Health Insurance in St. Augustine and St. Johns County

Who buys their own coverage in St. Johns County

The county grew from about 273,000 residents in 2020 to about 346,000 in the Census Bureau's 2025 estimate, a pace few Florida counties match. That growth shapes who calls me:

• Early retirees. Couples who sold a business, took a buyout or retired from a corporate job up north and moved to St. Augustine, World Golf Village or Ponte Vedra years before Medicare.
• Remote workers and consultants in Nocatee, Durbin Park and the SR 16 corridor who work for out-of-state companies as contractors rather than employees.
• Tourism and hospitality owners. St. Augustine's historic district, the beaches and the restaurants, inns, charters and shops that serve visitors are mostly small businesses with no group plan.
• Builders, trades and real estate agents working one of the busiest new-home markets in the state.
• Commuters to Jacksonville who are between jobs or waiting out a new employer's waiting period.
• Farm families in the Hastings and Elkton area, where potato and cabbage fields still cover the western side of the county.

Early retirement in St. Johns County: the income problem

If you retire at 58 or 60, Medicare is still years away, and the Marketplace prices your plan on two things: your age and your income. The age part hurts, because a 62-year-old can pay close to three times what a 21-year-old pays for the same plan. The income part is where planning matters.

Marketplace help is based on modified adjusted gross income, and for 2027 it stops at 400 percent of the poverty level: $63,840 for one person and $86,560 for a couple. Retirees cross that line in ways they do not expect:

• An IRA withdrawal or a Roth conversion.
• Capital gains from selling a house up north or rebalancing a portfolio.
• A pension plus part-time consulting income.

One extra dollar over the line and the tax credit disappears completely, which for a couple in their early sixties can mean paying the entire premium. Some retirees manage their income carefully to stay under the line, and for them the Marketplace can be a good deal. Others would rather not let health insurance dictate their withdrawals. For them, a private plan priced on health rather than income is worth comparing. The early retiree guide and the retiring at 62 guide cover the bridge to Medicare in detail.

Florida 2027: what changed

St. Johns County residents enroll in Marketplace plans through HealthCare.gov. The changes that matter this fall:

1. Premiums are rising about 10.4 percent on average in Florida's individual market, based on final rates. Older buyers feel it in dollars more than anyone. See Florida 2027 rates.
2. The subsidy line is back at $63,840 for one person and $132,000 for a family of four.
3. The out-of-pocket cap rose to $12,000 for one person on Marketplace plans.

Open enrollment runs November 1, 2026 to January 15, 2027. Pick a plan by December 15 for a January 1 start.

How a private plan works

A private, medically underwritten plan is bought outside the Marketplace. The insurer asks health questions, then prices the plan on your age, ZIP code, tobacco use and health. Your income never enters the formula, which means:

• Your withdrawals, conversions and capital gains do not change your premium.
• There is no tax credit to reconcile at tax time and no surprise bill in April.
• Coverage can start the first of any month, if approved, which helps when you retire mid-year or move from another state.
• Many plans use national PPO networks, useful for retirees who spend summers up north, visit grandchildren out of state or travel often.

Private plans also have limits. They can decline an application or exclude a specific condition, they are not ACA plans, and benefits and pre-existing condition rules vary by plan. If you or your spouse has a significant health condition, the Marketplace accepts everyone regardless of health history, and I will point you there. I sell both, so the recommendation follows your situation.

Hospitals and networks in St. Johns County

St. Augustine has a full-service hospital, and urgent care and outpatient centers have followed the growth into Nocatee, St. Johns and the SR 16 corridor. For the largest specialty, heart and cancer programs, most residents drive north to Jacksonville: about 20 to 30 minutes from Nocatee and Ponte Vedra, and 45 minutes or more from downtown St. Augustine or the beaches to the south.

That means your plan needs to work in two places. Before you choose, I check:

1. Your primary doctor and specialists, by name.
2. The hospital closest to your home and the Jacksonville system your specialists belong to.
3. Your prescriptions against the plan's drug list.
4. How the plan handles care out of state if you spend part of the year elsewhere.

Lower-cost Marketplace plans in the region are often built around one hospital system. That can work well, but only if your doctors are in it.

Couples with one spouse on Medicare

A common St. Johns County situation: one spouse turns 65 and moves to Medicare, and the younger spouse still needs coverage. The younger spouse's Marketplace eligibility is still based on household income, including the Medicare spouse's pension and Social Security. A private plan, if approved, prices only the younger spouse, on health. I compare both for you and help time the switch so nobody has a gap.

Tourism, hospitality and seasonal income

St. Augustine's visitor economy runs on small operators: inn and bed-and-breakfast owners, tour and charter companies, restaurant owners, wedding and event businesses and the shops along the historic streets. Their income follows the calendar, with strong spring and holiday seasons and slower stretches in between, and a hurricane or a bad season can change the whole year.

That pattern makes Marketplace estimates hard. If you guess low and business is good, you can owe part of your advance tax credit back at tax time. If you guess high, you overpay all year. A few practical rules I share with hospitality owners:

1. Base your estimate on net income after expenses, not gross sales.
2. Update your income on HealthCare.gov when the season turns out much better or worse than you planned.
3. If your income usually lands near the subsidy line, price a private plan too, because its premium does not move with your books.

Owners with a few employees also ask about offering coverage. Florida small-group premiums are rising about 11.4 percent for 2027, so I compare a group plan, individual coverage for the owner's family and an individual coverage HRA before anyone signs.

Who a private plan fits best in St. Augustine

• Healthy early retirees whose income is above the subsidy line, or who do not want to manage their income around it.
• Couples from 55 to 64 who travel or split the year between Florida and another state.
• Self-employed owners in hospitality, construction and real estate whose income moves from year to year.
• Newcomers moving to St. Johns County mid-year without a qualifying event. If approved, a private plan can start the first of the next month. The moving to Florida guide covers the timing.

How I work with St. Johns County clients

I am licensed in Florida and 30 other states, so if you still have family or a second home up north, I can often help there too. I am based in Tampa, and I work with St. Augustine clients entirely by phone or video, in English or Spanish, with screen sharing so you can see every plan as we talk.

1. A short call about who needs coverage, your doctors, prescriptions, health history and expected 2027 income.
2. Quotes side by side: private plans next to your real Marketplace price, with deductibles, out-of-pocket limits and networks in plain terms, and my honest pick.
3. The application. Private plans ask health questions, and decisions usually come back within days. If approved, coverage starts the first of the following month.
4. No gap. I never cancel your current coverage until the new plan is approved and paid.

There is no fee. The insurer pays the broker, and your premium is the same either way. Get a quote or call or text (786) 218-2384.