Waiting for Medicare and skipping prescriptions: Meet the Americans on the brink of losing health insurance

• Without enhanced ACA subsidies, Americans saw their insurance costs spike by hundreds each month.
• Business Insider heard from people who are skipping care or dropping their plans due to cost.
• Over 1 million Americans canceled their marketplace plans between early 2025 and 2026.

CJ Richey is looking forward to celebrating something special on her 65th birthday: Qualifying for Medicare.

The now 60-year-old is a self-employed counselor in Colorado. She relies on the Affordable Care Act marketplace for health insurance, and her monthly premium just jumped from $265 to $903. It's an expense she can't afford.

"It's frightening to think that I have to ration healthcare," Richey said. "It's very scary."

The price of health insurance has become unsustainable for millions of Americans. Enhanced ACA subsidies — a credit designed to make care more affordable for lower- and middle-income households — expired on December 31. Plans to renew them have fizzled out in Congress. People like Richey told Business Insider they're on the brink of losing coverage after their premiums spiked in January.

Marketplace plans are often the only insurance option for freelancers, gig workers, part-time workers, and others without employer-sponsored coverage. And the impact of this change is beginning to show: Enrollment in the marketplace dipped by 1.4 million in January, with more people expected to drop their plans in the coming months. Twenty-four million people were enrolled in ACA plans last year, a figure that had steadily increased since the enhanced subsidies took effect in 2021.

For Richey, dropping her health insurance altogether may make the most financial sense.

"I just don't know what to do," Richey said. "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."

'It's life or death'

With the end of enhanced ACA credits, many Americans are wondering if their health insurance plan is still worth it. The subsidies offered a break on insurance costs for families up to 400% of the federal poverty line, which is $128,000 for a family of four. The average enrollee saw their monthly costs more than double in January, per KFF.

Natalie Richards, 37, tries not to think about what would happen in an emergency. Her monthly premium jumped from $3 to $164 this year without a subsidy, and she's expecting her plan will be canceled in the coming months due to unpaid bills. She washes dishes at her local Chili's in Palestine, Texas, though her part-time schedule means she doesn't qualify for insurance through work.

Richards is a single mom, and she said she can't cover the increased premium without compromising on rent, groceries, or other bills. She skipped her January and February ADHD medications due to cost, which she said has been debilitating for her mental health.

"It's life or death," Richards said. "And beyond that, it's quality of life. I could be completely miserable and struggle for everything. Or, when I have my meds, I can look at problems, see the bigger picture, and figure it out."

Right now, Richards doesn't see a way to keep her insurance. She does not qualify for Texas Medicaid, and she can no longer afford the marketplace. She said she's searching for a job with employer-sponsored coverage and will likely avoid the doctor in the meantime. If she absolutely needs medical care, she will need to pay out of pocket. "The things I desperately need right now, I don't have access to," she said.

Richey is in a similar position. She began paying her higher ACA premium at the beginning of the year, but it's eating into her bank account. To compensate, she moved her car payment to a different date, is opting out of social plans, canceled streaming subscriptions, and is ordering prescriptions directly from Mark Cuban's CostPlus Drugs program. Even so, she expects to drop her marketplace plan this spring because of the cost.

In a nonscientific survey of over 50 Business Insider readers about healthcare costs, others on ACA plans shared that their premiums have spiked hundreds of dollars this year. A few are seriously considering dropping coverage to balance their budget, and some said they don't have a choice.

A 'very fragile market'

It will be months before we have a clear picture of America's health insurance landscape without enhanced ACA subsidies. Policy analysts told Business Insider that more households are likely to drop their plans due to high costs. That 1.4 million enrollment dip from January 2025 to January 2026 is just a snapshot.

Sara Rosenbaum, a professor emeritus of health law and policy at George Washington University, told Business Insider that, "We're in a death spiral here if we don't make the coverage affordable again and we don't give people good value."

ACA subsidies are still available for some lower-income enrollees, but credit availability and amounts vary by state. Rosenbaum said that older Americans under 65 and families with incomes slightly above the cutoff threshold have the most to lose. Too young for Medicare and with incomes too high to qualify for Medicaid, she said these demographics will fall through the healthcare safety net.

"We have made people so dependent on this very fragile market," Rosenbaum said. "If you take away affordability, then the core issue is that health insurance begins to crumble. Young people who don't have health problems think they can go without it; they're very price sensitive. And it leaves older people with no affordable insurance."

Of course, affordability challenges aren't isolated to government plans. A KFF poll released in January found that healthcare costs are among the top financial stressors in the US, regardless of insurer, beating housing and groceries. Premiums and care costs have risen substantially for employers and employees with private coverage, too.

For many self-employed and part-time workers under 65, however, a subsidized marketplace plan was their only option. Richey is counting down the days until she isn't dependent on the marketplace — and praying she doesn't rack up more medical bills.

"I'm doing OK financially," she said. "But it's one of those situations where if one thing happens, it's done for me. I think that's just the majority of Americans."