Open enrollment for 2027 marketplace coverage starts November 1, 2026 and runs through January 15, 2027 in Florida. Enroll by December 15 and coverage starts January 1; enroll after that and it starts February 1. For most families this is an annual chore. For a family whose child receives ABA therapy, it is one of the larger financial decisions of the year, because the plan you pick determines what twenty or more hours a week of therapy costs you out of pocket.
This year the decision got harder. The enhanced federal subsidies that held premiums down since 2021 expired at the end of 2025. Households above 400 percent of the federal poverty level no longer qualify for any subsidy, and subsidy-eligible families now pay between 2.15 and 10.22 percent of household income for the benchmark plan. Premiums are up, which makes it tempting to pick the cheapest plan, and for an ABA family the cheapest premium is often the most expensive choice.
This guide covers how to compare plans when ABA is part of your year. It pairs with our guide on how ABA coverage and authorization work in Florida, which picks up after you have a plan.
The one number that matters most: the out-of-pocket maximum
A child in regular ABA therapy will almost certainly hit the plan's out-of-pocket maximum every year. Twenty hours a week of a service billed in 15-minute units reaches any deductible quickly, and then keeps going. That changes which number you shop on.
For most shoppers, premium and deductible drive the choice. For a high-utilization family, the real annual cost of a plan is roughly twelve months of premium plus the out-of-pocket maximum, because you should assume you will pay all of it. Run that sum for every plan you compare. A silver plan with a higher premium and a lower out-of-pocket maximum frequently beats a bronze plan whose low premium hides a maximum thousands of dollars higher.
Check whether the plan's deductible applies to ABA or whether therapy visits carry a copay before the deductible is met; the Summary of Benefits and Coverage, the standardized document every plan must publish, states this on its habilitative services line.
Habilitative services: the line in the SBC that covers ABA
Marketplace plans cover ABA under the habilitative services category of the essential health benefits, services that help a person keep, learn, or improve skills. In each plan's Summary of Benefits and Coverage, find the row for habilitative services and read three things: the cost sharing, whether prior authorization is required, and whether any visit or hour limits are listed.
Do not assume two plans from the same insurer treat this line identically. Plan documents, not the carrier's name, control. If the SBC is ambiguous about ABA specifically, call the plan and ask directly whether applied behavior analysis delivered by a BCBA-supervised team is covered, and note the date, the representative, and the reference number of the call.
Networks: verify your provider, not just the carrier
A carrier being familiar does not mean a given marketplace plan includes your ABA provider. Marketplace networks are often narrower than employer-plan networks under the same brand, and HMO plans may require referrals and cover nothing out of network.
Before choosing, search the plan's own provider directory for your current or intended ABA provider, and then confirm directly with the provider that they accept that specific plan for the coming year; directories lag reality in both directions. If you are mid-treatment, continuity is worth weight in the decision: switching providers to fit a network costs a child weeks of re-assessment and rapport-building that no premium savings repays.
We verify coverage for families as part of intake, including marketplace plans, so if a plan you are considering leaves you unsure, ask us before you enroll rather than after.
The 2027 subsidy reality, in plain terms
The expiration of the enhanced subsidies restores the rules from before 2021. If your household income is under 400 percent of the federal poverty level, you qualify for premium tax credits on a sliding scale, paying between 2.15 and 10.22 percent of income for the benchmark silver plan. Above that line there is no subsidy at all, the cliff is back, and a raise that crosses it can cost more in premiums than it adds in income.
Two practical consequences. First, estimate your 2027 income carefully, because subsidies reconcile at tax time. Second, if your income sits near the 400 percent line, it is worth an hour with a tax professional before you enroll; timing of income matters in a way it has not for several years.
Families who lose marketplace affordability entirely should look at the other doors: Florida KidCare for the child's own coverage, Medicaid if income qualifies, and the Family Empowerment Scholarship, which is education funding rather than insurance but changes the overall math for many families.
A two-week plan for picking well
Before November 1: list your child's current services and hours, pull this year's explanation-of-benefits statements to see what ABA actually billed, and confirm with your provider which plans they will accept for 2027.
During the first two weeks of enrollment: shortlist two or three plans, read the habilitative services line in each SBC, run the premium-plus-maximum arithmetic, and verify networks in the plans' own directories. Then enroll by December 15 so coverage starts January 1 with no gap, and calendar your authorization renewal so the new plan's prior-authorization process starts before the old authorization lapses.
If this is your first time pairing insurance with ABA services, our coverage and authorization guide walks through what happens after enrollment, and our clinical team can verify a specific plan before you commit to it.
