When health insurance costs $2,500 per month, families make tough choices

Parveen Vohra and Ken Warner had an expensive year in 2025. They're in their mid-50s, and they live in Manchester, Conn., with two dogs and three cats. They're both self-employed, Vohra as a mental health counselor and Warner as an independent sci-fi and fantasy author.

"We needed a new roof and a boiler the same year as [two] surgeries — I had a hip replacement and Parveen had some eye surgery that had to get done," Warner says. The couple gets their health insurance through the Affordable Care Act marketplace. Even with a good plan, they had out-of-pocket costs.

To cover those expenses, they wiped out one of two small retirement accounts they had through previous jobs, before they became self-employed.

This year is shaping up to be expensive, too. When the enhanced federal subsidies expired for ACA plans, their premium costs spiked.

"In 2025, we were paying $630 per month total to cover the two of us for the medical, and it was like another $100 for the dental," Warner explains. "Now, we're over $2,500."

To be specific, $2,531.07 every month. That number, he says, is insane. It's about the cost of the average U.S. mortgage payment. "We can't afford that — who can afford that?" Warner asks.

They hoped Congress would make a deal to extend the subsidies, and for a few weeks in January, it seemed like that could happen. The House passed a bipartisan three-year extension, and senators held talks on their own deal. But in the end, those efforts failed, and federal lawmakers are no longer actively working on a solution.

For Warner and Vohra and millions of people like them, that means these high premiums are a new reality — an added expense they've been coping with for three months so far, since January 2026.

Cutting back on groceries

The Affordable Care Act marketplaces had been growing in popularity for several years. Last year, 24 million people were enrolled.

When the enhanced subsidies expired, premium costs doubled on average, according to KFF, a nonpartisan health policy research and polling organization.

A new KFF survey of ACA plan enrollees finds that while seven in ten stuck with marketplace coverage, a substantial number of them downgraded their plan or decided to go without health insurance altogether.

"When we ask people about the reasons why, what we're hearing over and over again is cost," says Ashley Kirzinger, KFF's director of survey methodology.

In order to manage those higher costs, enrollees are making tough choices, she says.

"More than half said that they're cutting back on some sort of household spending. That includes people that are cutting back on groceries or may be finding an extra job or working more hours," she says. "A significant share are saying they're taking out a loan or increasing their credit card debt in order to cover the costs related to their health care."

There are signs that the number of people who drop coverage may grow as the months go on. "Nearly one in five say that they're not even confident that they're going to be able to afford their premiums for the entire year — so they may end up being uninsured," she says.

Federal data shows more than a million fewer people had signed up for ACA plans for 2026, as of mid-January.

Wondering what will be left to live on

Warner and Vohra sat down a few months ago to go through their monthly budget to find things they could cut. They changed cell phone plans, canceled streaming services, and stopped getting house-cleaning help.

"We're not doing any vacations, which [are] a good mental health practice," Vohra says. "But to offset that $2,500 a month…"

"…something's got to give," says Warner.

They're also trying to raise their income, although Vohra is already full time with her counseling practice and also takes her 87-year-old mother to doctors appointments. Warner is crowdfunding for a special edition of one of his epic fantasy books. He's also been applying for jobs with health benefits, without success so far.

Jarod Lew for NPR /

Ken Warner's novel, The Secret of Giza, is the first in a 10-volume series about twins who "are thrust into a war that spans worlds," according to the book description. There's an Access Health CT letter on the desk, too.

If Vohra and Warner made less money, they might qualify for subsidies. If they made more, they might find the unsubsidized premium manageable.

Hanging over them is the prospect of additional surgeries — Warner's other hip and Vohra's other eye. That has them looking to the last remaining retirement account.

"Now we're looking at, 'Oh, maybe we have to tap [that]'," Vohra says. "And this is supposed to be meant for our 60s and 70s and 80s."

She says the cost for her mother's long-term care at a nearby memory facility is about $10,000 a month. She wonders how she and Warner will possibly have that kind of money when they are elderly, especially if premiums stay high in the years to come.

"We know next year there's going to be probably another 10%, 20% increase," Warner says. "It's going to get worse — it's not like this was a one-time shot."

They both say they feel trapped in a broken system. "It really just has been an infuriating process to watch this all just go backwards," he adds. "I mean, it feels criminal. It feels like we're actually being robbed — they're literally just taking money away from people like us."

Copyright 2026 NPR