You might not realize how fast your health insurance costs climbed until your grocery cart starts looking thinner every single week. Millions of Americans who buy coverage through the Affordable Care Act marketplace are now facing that reality in real time. 

A major new survey from KFF, the nonpartisan health policy research organization, reveals that most returning ACA enrollees are making painful sacrifices to stay insured. The findings land at a moment when household budgets are already stretched thin by inflation, rising housing costs, and slow wage growth. 

For the roughly 22 million people who relied on enhanced premium tax credits, the numbers paint a deeply uncomfortable financial picture. Here is exactly what the KFF data show, what it means for your household, and what practical steps you can still take today.

Half of returning ACA enrollees say costs are now dramatically higher

The KFF follow-up survey, published March 19, 2026, re-interviewed 1,117 adults who had ACA marketplace coverage in 2025. The results confirm what health policy experts feared when the enhanced premium tax credits expired on Dec. 31 without renewal.

A full 80% of returning marketplace enrollees report that their premiums, deductibles, or cost-sharing amounts are higher than last year. Half of those returning enrollees, specifically 51%, say their overall health care costs are now significantly elevated compared to 2025.

Four in 10 returning enrollees told KFF that their monthly premiums specifically jumped sharply relative to their prior year’s coverage plan. That tracks with KFF’s earlier projection that average annual premium payments would rise 114%, from $888 in 2025 to roughly $1,904.

Enhanced premium tax credits expired after a bitter congressional standoff

The enhanced premium tax credits were first introduced under the American Rescue Plan Act of 2021 during the pandemic recovery period. Congress extended them through the Inflation Reduction Act of 2022, keeping the credits in place through the end of December 2025.

Those credits helped approximately 22 million ACA marketplace enrollees, more than 90% of all enrollees, afford coverage. A government shutdown at the end of 2025 stalled legislative efforts, and Congress ultimately failed to extend the enhanced subsidies.

The Congressional Budget Office projected that a permanent extension would keep 3.8 million more Americans insured over the coming decade. Without the credits, KFF estimated benchmark silver plan premiums rose by an average of 21.7% in the 2026 plan year alone.

The subsidy loss hit two groups especially hard

Low-income enrollees who previously paid zero dollars in monthly premiums now face real out-of-pocket costs for the first time since 2021.

Middle-income earners above 400% of the federal poverty level, roughly $63,000 for an individual, lost all subsidy eligibility entirely.

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A 34-year-old man in Texas described his situation to KFF, noting the cheapest two-person plan cost $800 per month for his household.

His $120,000 household income disqualified him from subsidies, making his mortgage nearly impossible to sustain alongside premium payments.

Most enrollees are cutting food and household spending to stay covered

The most striking finding in the KFF survey is how many enrollees are now sacrificing basic necessities to maintain health insurance coverage. A full 55% of returning marketplace enrollees say they have cut or plan to cut spending on food and basic household items.

Enrollees with chronic conditions face even steeper tradeoffs

Among returning enrollees with chronic health conditions, that number climbs to 62%, according to KFF’s detailed survey breakdowns for 2026. These are people who depend on consistent medical care and prescription access, making the coverage-versus-food choice deeply consequential.

Other financial sacrifices are piling up across households

• About 43% of returning enrollees say they are seeking additional work hours or a second job to cover their rising health insurance costs.
• Nearly 23% report skipping or delaying bill payments to free up cash for premiums and out-of-pocket medical expenses right now.
• Another 21% say they are taking on new debt through credit card balances or personal loans specifically to pay for their care.

These numbers reveal cascading financial pressure that extends far beyond the insurance premium itself into daily household survival mode. If you are juggling similar tradeoffs right now, understanding every available option is the most critical first step you can take.

Many households are sacrificing groceries and household essentials just to keep their health insurance active each month.

Cast Of Thousands/Shutterstock

One in 10 enrollees dropped coverage entirely, and more losses may follow

The KFF survey found that 9% of 2025 marketplace enrollees are now completely uninsured after choosing to drop their ACA coverage entirely. Another 28% switched to a different marketplace plan, with seven in 10 switchers citing cost as the primary reason for changing.

Downgrading to bronze plans creates a new kind of financial risk for you

A quarter of enrollees who switched plans downgraded their metal tier, moving from silver to bronze or from gold to silver plans. Bronze plans carry significantly higher deductibles, averaging $7,186 nationally in 2026, per the Peterson-KFF Health System Tracker.

If you downgraded to a bronze plan, you are essentially betting that you will not need significant medical care during this year. A single emergency room visit or unexpected surgery could leave you responsible for thousands of dollars in out-of-pocket costs.

More coverage losses could arrive by the end of March or shortly after

KFF conducted this survey between February 12 and March 2, 2026, about one month after open enrollment closed in most states nationwide. The grace period for making initial premium payments had not yet expired for many enrollees when they completed the survey questions.

KFF President and CEO Drew Altman warned publicly that the survey’s fallout will likely worsen as grace periods end in late March. About 17% of current enrollees told KFF they are not confident they can afford their monthly premiums for the entirety of 2026.

Three in four enrollees now worry about affording an emergency medical expense

Beyond premiums, the anxiety around out-of-pocket medical costs is running extremely high among the ACA marketplace population right now. Roughly 73% of returning enrollees told KFF they worry about affording emergency care or hospitalization costs during the 2026 plan year.

The scope of affordability concerns stretches across every type of care

• About 49% of returning enrollees say they are worried about affording routine medical visits, including checkups and specialist appointments.
• Approximately 45% expressed concern about affording prescription drug costs, which often rise alongside deductible increases each plan year.
• Worries are significantly worse among enrollees with lower incomes and those managing ongoing chronic health conditions on a daily basis.

If you carry a bronze plan with a deductible above $5,000, a single hospitalization could wipe out several months of household savings. Consider whether a health savings account, if your plan qualifies, could help you set aside pre-tax dollars for unexpected medical costs.

Practical steps you can take right now to protect your household finances

Open enrollment is closed in most states, but you still have options for managing rising health costs and protecting your family financially. Here are concrete steps to consider if you are an ACA enrollee facing premium shock or coverage uncertainty heading into spring 2026.

Check whether you qualify for a special enrollment period

Certain life events, including job loss, marriage, birth of a child, or a household move, can trigger a special enrollment period. If any of those apply, you may be able to switch to a plan with better cost-sharing or a lower premium outside of open enrollment.

Review whether your income qualifies you for Medicaid coverage now

If your income has dropped since you enrolled, you might now qualify for Medicaid, which provides coverage with minimal out-of-pocket costs. You can check your eligibility anytime through HealthCare.gov or your state marketplace website without waiting for the next enrollment period.

Explore cost-sharing reduction silver plans near the income threshold

Enrollees with household incomes below 250% of the federal poverty level can still access cost-sharing reductions on silver-tier ACA plans. These reductions lower your deductible and co-pays meaningfully, which can cut your total annual health spending by thousands of dollars.

Use the preventive care benefits your plan already covers at no cost

All ACA plans must cover a defined list of preventive services, including annual checkups, screenings, and vaccinations, at zero cost-sharing. Using these benefits helps you catch potential health issues early and reduces the chance of an expensive emergency visit down the road.

Health care costs may reshape the 2026 midterm election landscape entirely

The KFF survey also found that rising health insurance costs are becoming a powerful political motivator for marketplace enrollees across party lines. Among returning enrollees who experienced higher costs, 70% blame health insurance companies for the premium increases they are now facing.

About 54% placed blame on congressional Republicans, while 53% pointed to President Donald Trump and 52% cited pharmaceutical companies specifically. Nearly half of returning enrollees, 48%, say the cost of health care will have a major impact on their midterm voting decisions this year.

For you, this means health care costs are not just a personal finance issue right now but also a political one worth tracking closely. Congressional action on ACA subsidies remains possible, and your representatives’ positions on this issue could directly affect your premiums.

Related: Millions of Americans are skipping meals to pay for health care