Older Adults Face Tough Decisions as Affordable Care Act Tax Credits Expire

People ages 50 to 64 are struggling to afford health care coverage — and consider going without — as their monthly premiums skyrocket

Miriam Cross,

AARP

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Published December 24, 2025

a woman, dressed in purple shirt and black puffer vest, stands in front of a home in winter

ReShonda Young, who has relied on marketplace coverage since 2017, noticed her premiums drop substantially once the enhanced premium tax credits kicked in.

Danny Wilcox Frazier/VII

ReShonda Young’s Affordable Care Act health insurance helped pay for testing and diagnosis of her breast cancer last year.

“The ACA has been a lifesaver,” she says.

The 50-year-old small-business owner paid $94 per month for her gold-tier plan in 2025. But as she prepared to enroll for 2026, she saw that the monthly premiums would shoot up to $592. That’s a 500 percent increase.

“I can’t go without, but I can’t afford to pay the premiums at basically $600 per month,” she says.

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It’s the same story across the country. Adults ages 50 to 64 who rely on marketplace insurance rather than employer-sponsored coverage for a variety of reasons — early retirement, small-business ownership, contract work — are facing skyrocketing costs. The ACA’s enhanced premium tax credits, which give people with incomes that exceed 400 percent of the federal poverty line a break on costs (for the first time) and soften rates for those with lower incomes, are set to expire at the end of this year.

Congress will likely take up the matter in January, but the fate of the tax credits remains unclear. AARP has spent years lobbying for a permanent extension to these tax credits. Now the focus is ensuring that a proposed bipartisan three-year extension is passed when Congress comes back into session.

Generally speaking, Dec. 15 was the last day of open enrollment for coverage that begins Jan. 1, although some states have later deadlines or added last-minute extensions. Those who sign up or change plans from Dec. 16 to Jan. 15 will gain coverage on Feb. 1. As they sifted through options, older adults faced difficult decisions about whether to keep the plans they had at a higher cost, shift to less-generous coverage or gamble on forgoing health insurance altogether.

Here are six stories that illustrate the weight of these decisions.

a woman, dressed in black pants, purple shirt and black puffer vest, stands in front of a home in winter

ReShonda Young changed plans to avoid paying nearly $600 per month.

Danny Wilcox Frazier/VII

Downgrading plans to afford coverage

ReShonda Young, 50

Waterloo, Iowa

Young is thrilled with the coverage she receives from the federal ACA marketplace. She turned to the marketplace in 2017 when she left her dad’s maintenance contracting and transportation company to strike out on her own. Young served as a consultant to small-business owners before buying a health and nutrition shop in June. Her premiums decreased noticeably once the enhanced premium tax credits kicked in, from about $190 per month to under $100 per month.

“I’ve got a plan I would have had if I were working for somebody else, at a price I can afford,” she says.

But she can’t afford to shell out nearly $600 per month. Although she weighed the viability of a plan that does not comply with ACA requirements, she decided to downgrade to a bronze marketplace plan that costs $254 per month. Her deductible will shoot up from $1,500 with her current gold plan to $6,000. She intends to contribute to a health savings account to help cover out-of-pocket expenses.

“It really stinks to need to go this route,” she says.

a man stands in shadows at the bottom of a staircase

Chris Banescu can afford the higher premiums for his marketplace insurance this year but wonders what the next seven or eight years will bring, until he is eligible for Medicare.

Philip Cheung

Tightening the belt to absorb higher premiums

Chris Banescu, 58, and Cindy Banescu, 57

Santa Clarita, California

Before the enhanced premium tax credits existed, Chris Banescu and his wife, Cindy, weighed buying health insurance from California’s marketplace. But the price was unaffordable for them. Instead, they purchased coverage directly from insurers, relied on a Christian sharing plan that they ultimately decided was insufficient and risked going without health insurance for several years. (Christian sharing plans are not compliant with the ACA.)

Then a friend told them that things had changed in the health insurance marketplace. Although the couple’s combined income exceeded 400 percent of the federal poverty level, they were eligible for some help through tax credits. The coverage they found through the marketplace was far better value than what either of them — Chris, a small-business owner and adjunct faculty at universities, and Cindy, a real estate broker — could find through their jobs.

“I was incredibly surprised,” Chris says. In 2025, the couple averaged $376 per month for the lowest-cost bronze plan, “which was fantastic,” he says.

But the same policy will cost $1,431 per month in 2026. Between an increase in the base cost of the plan and the loss of the tax credits they qualified for this year, “we’re getting double-whammied,” he says.

To afford the increased premiums, Chris says they will “tighten the belt” as much as possible. “We have no choice,” he says. “All it takes is one broken leg, one car accident, one slip, one anything, and one week in the hospital is hundreds of thousands of dollars.”

But that’s just for 2026. If there is no fix by Congress, Chris wonders what costs will rack up in the next seven or eight years until he and Cindy are eligible for Medicare. He also questions what the cost will be to the economy if other small-business owners limit their travel and spending because they have to pay high monthly health care premiums.

“We shouldn’t be here, two weeks away from the end of the year, with the iceberg about to hit the Titanic,” he says.

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a man stands at a window, seen from outside the home

Brad Korb never considered going without insurance until he saw his bronze plan would increase from $338 per month to $966.

Tamika Moore

Drawing from savings to make up the difference

Brad Korb, 59

Huntsville, Alabama

Brad Korb closed out his 30-year career as an engineer at Boeing in 2020. At 53, he still had a ways to go before he was eligible for Medicare. After a year of extending his workplace insurance through COBRA, he turned to the marketplace at the beginning of 2021.

The gold-category plan Korb initially selected “was less than I was paying for COBRA, so I was happy,” he says. But as rates went up, he downgraded his plan from gold to silver to bronze, paying less in premiums in exchange for more limited coverage. Now Korb is paying $338 per month for a bronze plan with an $8,500 deductible. He is saving $480 per month thanks to the enhanced premium tax credits.

“The subsidies really help,” he says.

Soon his price for that policy will jump to $966 per month. At first, Korb considered going without insurance and paying for expenses out of pocket. The idea was jarring.

“I’ve been professionally employed my whole career,” he says. “Not having insurance is something I’ve never seriously thought about until now.”

But he knows firsthand how important that safety net is. Korb was billed $30,000 for a 24-hour stint in the hospital last year. His insurance knocked the price tag down to $4,000, and he is still paying that off. Korb also needs several prescription medications and appreciates that annual physicals are covered.

“Those are the reasons to keep insurance,” he says. He intends to lean on savings to make up the $600 monthly increase in premiums and may explore what options are available outside the marketplace — like buying directly from an insurer — next year.

Waiting until January to see what transpires

Amy Bielawski, 60

Tucker, Georgia

Amy Bielawski can count the number of times she went a doctor as a child. As she got older, medical care became more vital.

Bielawski owns Hare-Brained Productions, a small entertainment business that provides face painting, singing telegrams and a slew of other services at events. Before getting marketplace coverage in 2021, Bielawski relied on niche low-income health insurance programs or went without insurance entirely. Her experience with the marketplace has been mixed: “I can’t say I’m in love with any of the insurance companies, but it’s better than nothing,” she says.

Her premiums, however, were affordable: In 2025 she paid $30 per month for a bronze plan with minimal dental and vision coverage. That same plan will shoot up 800 percent, to $270 per month, in 2026. “As an entertainer who has seasonal business, there’s no way I can pay that kind of money,” she says.

A health insurance broker tipped her off to an ultra-low-cost plan on Georgia’s marketplace, but it would mean leaving her current doctor, whom she likes, and joining a new network. Bielawski can also make inexpensive appointments through the county health department, which she has done in the past, but in her experience, “it’s not great care,” she says.

Either way, Bielawski knows she cannot go without insurance. She needs prescription thyroid medication and worries about what would happen in case of an accident or major illness.

“Then I have nothing to fall back on,” she says.

Bielawski skipped open enrollment in December and will wait until Jan. 15 to see if Congress extends the enhanced premium tax credits. Then she can decide about signing up for coverage that starts in February.

“Knock on wood that nothing happens to me,” she says.

a man, holding a mug, sits in an outdoor chair in the yard of his home

Marty Jensen, who has type 1 diabetes, depends on his gold plan to stay healthy.

Charlie Neuenschwander

Sticking it out until Medicare

Marty Jensen, 64

Tulsa, Oklahoma

Marty Jensen has five months to go until he is eligible for Medicare. Those five months are going to be expensive.

Jensen has type 1 diabetes. Between insulin and supplies, he typically hits the deductible of his gold-tier BlueCross BlueShield marketplace plan by March of every year.

Jensen pays about $557 per month for health, dental and vision; without the enhanced premium tax credit, the monthly premium would be $1,510. For 2026, he saw that the monthly rate would balloon to $2,110.

Jensen spent most of his career in health care information technology, where he helped providers, insurance companies and federal and state governments reduce administrative costs. Now he owns a health care provider data firm with his husband, who is already on Medicare, so their income fluctuates.

Jensen considered buying a catastrophic plan and paying for his diabetes equipment out of pocket to tide him over. But he decided to stick with the high-quality plan he has.

“I have a substantial, defined set of expenses to pay every year and month just to stay healthy,” he says.

For example, he recently ordered sensors for his continuous glucose monitor. The supplier charged $2,220, but he paid only $270 thanks to his comprehensive insurance. That’s why he bristles at the idea that people like himself can make do with a catastrophic plan and a $1,500 health savings account.

“After 50 years living with a once-fatal disease, I remain healthy,” he says. “Millions of other people living with chronic conditions that require costly medical interventions are facing that same math problem.”

a woman stands behind a man who is sitting at a table. they are in front of a window showing woods and trees outside.

Gina (left) and Marc (right) Bartholomew hoped marketplace coverage would carry them through until they become eligible for Medicare.

Greta Rybus

Finding a solution at the last minute

Marc Bartholomew, 52, and Gina Bartholomew, 56

Bowdoin, Maine

Marc and Gina Bartholomew came very close to dropping their marketplace insurance in December.

The couple made a calculated gamble at the beginning of this year. Marc left his job as a chief technology officer at a boarding school in February because the stress was affecting his health. The couple paid off their mortgage and cut back on expenses so they could spend their time on part-time jobs and hobbies they enjoyed. Gina teaches yoga, while Marc hops between gig work in information technology.

They found a mid-tier silver plan on Maine’s marketplace for $89 per month at their income level. As their income changed midyear, the premiums rose to $120 per month. Either way, “it was a great deal,” says Marc.

The news about failing last-ditch efforts to save the enhanced premium tax credits “was particularly depressing,” he says. The Bartholomews saw that their existing plan will skyrocket to an unaffordable $2,225 per month in 2026. Their combined income of around $28,000 “works for us because we have a roof over our head and power and heat,” he says. “The ACA fit perfectly into that.”

But on Dec. 15, the deadline to enroll for plans that start on Jan. 1, Marc spoke with a representative from CoverME, Maine’s ACA marketplace, who explained why a technical error with the system was causing him to see such high numbers. Armed with this information, Marc re-entered the couple’s income from self-employment and turned up the same silver plan with a quote of $171 per month, meaning they will continue their coverage for 2026 after all.

“Every time I turn on the news, it’s saying they’re not redoing subsidies,” he says. “My logical conclusion is: I’m getting these quotes because there are no subsidies.” However, tax credits still exist for people with incomes that are 100 to 400 percent of the federal poverty line, albeit at less generous rates.

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