Rising ACA Premiums Force Americans Near Medicare Age to Delay Care
John Galvin, a recently retired resident of North Kingstown, Rhode Island, is delaying a medically necessary colonoscopy until December, when he qualifies for Medicare. His decision and that of others like him, underscores a growing trend of middle-aged Americans postponing healthcare as Affordable Care Act (ACA) premiums surge following the expiration of enhanced federal subsidies.
Galvin’s monthly Obamacare premium tripled this year to $2,460, consuming roughly a third of his income. Coupled with a $2,700 deductible, the cost of the colonoscopy – estimated at close to $3,000 – proved prohibitive. “I put it off,” he said. His wife, Nancy, is similarly delaying a CT scan for a few years, anticipating Medicare coverage will alleviate the financial burden.
The dramatic increase in premiums stems from the lapse of expanded subsidies at the end of December. These subsidies, implemented during the COVID-19 pandemic under the Biden administration, had provided financial assistance to those with incomes above 400% of the federal poverty level – $86,560 for a family of two. Adults aged 50 through 64 comprised approximately half of those ACA enrollees receiving this aid.
The removal of these subsidies has left many facing substantial cost increases. A KFF survey released this month found that nearly one in ten Americans enrolled in ACA plans dropped their coverage altogether last year. Of those who retained their plans, the majority reported significant premium hikes and concerns about affording other essential expenses. Average premium costs in 2026 are now $1,904, more than double the $888 average from the previous year, with approximately 23 million Americans currently enrolled in ACA plans, down from 24.2 million in 2025.
Health policy experts warn that delaying care could lead to more serious health issues and ultimately higher costs. “There’s going to be a lot of pent-up demand and unmet need,” said Jessica Schubel, a health policy consultant who previously worked in the Obama and Biden administrations. “Medicare is going to have to spend a whole heck of a lot of money covering and dealing with their treatment.”
The ACA had previously reduced the uninsured rate among those aged 50-64 by half, according to AARP, enabling some to retire early while maintaining coverage. The current situation is particularly dire for older marketplace enrollees, according to Matt McGough, a policy analyst with KFF, as the ACA allows insurers to charge those in their 60s up to three times as much as those in their 20s.
Marci Heinbaugh, a 63-year-old social services worker in rural Illinois, saw her monthly premium payments more than double, rising from roughly $1,100 to $2,333, with a $10,150 out-of-pocket maximum. She is now considering dropping her coverage altogether, expressing “petrification” at the prospect of being uninsured.
Alan Weil, senior vice president of public policy at AARP, emphasized that those who drop coverage or delay care may save money in the short term, but could face higher costs – and potentially burden taxpayers – later. “There’s significant possibility that the purported savings associated with reducing subsidies as people approach retirement end up turning into higher utilization costs for Medicare,” Weil said.
The financial strain extends to retirement savings. A 2024 AARP survey revealed that one in five adults over 50 have no retirement savings, and three in five worry about insufficient funds to support themselves. John Galvin anticipates depleting $30,000 from his retirement account to cover premium payments and his deductible until he becomes eligible for Medicare.
The issue is expected to remain politically relevant, particularly in this year’s midterm elections, according to Republican strategist Gregg Keller. “Is affordability going to be an issue? Absolutely,” he said. “Are health care prices going to factor into that? Yes.”