A nationwide PPO is still an option in Florida. Let me explain how self-employed bookkeepers and tax preparers are getting health coverage when they earn most of their annual income from January through April.
Hi, I'm Sam Jaber. I'm a licensed health insurance broker in Tampa, and I hold licenses in 36 states. We can handle everything by phone, and if you're a Florida tax professional, I'm perfectly fine waiting until your busy season ends.
You probably understand much of this already, more than most people I speak with. You've handled premium tax credit reconciliations for clients, and you're familiar with calculating net self-employment income. What you may not know is how Florida's insurance market changes the equation. This year's higher rates, the actual cost of a marketplace PPO, and Florida's unusual gap for people with very low incomes can make a big difference. I'll explain those Florida-specific issues here.
Here's something worth writing down first: nationwide PPO coverage remains available in Florida. If you're a healthy tax preparer earning above the premium tax credit range, you should compare what it costs.
Marketplace PPO pricing tells quite a story. Florida's marketplace file contains 410 medical plans, but only 14 are PPOs, and one insurer offers every one of them. Compare that PPO with the least expensive plan using another network in the same county, and the difference is 85% in St. Lucie, 110% in Martin, and 120% in Flagler. In the median county, you're looking at roughly double the cost.
There's another option outside HealthCare.gov: private coverage with medical underwriting. These plans can provide access to nationwide PPO networks, with premiums determined by your health. That's the alternative I'd put alongside the marketplace price.
Let's start with your household income for the year you're getting coverage. HealthCare.gov uses your projected net self-employment earnings to determine premium tax credit eligibility. The income limit sits around four times the poverty level and adjusts based on how many people are in your household.
That eligibility question matters especially much in Florida this year. According to Florida's insurance regulator, approved individual plan rates for 2026 rose an average of 34.1%, weighted by enrollment and calculated without subsidies. You can probably see the financial effect immediately. Below the eligibility cutoff, tax credits offset much of the increase. Above it, households absorb the entire higher premium themselves.
In that situation, I'd usually recommend starting with HealthCare.gov, because marketplace coverage is the only place you can apply that credit toward your premium.
The difficult part for seasonal businesses is predicting income before the filing season has even started. You have to enroll without knowing how much you'll actually earn. If business turns out better than expected, you could owe back part of the advance credit when you file your own taxes. I'd recommend exactly what you'd tell one of your clients: make a reasonable, honest projection, then revise your HealthCare.gov income after April when the numbers become clearer.
Because HMOs make up most marketplace coverage in Florida, we'll check whether your doctors participate before choosing a plan based only on its monthly premium.
Next step: Give me your expected income for the year, and I'll help you choose HealthCare.gov coverage that accounts for the possibility of a particularly profitable tax season.
Maybe you're running a one-person practice during a slow year, or you've just left a firm and started on your own. Your income could be unusually low. In many states, that would open the door to additional assistance. Florida works differently. Because the state hasn't expanded Medicaid and marketplace premium credits generally start at the poverty level, earning below that threshold can leave your household without access to either form of help.
From your own tax work, you know why this needs attention: when earnings are near an eligibility cutoff, both the income projection and when you enroll can affect the outcome.
Next step: When your expected income is hovering near that minimum, give me a call before signing up. We'll review your situation and determine which coverage assistance you qualify for.
Once your income exceeds the credit limit, you're responsible for Florida's full premium, including the increase. If everyone in your household is healthy, I'd compare that against a medically underwritten PPO with nationwide access.
Applying means answering questions about your health. After reviewing them, the insurance company may approve you, reject the application, or approve coverage while excluding a particular medical condition. Favorable health is what can bring the premium below the unsubsidized marketplace price. Since benefits differ from one plan to another, I'll explain exactly what each option covers and pays before you make a decision.
Next step: Once tax season is behind you, give me a call. We'll compare nationwide PPO premiums with marketplace prices in your county.
Straight answers, no sales pitch.
Start with a realistic projection of your net earnings for the entire year, then revise that estimate through HealthCare.gov once tax season gives you a clearer picture of your actual income.
Florida's insurance regulator reported an average 34.1% increase in approved individual coverage rates for 2026, before accounting for subsidies. If your income exceeds the credit cutoff, you're paying that entire increase yourself.
Yes. A single insurance company offers the PPO throughout every Florida county. In the median county, its premium runs approximately twice what the lowest-cost plan using another network charges.
You could fall into Florida's coverage gap. The state never adopted Medicaid expansion, while marketplace premium credits normally begin at the poverty level. That means earning below the poverty threshold could leave you without assistance from either program. Call me before making your decision.
Tell me your county, who needs to be covered, and what you expect to net this year. I'll compare the costs on both sides of the eligibility line, explain where you fall, and tell you if keeping your current plan makes more financial sense.
The guide for every state, and other work I help with