She's 60 and just lost ACA subsidies. Now her health insurance costs $903 a month — and she's avoiding the doctor.

• CJ Richey, 60, is among the millions of Americans who lost ACA subsidies on December 31.
• The marketplace credits helped low- and middle-income Americans afford healthcare.
• Richey is likely to drop her insurance coverage this spring due to the steep premium.

CJ Richey is avoiding the doctor.

Like many Americans, she saw her monthly health insurance premium spike this year — in her case, from $265 to $903.

The addiction recovery counselor in Colorado said that being self-employed means she sets her own schedule, and the job gives her a strong sense of purpose, but it comes with a trade-off: She doesn't have a company-sponsored healthcare plan.

For nearly a decade, Richey purchased insurance coverage through the Affordable Care Act marketplace. It has helped cover her prescriptions, doctor's visits, scans, and surgeries.

Enhanced ACA subsidies, a credit for which Richey qualified, were designed to help lower- and middle-income Americans pay for healthcare. Subsidized marketplace plans made insurance affordable for those who didn't have access to employer plans — and are the only option for many freelancers, gig workers, and people with part-time jobs. They expired on December 31, causing premiums for millions of former recipients to skyrocket. The policy was a key point of political tension during the last government shutdown, and efforts to renew it have lost steam in Congress. People like Richey are drowning in monthly bills before they even reach a hospital.

Twenty-four million people like her were enrolled in the marketplace in early 2025, a number that had steadily increased since subsidies took effect in 2021. That figure dipped by 1.4 million in January, with more people expected to drop their plans in the coming months. A KFF poll released last week found that 66% of Americans regularly worry about losing healthcare access, and medicine outranks housing and groceries as top financial stressors.

"I just don't know what to do," Richey told Business Insider. "I'm 60 years old, and I don't have an employee-sponsored healthcare plan. I don't have a spouse. Do I just wait it out for five years until I qualify for Medicare? It's just getting worse and worse."

Richey plans to drop her ACA plan due to high premiums

In all likelihood, Richey will drop her insurance coverage this spring. A $903 monthly premium isn't sustainable for her budget, and she has to reach an $8,000 deductible before her plan starts covering medication and doctor visits. She said the only reason she still has a marketplace plan is for emergencies — though she's debating whether it's still worth it. "There's no way I would ever call for an ambulance," she said. "The cost would be astounding."

To afford coverage, Richey has cut back her spending. She moved her car payment to a different date, stopped going to restaurants and social events, scaled back at the grocery store, and canceled all of her streaming subscriptions. She has picked up more hours with clients to make extra money, and she's worried her student loan payments — which are over $1,000 monthly — will kick back in soon under President Donald Trump's updated loan rules.

It makes Richey anxious: "That's a lot of money, $903 for a plan I basically am not able to use, and to think that was the cheapest plan I could choose from."

As her healthcare costs climb, Richey has experimented with paying out of pocket. She said she orders one of her regular medications from Mark Cuban's direct-to-consumer CostPlus Drugs program and occasionally pays providers in cash instead of filling out an insurance claim.

Even before the new premium spike, Richey faced steep medical costs. She said she's still paying off a surgery she needed a few years ago and has previously struggled to find in-network providers. But the loss of ACA subsidies feels different, and she's scrambling to find an affordable way forward.

For now, she plans to avoid the doctor for as long as possible.

"It's frightening to think that I have to ration healthcare. It's very scary," she said, adding, "This is the average American struggle."