Feb 28, 2026
Robert and Emily Sory care for special-needs animals at their sanctuary outside Nashville, Tennessee — but this year, they say they can’t afford to care for themselves.
Last year, Robert’s Affordable Care Act (ACA) marketplace plan cost $0 per month, thanks to enhanced federal subsidies that were expanded during the pandemic. But those enhanced subsidies expired at the end of 2025 — and for 2026, the least expensive plan available to him would cost about $70 a month (1).
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After both lost their jobs in November, even that price felt out of reach. The couple decided to go without coverage. “When you don’t have any income coming in, it doesn’t matter how cheap it is,” Robert told KFF, “It’s not affordable.” (1)
The Sory’s aren’t alone. Millions of Americans are facing higher premiums now that the enhanced ACA subsidies have come to an end (2).
‘Death spiral’: From free coverage to no coverage
At the end of 2025, Congress allowed the enhanced ACA subsidies to expire. Those temporary provisions had increased the amount of financial help available and removed the income cap that previously limited who qualified. Without that extra assistance, many enrollees are now responsible for a larger share of their premium even though the underlying price of coverage hasn’t necessarily changed.
Early federal estimates show the average monthly marketplace premium jumping from about $888 to more than $1,900 (2).
The biggest drop is expected among younger, healthier adults, who are typically less likely to use medical care. When those enrollees leave the marketplace, the remaining pool tends to be older or sicker on average. Because insurers set premiums based on overall risk, a smaller and less healthy risk pool can put upward pressure on prices.
Some analysts have raised concerns about what’s known in insurance markets as a “death spiral,” where rising premiums lead healthier people to drop coverage, which can then push rates higher for those who remain. Others note that it’s too early to know whether enrollment declines will reach that level, and much will depend on how insurers and states respond in the coming year (2).
The sharpest premium spikes are hitting people without employer coverage like self-employed workers, freelancers, early retirees and workers who lost jobs and benefits at the same time.
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That describes the Sorys who both lost their jobs in November, just days apart. Robert worked as a farmhand and Emily worked at a staffing firm. She lost her insurance the moment her job ended, and the reality of being uninsured was a shock. Emily takes three prescription medications. Her first month paying out-of-pocket cost $184.
Robert put the cost in perspective by comparing it to their sanctuary budget. “To equate that to kind of how we think about it, you’re talking about 350 pounds of food for these animals,” he said, referring to the money spent on prescriptions replacing what would otherwise go toward caring for the animals.
Without coverage, the couple have had to rethink their healthcare.
They both see the same psychiatrist, who agreed to charge $125 per visit for them to visit once every three months to keep their prescriptions current. When it comes to bigger bills, the Sory’s are hoping for the best.
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“I’m not somebody who gets sick super often, thank God,” Robert said. “And if I do, generally I go to an emergency room where they’re going to bill me later.”
Despite the headlines, ACA subsidies haven’t disappeared entirely.
The original ACA subsidies still limit how much eligible households must pay for a benchmark plan. For many lower- and middle-income enrollees, premiums are capped at roughly 10% of their annual income. That means someone earning $60,000 a year, for example, would not be required to pay more than about $6,000 annually for a benchmark plan before subsidies are applied (3).
Where you live also matters. Some states, including California, New Jersey and Massachusetts, offer their own supplemental subsidies on top of federal assistance (4). If you’re shopping for coverage, check your state’s marketplace website to see whether additional financial help is available and whether you qualify.
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What consumers can do now
Even though open enrollment for 2026 has closed in most states, special enrollment periods are available year-round if you experience a qualifying life event, including:
- Losing job-based coverage
- Moving
- Getting married or divorced
- Having a baby
If you’re facing higher premiums, here are some strategies that you can consider to deal with the costs:
1. Recalculate your income
Subsidy eligibility is based on your Modified Adjusted Gross Income (MAGI). Contributions to certain types of accounts can reduce your taxable income, so you may be able to lower your MAGI and boost your subsidy by (6):
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- Maximizing 401(k) or IRA contributions
- Contributing to a Health Savings Account (HSA)
- Using self-employed retirement plans like a SEP-IRA or Solo 401(k)
2. Shop and compare total costs
When you’re comparing healthcare plans, don’t just look at the premium. Be sure to review (7):
- Total costs, including out-of-pocket and deductibles
- Plan types that may limit your choices or charge more for certain providers
- The different tiers of each plan, which are grouped into Bronze, Silver, Gold and Platinum — Bronze plans typically have lower premiums but higher deductibles, while Gold and Platinum plans cost more per month but cover a larger share of medical expenses
3. Check Medicaid and low-income programs
If your income dropped, you may now qualify for Medicaid, especially in states that expanded their coverage. Eligibility rules vary by state, so it’s worth checking even if you didn’t qualify before (8).
How insurers respond to enrollment changes will shape future pricing. If healthier enrollees leave the marketplace in large numbers, premiums could face upward pressure in future years. However, state-level policy changes or renewed federal subsidies could offset some of those effects.
For now, the end of enhanced subsidies has shifted the math for many Americans who buy coverage on their own. For some households, that means reassessing budgets, exploring alternatives or temporarily going uninsured.
Article sources
We rely only on vetted sources and credible third-party reporting. For details, see our editorial ethics and guidelines.
KFF (1); CNBC (2); CNN (3); HealthInsurance.org (4); Healthcare.gov (5, 6, 7)
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Jessica is a freelance writer with a professional background in economic development and small business consulting. She has a Bachelor of Arts in Communications and Sociology and is completing her Publishing Certificate.
