981. This week, Laura reviews the history of the Affordable Care Act (ACA) and options for purchasing comprehensive health insurance.
981. This week, Laura reviews the history of the Affordable Care Act (ACA) and options for purchasing comprehensive health insurance.
Find a transcript here.
Have a money question? Send an email to money@quickanddirtytips.com or leave a voicemail at (302) 364-0308.
Find Money Girl on Facebook and Twitter, or subscribe to the newsletter for more personal finance tips.
Money Girl is a part of Quick and Dirty Tips.
Links:
https://www.quickanddirtytips.com/
https://www.quickanddirtytips.com/money-girl-newsletter
https://www.facebook.com/MoneyGirlQDT
If you don’t get health insurance through an employer, or you’re between jobs, a freelancer, or an early retiree, shopping for health insurance right now can be downright confusing. The entire landscape of individual health insurance feels like it’s reaching a crisis point.
The rising cost of healthcare, combined with the looming year-end expiration of federal tax credits that significantly reduce the cost of health premiums, means coverage will become unaffordable for millions of households.
This post will review the options for purchasing comprehensive health insurance for 2026. I’ll also review the history of the Affordable Care Act (ACA) and what the future may hold.
While I can’t say there’s a surefire way to make health insurance affordable, knowing your options empowers you to shop and compare costs and benefits. In my opinion, choosing a plan that protects your health and wealth has never been more important!
Welcome back to episode 981 of Money Girl–I appreciate you downloading the show! I'm Laura Adams, an award-winning author, on-camera spokesperson, female money speaker, and founder of The Money Stack, my Substack newsletter. Free subscribers automatically receive my Money Success Toolkit, which includes the exact templates I use to manage my finances.
You can learn more, ask questions, and sign up for the Money Stack for free at LauraDAdams.com. Or leave a voice message with your question or comment by calling 302-364-0308. I'd love to feature your question on Finance Friday, our weekly Q&A, bonus edition of the show!
What’s the history of the Affordable Care Act?
The ACA was enacted in 2010 as a major overhaul of the U.S. healthcare system. Its goal was to:
The most significant financial changes for individual consumers comes from the following ACA regulations:
More ACA benefits include:
Soon after the ACA took effect, the uninsured rate for the total U.S. population was nearly halved, falling from about 14.5% in 2013 to 8.6% in 2016. The biggest wins were for low-income adults who became eligible for Medicaid in 41 states that participated in an expansion. However, states that rejected ACA’s full expansion of Medicaid are:
Despite the high number of newly insured people, there are still over 25 million Americans who don’t have health insurance, who mainly live in the ten states that didn’t expand Medicaid.
How did the pandemic affect the ACA?
The premium tax credits that can be applied when you purchase a marketplace health plan can be complicated, but I’ll give you a summary. Due to the pandemic, the American Rescue Plan Act (ARPA) in 2021, set new, lower premium limits. Then, they were temporarily expanded by another law called the Inflation Reduction Act (IRA) through the end of 2025.
As of 2025, if you earn up to 150% of the FPL, you pay $0 for an ACA health plan. If you earn above 400% of the FPL, the required payment is capped at 8.5% of household income.
Before those laws, the percentage of income you had to pay for premiums was higher. In addition, those with incomes above 400% of the FPL were not eligible for any premium tax credits.
Therefore, if Congress does not act to extend the “enhanced” premium tax credits before the end of 2025, which is unlikely to happen, they will expire. That will put the original ACA caps into effect, significantly increasing the cost of health coverage for millions of Americans.
RELATED: 7 ways to cut healthcare costs
Shopping the ACA marketplace for 2026 health coverage
In most states, you have until December 15, 2025 to purchase a health plan that begins on January 1, 2026. The last day to enroll is January 15, 2026, for a plan that begins on February 1, 2026. After that date, you must have a qualifying event (such as getting married, starting a family, or relocating) to purchase or change ACA coverage.
For most people, the best deal is to shop on the official federal marketplace website at Healthcare.gov. It will direct you to a state marketplace if you live in a state that has its own exchange and website. If you have low income, it will direct you to enroll in Medicaid or the Childrens’ Health Insurance Program (CHIP).
The upside is potentially qualifying for ACA tax credits that cut your health premiums. In addition, you’ll know that you have an ACA-qualified plan that comes with essential benefits, a maximum out-of-pocket limit, and many other advantages.
The downside of purchasing an ACA health plan is that the open enrollment period is limited and ends on January 15, unless you live in a state that extends it. You also must estimate your current year’s income for purposes of calculating a subsidy benefit. If you guess too low, you may have to repay subsidies at tax time.
If you think you’re eligible for any financial assistance or are unsure, it’s best to start at Healthcare.gov.
LISTEN ALSO: HSA benefits–save on taxes, healthcare, and retirement
Shopping off the marketplace for 2026 health coverage
Another option is buying a health plan directly from an insurance carrier or private broker. They typically offer both ACA- and non-ACA-compliant health plans. Remember that to qualify for ACA tax credits, you must apply through the marketplace. So, be sure any representative or broker is connected to Healthcare.gov.
If you’re sure that you don’t qualify for any financial assistance, you might choose a non-ACA-compliant health plan. The upside is that you can enroll at any time of the year, may have more plan options, and may pay less.
The huge downside of a non-ACA health plan is that it typically gives you fewer protections. For example, it could deny claims for pre-existing health conditions, not cover maternity, or mental health claims. In addition, many have annual coverage maximums and no limits on your out of pocket costs, exposing you to potentially huge, devastating medical bills.
I recommend only using a non-ACA compliant health plan as a last resort or for a short period. That’s because they typically don’t reduce your financial risks for a worst case scenario. Your health is your greatest asset, so it’s not wise to skimp on protection.
Other options for 2026 health coverage
If you leave an employer’s group health insurance, you might opt for COBRA coverage. While it’s expensive, it allows you to keep your exact same medical and dental plans for up to 18 months after you leave a group policy.
There are also healthcare sharing plans, which may be affiliated with religious organizations. Be aware that they’re not actual insurance, but a membership where you agree to share medical costs.
Medical sharing plans are exempt from ACA rules and therefore may not cover necessary services or limit your out-of-pocket expenses. Be sure you fully understand how a sharing plan works before enrolling.
If you’re self-employed, you may have options to enroll in health coverage through an industry association or a collective. For instance, I’ve featured Solo Heath Collective before, which is available for solopreneurs with no employees. It offers ACA-compliant major medical coverage for businesses of one.
LISTEN ALSO: How to get benefits and a health plan as a solo business owner
What’s the future of the ACA?
The future of the ACA is subject to lots of political and legislative debate, but many Americans don’t want to see their health protections decline. Enrollment in marketplace health insurance has reached record highs, showing that the ACA is a crucial source of coverage.
For the 25 million people without health insurance, it means they’ll have poorer health outcomes. If you’re uninsured, you’re likely to delay or entirely skip necessary medical care, including checkups, cancer screenings, and care for conditions like diabetes or high blood pressure.
Unfortunately, the uninsured are often diagnosed with diseases at later, more advanced stages, leading to poorer treatment outcomes. They’re also more likely to suffer complications from manageable chronic conditions and die at a younger age than those with health insurance.
When the uninsured do seek medical treatment, it’s often in an emergency room for critical issues, and they face undiscounted, high medical bills. Not being able to pay medical debt is a leading factor in personal bankruptcies.
Hospitals must treat the uninsured for emergency conditions by law. So, when these costs go unpaid, providers recover their losses by charging higher rates to group and individual health insurers, causing higher premiums for everyone.
So, when 25 million Americans voluntarily or involuntarily go without health coverage, not only does it affect their finances, but it strains the entire healthcare system. So my hope is that we continue reforming healthcare until it’s more streamlined, accessible, and affordable for all Americans.
That's all for now. I'll talk to you soon. Until then, here's to living a richer life!
Money Girl is a Quick and Dirty Tips podcast, and I want to thank our fantastic team! Steve Riekeberg audio-engineers the show. Holly Hutchings is our director of podcasts, Morgan Christianson is our advertising operations specialist, Rebekah Sebastian is our marketing and publicity manager, and Nathaniel Hoopes is our marketing contractor.