Key facts
~74,000
Population
113
Florida Keys — mile chain of islands in the Gulf of Mexico and Atlantic
County seat: Key West — southernmost city in the continental U.S.
ACA carriers: Florida Blue, Ambetter
Healthcare access challenge: no trauma center in the Keys
High cost of living; significant hospitality and tourism workforce
Monroe County is unlike any other county in Florida — and perhaps unlike any other county in the continental United States. Stretching 110 miles from Card Sound to the Dry Tortugas, the Florida Keys form an arc of coral limestone islands connecting the Gulf of Mexico to the Atlantic Ocean. Key West, the southernmost city in the continental U.S., is the county seat and the cultural capital of a county that has more in common with the Caribbean than with mainland Florida.
The Keys' Gulf side — the Florida Bay and Gulf of Mexico — is a world-class shallow-water fishing destination. Backcountry flats fishing for bonefish, tarpon, and permit in the Gulf waters north of the Keys is considered some of the finest saltwater fly fishing in the world. Charter captains, dive operators, and fishing guides represent a significant self-employed workforce throughout the Keys.
Monroe County's healthcare situation is uniquely challenging. The Florida Keys have no Level I or Level II Trauma Center. The Lower Keys Medical Center in Key West handles emergencies and primary care, but serious trauma, cardiac events, and complex surgeries require transport (by helicopter or air ambulance) to Miami-Dade County. This geographic isolation makes health insurance selection — particularly understanding emergency air transport coverage — critically important for Keys residents.
Monroe County has two ACA marketplace carriers in 2026: Florida Blue and Ambetter. The Keys' geographic isolation limits carrier competition. Compare both at HealthCare.gov using your Key West, Marathon, or Islamorada zip code.
Health insurance in Monroe County
The following income thresholds govern 2026 ACA subsidy eligibility (using 2025 FPL). Florida has not expanded Medicaid — adults in Monroe County below 100% FPL without dependent children fall into the coverage gap.
| Household Size | 100% FPL | 150% FPL | 200% FPL | 300% FPL | 400% FPL |
|---|---|---|---|---|---|
| 1 person | $15,060 | $22,590 | $30,120 | $45,180 | $60,240 |
| 2 people | $20,440 | $30,660 | $40,880 | $61,320 | $81,760 |
| 3 people | $25,820 | $38,730 | $51,640 | $77,460 | $103,280 |
| 4 people | $31,200 | $46,800 | $62,400 | $93,600 | $124,800 |
Lower Keys Medical Center (Key West) and Fishermen's Community Hospital (Marathon) are the primary hospitals in Monroe County. Both handle emergency and primary care; neither can manage serious trauma, complex cardiac events, or major surgery. Air transport to Jackson Memorial Hospital, Baptist Hospital, or another Miami-Dade facility is the standard protocol for serious emergencies. Ensure your ACA plan covers air ambulance transport and Miami-Dade hospitals — this is not a theoretical concern in the Keys.
Key West's hospitality economy — restaurants, bars, hotels, charter boats, dive shops — employs thousands of workers who lack employer-sponsored insurance. The cost of living in Key West is among the highest in Florida, meaning many hospitality workers earn enough to be above some subsidy thresholds but not enough to afford full-price premiums comfortably. ACA subsidy calculations are particularly important for this workforce.
The Keys also have a substantial seasonal and part-time population — residents who split time between the Keys and other states or seasonal workers who come for high season. If Florida (specifically Monroe County) is your primary legal residence, you enroll in Florida's ACA marketplace with your Keys zip code. Snowbirds who primarily reside elsewhere should enroll in their primary state's marketplace.
Explore ACA coverage across the region: Southern Plan Finder — Florida Gulf Coast Health Insurance — Collier County Health Insurance.