Your Health Insurance Just Got More Expensive

If you buy health insurance through the ACA marketplace, you probably got an unpleasant surprise when you logged in to renew your coverage for 2026. The enhanced premium subsidies that had been in place since 2021, first through the American Rescue Plan, then extended by the Inflation Reduction Act, expired on December 31, 2025.

For the roughly 22 million people who buy insurance through Healthcare.gov and state exchanges, this isn't an abstract policy change. It's a real, immediate hit to the monthly budget.

The Numbers Are Stark

The Kaiser Family Foundation estimates that subsidized enrollees will see an average premium increase of 114%. That's not a typo. For many people, especially those earning between 150% and 400% of the federal poverty level, the monthly premium increase will be hundreds of dollars.

The subsidy cliff is also back. Under the enhanced subsidies, nobody had to pay more than 8.5% of their income for a benchmark plan, regardless of income. Now, if you earn more than 400% of the federal poverty level (about $58,000 for a single person), you lose subsidy eligibility entirely. A 59-year-old earning $59,000 could see their annual premium go from around $5,000 to over $15,000.

Congressional Budget Office projections suggest roughly 3.8 million people will drop their marketplace coverage in 2026 because of the cost increase. Another several million will downgrade to cheaper, higher-deductible plans.

Higher Premiums, Higher Stakes for Every Dollar

Here's the thing that frustrates me about the way this gets covered in the news. The focus is almost entirely on the premium increase itself, as if the monthly insurance bill is the only healthcare cost that matters.

But premiums are just the entry fee. If you're being forced into a higher-deductible plan to keep your monthly costs manageable, you're going to be paying more out of pocket for every procedure, every scan, every lab test until you hit that deductible. A Bronze plan might save you $200 a month in premiums compared to Silver, but if you need an MRI, you could be on the hook for the full negotiated rate, which could be anywhere from $400 to $3,500 depending on where you go.

This is where price transparency stops being a nice-to-have and becomes genuinely urgent. When your deductible is $4,000 or $6,000, the difference between a $600 colonoscopy and a $3,200 one at the hospital across town is real money. That's not a rounding error. That's a month of rent.

Why Price Shopping Matters More Than Ever

I've been building Panopticare for a while now, and the subsidy expiration is honestly one of the things that keeps me motivated on the hard days. Because the people who are going to be hit hardest by this change are exactly the people who benefit most from being able to compare healthcare prices.

If you're on a high-deductible plan, every dollar you save on a procedure is a dollar you actually keep. It's not absorbed by your insurance company's negotiated rates or hidden in some opaque billing arrangement. You're the one paying, so the price difference comes directly out of your pocket, or stays in it.

The data we've been pulling together shows price variations of 3x to 8x for common procedures within the same metro area. Knee replacements, cataract surgery, imaging, lab work, you name it. Those gaps exist whether you're insured or not, but they matter a lot more when you're paying out of pocket up to your deductible.

And the kicker is that the higher-priced hospital isn't necessarily better. The research on healthcare pricing is pretty clear on this: there is almost no correlation between price and quality for most common procedures. You're not paying more for a better outcome. You're paying more because that hospital has more market power and negotiated a higher rate.

What You Can Actually Do

I know this is frustrating. The subsidy expiration was a political decision, and no amount of price shopping is going to replace the federal support that just evaporated. But within the reality we're now in, there are some concrete steps that can make a real difference.

First, if you haven't already, shop your plan carefully. The plan that was cheapest last year may not be cheapest this year, and the network changes can be significant. Use the marketplace tools to compare total expected costs, not just premiums.

Second, for any planned procedure or diagnostic, compare prices before you schedule. This is especially true for imaging, outpatient surgery, and lab work, where the price variation is enormous. Ambulatory surgery centers are often half the price of hospital outpatient departments for the same procedure with the same surgeon.

Third, ask for the cash price. Seriously. For some services, the cash price at a transparent facility is lower than the insurance-negotiated rate, which means paying cash and not running it through insurance can actually save you money. It's absurd, but it's how the system works.

The subsidy expiration is going to push millions of people into a position where they're more exposed to the actual cost of healthcare than they've been in years. If there's a silver lining, it's that this might be the thing that finally makes price transparency matter to enough people to create real market pressure. When 22 million people suddenly have a direct financial interest in knowing what things cost, the hospitals that have been hiding their prices might finally have to answer for it.