What To Do If You Can’t Afford It – Forbes Advisor

With just a few months to go before the Affordable Care Act (ACA) marketplace opens for enrollment in November, many registrants may notice hefty upticks in policy costs.  

Millions of Americans access ACA health insurance only through heavily subsidized plans and rising costs force many to forgo health care due to financial strain. For intermittent gaps in coverage, consumers can turn to short-term health insurance plans as a reprieve. 

The Highest Increase Since 2018 

A health system tracker report from Peterson-KFF shows a median proposed premium increase of 18% for 2026 across 312 insurers in the marketplace from all 50 states and the District of Columbia. For reference, that uptick is 11 percentage points higher than last year’s proposed premium increase of 7%. KFF notes that this is the largest rate change request since 2018. 

The report also notes that ACA Marketplace insurers are raising premiums by 20% on average going into 2026. On top of that, expiring premium tax credits could make ACA Marketplace coverage unaffordable for many. The tax credits, currently in place, expanded access to low-income individuals and households who would otherwise struggle to afford insurance. 

According to KFF, 92% of ACA Marketplace enrollees in 2025 receive a subsidy. Recipients of a subsidy may not expect to face premium increases, depending on the plan they select. However, if the enhanced premium tax credits expire without renewal, affordability will decrease substantially for subsidized enrollees, leading to a more than 75% increase in average out-of-pocket premium payments. 

The large, proposed spike in premiums reflects rising healthcare costs, including hospitalizations, prescription drugs, specialty medications like GLP-1s, inflation, labor costs and tariffs. 

A January 2025 AARP report found that drug companies have increased the prices of 25 top Medicare Part D drugs that are not currently selected for Medicare drug price negotiation. On average, prices for these drugs increased 98%, nearly doubling since they first entered the market. 

“Brand-name drug prices have been increasing faster than the rate of general inflation for decades, putting life-saving medications out of reach for millions of patients who need them,” said Leigh Purvis, author of the report and prescription drug policy principal at the AARP Public Policy Institute. 

“Meanwhile, the median price of a new brand name prescription drug is now approximately $300,000 per year, so even a small price change could increase a drug’s price by thousands of dollars.” 

The expiration of premium tax credits would also raise premiums by an estimated four percentage points more than they would otherwise rise, unless Congress acts to extend them. 

What To Do in the Short-Run 

Short-term health insurance policies, such as COBRA, help supplement temporary gaps in coverage. Unlike long-term policies, these plans are usually not renewable once the term ends. They also typically offer fewer comprehensive benefits than essential plans available through the ACA Marketplace.  

Before applying for a short-term policy, carefully read the terms. Essential benefits may not be covered, including maternity care, prescription drugs, preventative care and mental health care. 

Short-term plans typically cost less than ACA Marketplace plans. A KFF review found that the cheapest short-term policies offered on two large private insurance marketplaces—eHealth and Agile Health Insurance— cost 20% or less of the premium for the lowest-cost ACA-compliant bronze plan in the same areas. 

Remember when selecting a plan that policies can be restrictive. We’d recommend window-shopping and comparing plans, reading the terms carefully to decide what meets your specific needs.