Millions of Americans are confronting the highest health insurance costs in years. For those enrolling in Obamacare for next year, the plans will cover a considerably smaller fraction of their medical bills.
More and more people are discovering that their deductibles are rising significantly, worsening fears that they will no longer be able to pay for medical care. That’s on top of higher premiums; they could more than double.
With affordability increasingly out of reach, some people are facing the dire prospect of dropping their insurance altogether, even if they’re still eligible for subsidies. Others may forgo doctors’ visits or trips to the emergency room to avoid the expense.
The contentious debate in Congress over the future of the enhanced subsidies under Obamacare that are set to expire this month has largely focused on the rise in premiums. Most people will still qualify for some federal tax credits in 2026, but many will find that monthly costs are doubling if the generous subsidies are not extended.
The Senate is expected to vote on whether to extend the subsides, although Congress could wait until early next year, even after the subsidies have expired. President Trump has floated supporting some sort of extension, but it is unclear what kind of compromise would muster enough Republican backing to pass.
As medical costs have climbed, health insurance at all levels has become more expensive. Contributing factors cited are higher overall prices for prescription drugs, the cost and the exploding use of obesity drugs, tariffs and increasing labor expenses.
Because many plans under the Affordable Care Act already carry a high deductible, people may not be able to find cheaper policies to significantly reduce costs.
Nearly a third of the 24 million people who signed up for coverage under the A.C.A. last year enrolled in the least expensive kind of plan available to everyone, a so-called Bronze plan.
These individuals already pay a large share of their medical bills. The average deductible for a Bronze plan has climbed steadily, to roughly $7,500 in 2026 from under $7,000 in 2021, according to KFF, a health research group.
“They don’t have that option to switch to a lower-premium plan with a higher deductible,” said Cynthia Cox, an expert on Obamacare for KFF.
Some of those affected retired early and must wait until they are 65 to enroll in Medicare. “These people are really in a difficult situation,” she said.
In addition to high deductibles, some plans may require people to pay a large share of out-of-pocket costs in other ways — asking for co-payments, which are fixed amounts when they go to the doctor, or coinsurance, which is a percentage of their medical bills.
Even the caps on how much people have to pay in out-of-pocket costs are going up. The out-of-pocket maximum, which does not apply to those with the lowest incomes, will reach $10,600 next year, about $1,200 more than in 2025.
“People look at $10,600 and panic,” said Jennifer Chumbley Hogue, an insurance broker in Texas who sells A.C.A. plans. “There’s a big difference to the consumer between $9,000 and $10,000.”
Others are worried about the financial risks of a hospitalization, which would require upfront payments of thousands of dollars.
For example, Patty Reed, a small-business employee in Los Angeles, had a plan with no medical deductible, but next year she will have a deductible of $5,200.
That is on top of her plan’s higher premium — $1,700 a month next year. Ms. Reed, 60, had qualified for federal and state subsidies that brought the premium cost down to about $1,100. Because her income varies year by year, it remains unclear whether she will qualify again.
“I feel like I can never get ahead,” Ms. Reed said. She is weighing buying a plan with a higher deductible but worries about what she might have to pay if she goes to the hospital. “It’s a gamble,” she said.
In a KFF poll in early November of people enrolled in Obamacare, a quarter reported that they were “very likely” to go without coverage if their premiums doubled or if they had to pay $50 more a month if they paid no premiums for 2025.
Half said finding another source of insurance if their Obamacare coverage became unaffordable would be “very difficult.”
Eric Littman, a self-employed chiropractor in New Jersey, knows he will be paying more to insure his family of four. “The problem is that what is also going up is the deductible, coinsurance and out-of-pocket amounts,” he said.
Absent federal tax credits, Dr. Littman could pay about $35,000 in annual premiums for a mid-tier plan that will have a higher out-of-pocket maximum of $17,000.
A cheaper plan further limits coverage, raising the specter of even higher personal cash outlays. “You essentially don’t have insurance for the small things — you only have insurance for the $100,000 hospital bill,” Dr. Littman said.
With Republicans and Democrats still at a stalemate over the subsidies, expiration seems increasingly likely.
Some Republicans say they plan to develop an alternative to the Affordable Care Act, and President Trump has suggested replacing the subsidies with cash payments.
Obamacare critics argue the law provides coverage that is far too generous and too costly. They also contend that doling out the expanded subsidies encourages people like Ms. Reed and Dr. Littman to choose plans with lower deductibles and out-of-pocket costs.
If people spent more of their own money, they would be smarter shoppers for medical care, the theory goes. “Americans can be wise consumers,” said Brian Blase, the president of the Paragon Health Institute, an influential conservative health policy group, at a hearing before the Senate Finance Committee in mid-November.
Research contradicts Mr. Blase’s assertions, finding that people with high-deductible plans often go without needed medical care. Their decisions can be haphazard: They may skimp on a lifesaving heart medicine but favor expensive imaging that is much less important. They can be confounded by information overload about doctors, perhaps unable to properly navigate and evaluate the right specialist.
“We have very little evidence that people are good at shopping for their care,” said Adrianna McIntyre, an assistant professor at the Harvard T.H. Chan School of Public Health.
The KFF poll found an additional $1,000 in health care expenses would likely cause two thirds of the Obamacare enrollees to cut back spending on household expenses like food or clothing.
People said they were already struggling to afford medical care with six in ten saying it is already very or somewhat difficult to afford their deductibles and out-of-pocket costs.
For those covered under the Affordable Care Act, next year’s policies are breaking their household budgets and providing coverage that is often much less generous.
“For a lot of people, this isn’t very good insurance,” said John Holahan, a health economist at the Urban Institute, a left-leaning think tank. He thinks some people will drop their coverage next year when confronted with the expense and the amount they could owe in medical bills.
“People will make their judgment that it’s just not worth it to pay a higher premium for policies that have high deductibles,” he said.
Others may opt for so-called junk plans that do not always meet the A.C.A.’s standards and may not pay for expensive medical care or may refuse to cover a pre-existing condition. They may also choose an insurance look-alike, one that promises to pay for medical expenses but is not true insurance, like some plans offered by Christian health-sharing ministries.
The price of an insurance plan typically tries to balance the cost of premiums with how much the plan covers. Under the A.C.A., people with very low incomes are protected from high medical bills by being able to purchase special mid-tier, or Silver plans. About half those enrolled in Obamacare are in these plans.
Some individuals may also be eligible for a catastrophic A.C.A. plan, which is not available to everyone, and has a deductible of $10,600.
Peggy Maryanski, 64, is a retired schoolteacher in Ventura, Calif., and cares for her husband, who has bladder cancer. Her monthly costs are $943, after she receives subsidies, but will go up next year to nearly $1,700 if she stays with the same plan.
She is hesitant to move from her Silver plan to a Bronze one because emergency room visits could go from $400 a visit to 40 percent of the overall cost — after she meets her annual deductible of $5,800.
“It just felt too high a risk for someone my age,” Ms. Maryanski said. “We’re trying to stick with the Silver.”
Other plans don’t offer as wide a selection of doctors. “There are alternatives, but they are not that desirable,” she said.
Even though her husband is covered under Medicare, the couple still pays thousands of dollars in medical bills — in addition to premiums. “It’s a lot,” she said.
“When you retire, there is no income,” she said. “You are spending your savings. You know there is no more from where that came from.”
Reed Abelson covers the business of health care, focusing on how financial incentives are affecting the delivery of care, from the costs to consumers to the profits to providers.
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