Health insurance in St. Augustine and St. Johns County

Your plan is priced on the county you live in. Your hospital might be in the one next door.

That is the thing to know about St. Johns County. If you are in Fruit Cove or Ponte Vedra, the hospitals you would realistically use are in Duval. If you are in Nocatee, Ascension St. Vincent's on CR 210 is closer than either. If you are in St. Augustine, UF Health Flagler is right there. One county, three different answers, and your plan does not care which one applies to you unless you check.

Check your hospitals before you check the price

Here is the map most people never draw before they enroll.

Inside St. Johns County: UF Health Flagler Hospital on Health Park Boulevard in St. Augustine, which UF Health took over in 2023 and renamed. Ascension St. Vincent's St. Johns County on Trinity Way at I-95 and CR 210, which is a full hospital with an emergency room and is the closest one to Nocatee. The Baptist and Wolfson location in St. Augustine, which is a freestanding emergency room and imaging center rather than a hospital, so there are no inpatient beds there. And UF Health's Durbin Park site off Race Track Road, which is still under construction, with the hospital expected to open in fall 2026.

North, in Duval County: Mayo Clinic. Baptist Medical Center South, which sits close enough to the county line that it functions as the local hospital for Fruit Cove and Julington Creek. Baptist Medical Center Beaches, if you are out toward Ponte Vedra.

Write down the two or three you would realistically drive to at 2 a.m. or for a specialist referral, then check every one of them against any plan you are considering. Not the network name. The actual hospital, looked up in that plan's directory.

A hospital being nearby, or being listed on a system's website, tells you nothing about whether your plan covers it. Networks are renegotiated every year, and plan directories are wrong often enough that it is worth calling the plan to confirm rather than trusting a search box.

Where you live is what prices your plan

Marketplace plans are priced and built county by county, and the county that counts is the one you live in. A Nocatee address is rated on St. Johns County whether you work in Jacksonville, work from a spare bedroom, or fly out of JAX every Monday.

Your work county still matters, just not for price. It decides which doctors are convenient, which is a network question. So the two things to hold separately are: St. Johns sets what you pay, and your network decides where that payment is good.

Clay County has the same split for the same reason, which I wrote up on the Orange Park and Clay County page if you have family over that way.

If you are self-employed here, read this part twice

The northern end of this county has an unusual concentration of people who buy their own coverage. Consultants, remote executives, physicians and attorneys in private practice, people who sold something and retired at 58, families running a business out of the house. Ponte Vedra and Nocatee are full of them.

Two things follow from that.

The first is that a lot of households here earn past the point where a premium tax credit does anything, and that line got harder in 2026. The enhanced subsidies that ran through 2025 expired, which brought back the 400 percent of poverty cliff. It is a cliff and not a slope: one dollar over and the credit goes to zero. For a couple in their early sixties that swing is regularly five figures a year, so the number you put on the application deserves real attention.

If you are past that line, you are not stuck with the sticker price. Depending on your health history, a medically underwritten plan sold outside the marketplace can come in lower. That route is worth pricing, but go in clear-eyed: those plans can decline you or exclude what you already have, they are not required to cover maternity, prescriptions or mental health the way marketplace plans are, and losing one is not a qualifying event, so a diagnosis in March can leave you waiting until January. The tradeoffs are laid out in the private plans versus the marketplace guide.

The second is that self-employment income is lumpy, and what you project for the year drives everything: your subsidy, your reconciliation at tax time, and whether you land in the gap below. If you are newly self-employed, that projection is worth a conversation before you file it, not after.

If you are close to 65

A lot of people here retire before Medicare starts. Someone leaves a practice or sells a business at 61 and needs four years of coverage that has nothing to do with an employer. That bridge is squarely what I do, and it is one of the more expensive stretches to get wrong, because you are buying at an age when premiums are high and you no longer have a group plan absorbing part of it.

Once you are actually on Medicare, that is a different product with its own carrier appointments and annual certification, and I do not sell it. What I will do is give you the name and number of someone I trust who does, and you call them directly. I do not pass your information along to anyone and there is no fee either direction.

The Medicaid gap, said plainly

Florida uses HealthCare.gov and has never expanded Medicaid. The practical effect is a band of income that is too high to qualify for Florida Medicaid and too low to qualify for a premium tax credit. People in it are eligible for very little, which is a policy problem rather than a paperwork one.

It catches seasonal workers, people in their first year of self-employment, and anyone whose income dropped mid-year. If that might be you, do not guess at the number on the application. Call someone first.

The dates

Open enrollment for 2027 coverage runs November 1, 2026 through January 15, 2027. The date that matters more is December 15, which is the last day to enroll for coverage that starts January 1. Miss it and you are looking at a February 1 start with a January gap. A court case could change these windows in future years, and the open enrollment guide tracks that, but those are the dates for this one.

Outside open enrollment you need a qualifying event: losing other coverage, moving, marriage, a birth. One catch worth knowing in a county people move into constantly: the moving event only works if you already had coverage for at least one of the 60 days before the move. You cannot be uninsured, relocate to St. Johns County, and use the move to get in. Losing job coverage starts two separate 60-day clocks, and most people only notice one of them.

Questions I get from St. Johns County

Do you work with people in St. Augustine and Ponte Vedra?

Yes. I am a Florida resident licensed broker, NPN 22091157, and St. Johns is one of the counties I work in most. I grew up in Jacksonville, so the geography here is not something I had to look up. Everything is done by phone, text or video, and it costs you nothing either way.

Which hospitals should I check before I pick a plan?

Inside the county: UF Health Flagler Hospital in St. Augustine and Ascension St. Vincent's St. Johns County on Trinity Way. The Baptist and Wolfson site in St. Augustine is a freestanding emergency room and imaging center, not an inpatient hospital, and UF Health's Durbin Park hospital is still under construction with a fall 2026 target. North in Duval, where a lot of St. Johns residents actually go: Mayo Clinic, Baptist Medical Center South, and Baptist Medical Center Beaches. Make a short list of the ones you would realistically drive to and check every one against the plan directory before you enroll.

Is Mayo Clinic covered by my plan?

Not automatically, and this is the assumption that costs people the most around here. Mayo is not in every plan's network. Living twenty minutes away does not put it in yours. If Mayo matters to you, treat it as the first thing you verify, not the last, because switching plans afterward means waiting for open enrollment or a qualifying event.

I live in St. Johns but work in Jacksonville. Which county counts?

Where you live. Marketplace plan availability and pricing are set by your county of residence, not the county your office is in. A Nocatee address is priced on St. Johns County no matter where you commute. What your work county does affect is which doctors are convenient, and that is a network question rather than a pricing one.

What if I earn too much for a subsidy?

It happens a lot in Ponte Vedra and Nocatee, and it got sharper in 2026 now that the enhanced subsidies have expired and the 400 percent of poverty cliff is back. You can still buy a marketplace plan at full price. Depending on your health history a medically underwritten plan sold outside the marketplace can cost less, but those plans can decline you or exclude conditions you already have, they are not required to cover maternity, prescriptions or mental health, and losing one does not open a special enrollment period. Worth pricing, and worth understanding before you sign.

Does Florida have a Medicaid gap I should worry about?

Yes. Florida uses HealthCare.gov and has never expanded Medicaid, so there is an income band that is too high for Florida Medicaid and too low for a premium tax credit. If your income is irregular, seasonal, or you are early in self-employment, this is worth a conversation before you file anything, because how you project your annual income changes what you qualify for.

I am retiring at 62. What do I do until Medicare?

That gap is one of the main things I handle. An individual plan is one route, but so is COBRA for up to 18 months, a spouse's employer plan, or retiree benefits if you have them, and they are worth comparing rather than assuming. On income, be careful: what counts includes IRA and 401(k) withdrawals, pensions, Roth conversions and capital gains, so plenty of early retirees living off a portfolio land above the subsidy cliff rather than below it. That calculation is worth doing before you retire, not after.

Do you handle Medicare?

No. Medicare has its own carrier appointments and annual certification, and I am not set up for it. If you are turning 65 or already on it, I will give you the name and number of someone I trust who does, and you reach out to them directly. No fee, and I do not hand your information to anyone. If you are under 65 and bridging toward Medicare, that part is mine.

When can I enroll?

Open enrollment for 2027 coverage runs November 1, 2026 through January 15, 2027, and December 15 is the cutoff for coverage that starts January 1. Outside that window you need a qualifying event: losing coverage, moving, marriage, a birth. If you are moving here, note that the move only counts if you already had coverage in the 60 days before it.

The bottom line

St. Johns County is priced as St. Johns County, but a good share of the care people here actually use is across the line in Duval. A plan that ignores that is cheap right up until the day it is not.

Pick your hospitals first. Price the plan second. If those two steps disagree, that is exactly the conversation worth having, and it costs you nothing to have it.

Last reviewed August 31, 2026. Hospital construction timelines and enrollment dates both move. If you are reading this well after that date, call and I will tell you what has changed.