As insurance prices rise, families question options

New York artist Cynthia Freeman, 61, is trying to figure out how to maintain the Affordable Care Act health plan she and her husband rely on.

“If we didn’t have health problems, I would go back to where I was in my 40s and I wouldn’t have health insurance,” she said, “but we’re not in that situation now.”

Freeman and her husband, Brad Lawrence, are freelancers working in storytelling and podcasting.

In October, Lawrence, 52, became very ill, very quickly.

“I knew I was in trouble,” he said. “I went to the emergency room, walked up to the office and said, ‘Hello, I’ve gained 25 pounds in five days and I’m having trouble breathing and my chest hurts.’ And they stopped blinking.

Doctors diagnosed him with kidney disease and he was hospitalized for four days.

Lawrence now has to take medication at an average cost without insurance of $760 per month.

In January, the cost of the couple’s current “silver” plan increased by nearly 75 percent, to $801 per month.

To earn extra money, Freeman took a part-time job as a bartender.

Millions of middle-class Americans with ACA health plans will face skyrocketing premiums in 2026, without help from enhanced subsidies that Congress failed to renew. Some are considering big changes in their lives to cope with the new rates that took effect January 1.

It often falls to women to solve the family insurance puzzle.

Women generally use health care more than men, in part because of their need for reproductive services, according to Elizabeth Tobin-Tyler, a professor at Brown University’s School of Public Health.

Women also tend to make medical decisions for the family, she explained, especially for children.

“Women play a disproportionate role in families when it comes to what we consider a mental burden,” Tobin-Tyler said, and that includes “making decisions about health insurance.”

Before the recess, Congress considered some forms of relief from premium increases, but nothing came to fruition and important deadlines have already been missed.

Are you no longer insured?

As the clock ticks to 2025, B. worries about her family’s insurance options. She was looking for a full-time job with benefits because the premiums she was seeing for ACA 2026 plans were alarming.

In the meantime, she decided, she and her husband would drop their coverage and insure only the children. But it would be risky.

“My husband works all day with major tools,” she said, “so it’s like rolling the dice.”

NPR and KFF Health News are identifying B. by her initial because she believes her insurance needs could affect her continued search for a job with health benefits.

The family lives in Providence, Rhode Island. Her husband is a self-employed carpenter, and she worked full time as a nonprofit director before losing her job last spring.

After losing her job, she turned to the ACA market. The family’s “gold” plan cost them nearly $2,000 a month in premiums.

It was a lot, and they dipped into their retirement savings to pay for it while B. continued to look for a new job.

Because Congress failed to extend enhanced subsidies for ACA plans, despite ongoing political battles and a long government shutdown on the issue, B.’s family plan would have cost even more in 2026 – almost $3,000 per month.

“I don’t have an extra $900 in my family budget to pay for this,” she said.

B. had already withdrawn $12,000 from his retirement funds to pay his family’s rates in 2025.

Unless she finds a new job soon, the projected family income for 2026 will be less than 266% of the federal poverty level. This means that children are eligible for free coverage through Medicaid.

So B. decided to purchase a plan on the ACA marketplace for herself and her husband, paying premiums of $1,200 per month.

“At the end of the day, none of this is affordable,” she said, “so we’re going to dip into our savings to pay for this.”

Postpone a wedding

The prospect of soaring insurance premiums has put an end to Nicole Benisch’s wedding plans.

Benisch, 45, owns a holistic wellness business in Providence. She paid $108 a month for a “silver” plan with no deductible on the Rhode Island Insurance Exchange.

But the cost in 2026 has more than doubled, to $220 per month.

She and her fiancé had planned to get married on December 19, her late mother’s birthday. “And then,” she says, “we realized how dramatically this was going to change the cost of my premium. »

As a married couple, their combined income would exceed 400 percent of the federal poverty level and make Benisch ineligible for financial aid. The monthly premiums on his current plan would triple, costing him more than $700 per month.

Benisch considered a less expensive “bronze” plan, but it wouldn’t cover voice therapy, which she needs to treat muscle tension dysphonia, a condition that can make her voice strain or give way.

If they get married, there is another option: switching to her fiancé’s health plan in Massachusetts. But that would mean losing all of its Rhode Island doctors, who would be out of network.

“We have some tough decisions to make,” she said, “and none of the options are really good for us.”

This article comes from a partnership with NPR.

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