Healthcare Is About to Get a Lot More Expensive

This article was originally published by Dr. Eric Lullove as “The 2026 Healthcare Cliff: Why Millions are Bracing for a ‘Rate Shock’”. Blue Amp Media is republishing here with permission.

by Dr. Eric Lullove

For the past few years, the American healthcare landscape has felt deceptively stable. Record-high enrollment in the Affordable Care Act (ACA) and a surge of “zero-premium” plans suggested we had turned a corner on affordability.

But as we look toward 2026, the safety net is fraying. A combination of expiring federal subsidies, the exit of major national insurers, and a fundamental shift in how employer-based insurance works is creating a “perfect storm” that will hit the self-employed and lower-income families hardest.

Here is the breakdown of the 2026 healthcare “cliff” and what it means for your wallet.

1. The Death of the “Enhanced” Subsidy

The single biggest driver of this crisis is the expiration of the Enhanced Premium Tax Credits (PTCs) on December 31, 2025. These credits, originally part of the pandemic-era relief and extended by the Inflation Reduction Act, did two things: they capped premiums at 8.5% of income and opened up subsidies to middle-income earners (those above 400% of the Federal Poverty Level) for the first time.

The Fallout:

• The “Subsidy Cliff” Returns: Since Congress chose to expire the additional premium insurance subsidies — that 8.5% cap vanishes. A self-employed couple in their 60s earning $85,000 could see their premiums jump from roughly $600 a month to over $1,800 a month—essentially a second mortgage.

• Lower-Income Impact: For those near the poverty line, $0 premium plans will likely become a thing of the past. Average net premiums are projected to more than double, rising from about $888 to over $1,900 annually.

• The Uninsured Surge: The Urban Institute estimates that 4.8 million people will become uninsured in 2026 simply because they can no longer afford the “rate shock.”

2. The Great Retreat: Aetna and UnitedHealthcare

Affordability isn’t just about subsidies; it’s about competition. Unfortunately, the “big players” are heading for the exits.

Aetna (CVS Health) has officially confirmed it will stop offering individual and family ACA plans in 17 states (including Florida, Texas, and Virginia) starting January 1, 2026. After a brief return to the market in 2022, the company cited a lack of profitability and the high cost of claims as reasons for the retreat.

UnitedHealthcare and Humana are following a similar “retrenchment” strategy, pulling back from hundreds of counties, particularly in their Medicare Advantage and certain ACA segments.

Why this matters: When national giants leave, they take their massive provider networks with them. Residents in affected areas will be forced into “narrower” networks offered by regional insurers, which often means losing access to specific specialists or hospitals.

3. The “Under-Insurance” Trap in Employer Plans

If you get your insurance through work, you might think you’re safe. You’re not. Employer health costs are projected to rise by 9% to 10% in 2026—the third consecutive year of near-double-digit increases.

To keep their own costs down, employers are aggressively shifting the financial burden to employees through “plan design changes.”

• The Rise of High-Deductible Health Plans (HDHPs): More companies are making HDHPs the only option, meaning you may have to pay $3,000 to $6,000 out of pocket before your insurance kicks in a single cent.

• Coinsurance vs. Copays: We are seeing a shift away from $30 “flat” copays toward 20–30% coinsurance. On a $10,000 outpatient surgery, that’s the difference between a small office fee and a $3,000 bill.

• The “GLP-1” Surcharge: The explosion in popularity of weight-loss drugs (like Ozempic and Wegovy) is a massive cost driver. Many employers are responding by tightening “prior authorization” rules or increasing the coinsurance specifically for these specialty drugs.

4. The Self-Employed “Tax Trap”

For freelancers and small business owners, 2026 brings a new technical danger: Elimination of Repayment Limits.

Previously, if a self-employed person underestimated their income, there was a “cap” on how much of the subsidy they had to pay back to the IRS. Starting in 2026, those caps are effectively gone. If your business has a surprisingly good year and pushes you over the 400% poverty threshold, you may be required to repay every single dollar of the subsidy you received—a “tax bill” that could easily reach $15,000 or more.

The Bottom Line

2026 marks a pivot point where “having insurance” no longer equates to “having healthcare.” Between the loss of subsidies and the rise of massive deductibles, millions of Americans are becoming “under-insured”—holding a card in their wallet they are too afraid to use because of the out-of-pocket costs.

References

1. Congressional Budget Office (CBO): “The Estimated Effects of Enacting Selected Health Coverage Policies on the Federal Budget” (September 2025 Update)

2. The Urban Institute & The Commonwealth Fund: “4.8 Million People Will Lose Coverage in 2026 if Enhanced Premium Tax Credits Expire” (September 2025).

3.KFF (Kaiser Family Foundation): “ACA Marketplace Premium Payments Would More than Double on Average If Enhanced Tax Credits Expire” (September/October 2025).

4.Aetna/CVS Health: “Aetna CVS Health 2026 Plan Information” (Official Corporate Disclosure, late 2025)

Dr. Lullove is a Board-Certified Foot and Ankle Surgeons with Additional Board Certifications as a Certified Wound Specialist-Physician. He is the Medical Director of the West Boca Center for Wound Healing in Coconut Creek, FL. Dr. Lullove serves as one of the healthcare policy experts involving Wound Management, Diabetes, Venous Disease and is actively involved in writing healthcare policy nationally for stakeholder groups.