The sticker shock Reagan Fisher Wyssbrod felt when she opened her 2026 marketplace health insurance estimate sent her into a panic.
“How am I going to pay the mortgage, repair the house and pay for health insurance? Something’s got to give. How are we going to afford all of this? And really, we can’t,” Wyssbrod said. “We’re cutting back everywhere we can just so we can afford health insurance. It’s the most expensive thing we pay out.”
Wyssbrod and her husband, who live in Salem, have two children, one in elementary school and one in middle school. Going without coverage isn’t an option for them, but because her husband is self-employed, the marketplace is their only path to insurance.
She is looking for a full-time job solely to secure affordable coverage, a move she worries will mean sacrificing time with her kids.
“They have after-school clubs and Christmas parties,” she said. “Who’s going to go to their parent-teacher conferences?”
About 400,000 Virginians rely on Affordable Care Act marketplace plans, which use federal tax credits to lower monthly costs. The American Rescue Plan Act and later the Inflation Reduction Act temporarily expanded those subsidies for people with lower incomes and for people earning more than 400% of the federal poverty level.
Wyssbrod’s experience isn’t an outlier. Instead, it’s a preview of what many Virginians will face when some federal subsidies for marketplace plans expire at the end of the year. The change will drive up premiums for most enrollees, hitting older adults, self-employed workers and families without employer coverage especially hard.
About 100,000 Virginians could lose coverage simply because they won’t be able to afford the premiums, Keven Patchett, director of the Virginia Health Benefit Exchange, said during a July presentation to state lawmakers.
Congress did not include an extension of the so-called enhanced subsidies in the federal spending bill, also known as the One Big Beautiful Bill, which was signed into law in July. This absence was one of the key points of contention that contributed to the historic 43-day federal government shutdown.
Even after the enhanced subsidies expire, the ACA’s original premium tax credits will remain in place. These credits still help lower monthly costs for people with incomes between 100% and 400% of the federal poverty level. But without the enhancements, many consumers will see their assistance shrink or disappear entirely.
On average, marketplace enrollees will pay about 114% more in monthly premiums, according to KFF, an independent, nonprofit organization that provides analysis on national health issues.
‘We’ll wrap some bubble wrap around us’
Wyssbrod works three part-time jobs to help support her family while keeping the flexibility she needs for her children. She spends some days as a substitute teacher and is a business manager for a library association. She also does some bookkeeping on the side. None of these jobs offer benefits.
She has a bachelor’s degree in psychology and roughly two decades of experience in health insurance and accounting. Even so, she’s now willing to take almost any job that offers benefits, even if that means working at McDonald’s, she said. Letting her kids go without access to health care isn’t an option.
Her projected monthly premium increased by $400, raising her monthly out-of-pocket cost to $1,900. On top of that, her longtime doctor moved out of network.
“It’s astonishing,” she said.
She spent three weeks combing through plans and eventually found one that saves the family about $100 a month, bringing their monthly premium down to about $1,800. It allows them to keep their doctors, but the deductible is much higher. Worst-case scenario, she said, the out-of-pocket cost would be $20,000 on top of the monthly premium.
“Ultimately it came down to: I don’t go to the doctor that often. My kids don’t go to the doctor that often. And so we just rolled the dice,” she said. “We’ll wrap some bubble wrap around us, I guess.”
Small-business owners at risk of high premiums
Victoria Cassels, an accountant in Roanoke, worries about her adult daughter in Richmond. She’s a self-employed graphic designer and has an autoimmune disease. Her condition limits how much work she can take on, and she depends on marketplace coverage.
This year, her monthly premium rose by $400, about three times higher than it was last year, Cassels said. Cassels plans to help her daughter cover the cost if she can’t take on enough work to meet the new expense.
Ben Pearman, a financial adviser from Bent Mountain in Roanoke County, also runs his own business. His business is well-established, and he has a steady income. However, the higher monthly cost has led him to reconsider his options. As a single man in his 50s, he pays for his own health plan, and next year, his monthly premium will jump from $724 to $935. He can absorb the higher cost but is considering switching to concierge care, a care model in which patients pay a flat monthly rate or annual fee to a doctor and can access most primary care without insurance. However, that would leave him without insurance if an accident happened.
Cassels, who prepares taxes for individuals and small businesses, says more of her younger clients are talking about dropping health insurance altogether.
In the last few years, she’s had a slew of clients in their 20s and 30s who have started their own businesses. They’re just getting started in life, she said. They don’t have savings to afford the increasing cost of health insurance.
Earlier this year, experts in Virginia warned that younger, healthier people would likely leave the marketplace as costs rise, shrinking the risk pool and driving premiums even higher for everyone who remains.
End of the repayment cap could leave consumers on the hook
Cassels is also alerting clients to another change: the end of the repayment cap. Previously, if a household’s income exceeded expectations, the amount of subsidy they had to repay at the end of the year was limited. Those caps are now gone.
Lois Caliri, who helps people find health plans as a certified health insurance navigator with Enroll Virginia, is urging consumers to double-check their projected 2026 income.
Since subsidies are based on estimated income for the coming year, anyone who exceeds that estimate must pay back part of the assistance. With the caps gone, those repayments can be significant.
For example, if someone received $5,000 in tax credits but exceeded eligibility by $2,500, they will have to pay back the full $2,500, Caliri said.
The cap applies to those who earn less than 400% of the federal poverty level, according to KFF. For all of those people, the cap is then determined by income. For 2025, this cap is still in place, but that will change next year.
Caliri encourages clients to update their marketplace application whenever their income changes during the year to avoid large year-end bills.
So far, she hasn’t seen clients drop coverage, though most are paying $100 to $200 more per month. The exact amount varies widely based on income and household size.
“It’s more important than ever to shop around,” Caliri said. Navigators can help people compare plans and consider future medical needs, but the final choice is always the consumer’s.
She added that some older adults are seeing their premiums rise, too, but many say they can absorb the increase because they have more financial stability.
Older adults will face some of the steepest increases
People earning above 400% of the federal poverty level will lose all premium tax credits once the enhanced subsidies expire. This group, mainly older adults, will feel the biggest impact because they already face the highest full-price premiums.
More than half of marketplace enrollees in this income range are between 50 and 64 years old, and their premiums will see some of the steepest increases.
Linda Bartlett, who’s 64, entered semi-retirement last year and now works part-time at Roanoke’s Mast General Store. She turned to the marketplace until she qualifies for Medicare.
Starting Jan. 1, her premium will double, bringing her monthly payment to about $1,200. That’s nearly all of her Social Security check, she said.
“We can manage it, but it’s just a shock,” she said.
Bartlett worked with Caliri to try to find a more affordable plan, but saved only $10 a month.
Virginia Democrats consider funding to backfill for enhanced tax credits
Democrats in the House of Delegates have indicated that they’re considering allocating money to offset the loss of the premium tax credits.
In a Nov. 20 presentation by the House Appropriations Committee, a $400 million allocation was included to backfill the gap left by federal enhanced premium tax credits. This would help lower the premiums for people making up to 400% the federal poverty level.
When the federal government opened back up on Nov. 12, it did so under a new continuing resolution, which included funding the federal government through Jan. 30 and the promise of a Senate vote on the extension of enhanced premium tax credits in mid-December. However, there is no clear path to addressing this issue again, according to an article in Health Affairs, a nonpartisan journal that provides analysis on health policy.
It’s still unknown exactly when the vote will happen, what process lawmakers will use, whether each party will introduce competing plans or if an extension will attract bipartisan backing.