fairly straightforward. You’ll confirm your information, select your plan, and submit your application. Your coverage isn’t active until you pay your first premium, so don’t skip that step.
If you enrolled by December 15, your first premium is due before January 1 for coverage to start on time. Insurers typically send payment instructions by mail or email after enrollment is confirmed.
An independent insurance agent who works with these plans every day can do all of that with you, and it costs you nothing. Agents are paid by the insurance carriers, not by you, so the service is completely free regardless of which plan you choose.
At Martindale Insurance Services, Dain Martindale works with individuals and families across the Tampa Bay area, including Clearwater, Palm Harbor, Dunedin, Tarpon Springs, Safety Harbor, Oldsmar, New Port Richey, and Tampa. As an independent agent representing over 13 insurance carriers, Dain can compare your options across the full market and make sure you’re not leaving money on the table or signing up for a plan that doesn’t actually fit your needs.
Whether you’re getting ACA coverage for the first time, re-evaluating your plan after the 2026 premium increases, or trying to figure out whether a Marketplace plan even makes sense compared to other options, a one-on-one conversation is the fastest way to get clarity.
Give Dain a call at (727) 513-2767 or book an appointment online. The office is located at 536 E Tarpon Ave, Suite 1B in Tarpon Springs. Dain works with clients in person, by phone, or online.
