The Affordable Care Act (ACA), which is often referred to as Obamacare, was a very hot political topic at the end of 2025 due to the expiration of “Enhanced Subsidies” that were enacted in 2021 as part of the American Rescue Plan and extended by the Inflation Reduction Act of 2022. These laws did two things; eliminated the income cap to get subsidies that help significantly lower the cost of individual health insurance purchased on the Federal or a state “Marketplace” and also provided extra subsidies that made premiums even more affordable.
Prior to 2021, there was an income limit of 400% of the Federal Poverty Level to get subsidies. Any individual or family with a Modified Adjusted Gross Income (MAGI) that exceeded this 400% had to pay full cost for plans. When that cap was eliminated in 2021, hundreds of thousands of people could now afford coverage. My agency became extremely busy with new clients who were able to retire early thanks to the Enhanced Subsidies.
However, the Enhanced Subsidies weren’t made to be permanent by either of the American Rescue Plan or the Inflation Reduction Act and were scheduled to sunset at the end of 2025.
The controversy that emerged was the fight to extend the Enhanced Subsidies that took place between our two major political parties. Negotiations between them occurred for several months leading up to the end of 2025, but no agreement was ever reached that was satisfactory to both parties and the Enhanced Subsidies ended on January 1st, 2026.
The biggest issue wasn’t that the extra subsidies went away. That resulted in premiums that were $20 to $100 higher per month on average, significant, but not catastrophic like it was for those who now found themselves ineligible for even one dime in subsidy because the income cap of 400% went back into effect.
Today, the bottom line is ACA plan premiums are incredibly high for those who have to pay full cost.
Here are some examples for a 60 year old:
In Western Pennsylvania (Pittsburgh area), full cost for the least expensive available Bronze plan that has a deductible of $6,700 is $654 per month. A $0 deductible Gold Plan is $947/month.
If you think that’s bad, just south in West Virginia, the least expensive Bronze Plan available for that same 60 year old has a deductible of $10,600 and costs $1,266 per month! A $0 deductible Gold plan is $2,199 per month.
People need to keep this in mind who hope to retire early, go part time, start their own business, or are considering a job that doesn’t come with health insurance.
Only individuals or families with a Modified Adjusted Gross Income under 400% of the Federal Poverty level can get what I consider to be a decent price for individual health insurance. And the difference is premiums are huge! In West Virginia, for example, instead of those two plans costing $1,266 and $2,199, someone under 400% of the poverty level by just $600 pays $0 for the Bronze plan and $452 per month for the $0 Gold deductible plan!
Here are those 400% figures for family sizes of 1-7:
1 person: $62,600 per year
2 people: $84,600 per year
3 people: $106,600 per year
4 people: $128,600 per year
5 people: $150,600 per year
6 people: $172,600 per year
7 people: $194,600 per year
One warning for everyone who needs individual health insurance: In almost every state in the country, unfortunately, there are zero legitimate alternatives for health insurance to the ACA. Plenty of companies and rogue agencies or agents market them, but almost none will protect you or your family in the instance of a serious health condition such as cancer, heart attack, stroke, hospitalization, etc.
DO NOT BUY THE GARBAGE THAT’S BEING MARKETED AS AN ALTERNATIVE TO THE ACA OR OBAMACARE. If it’s far less expensive, it’s not real insurance. Again, it will not protect your assets in the event of a major accident, sickness, or diagnosis! You will be on the hook for tens of thousands of dollars in bills or worse, unable to get necessary care without payment of that money up front!
The Health Insurance Store has been helping people with the ACA since its inception in 2014 and are experts in the nuances, rules, and regulations. We also understand how to use all legal loopholes to get income under that magic 400% so health insurance can be affordable.
If you have questions or would like to make an appointment for a no cost consultation, give us a call at the office, 724-603-3403 or email me personally, Aaron@GetYourBestPlan.com.