Your 2026 Healthcare Decisions: What’s Changing and How to Save

At the time of writing, the government shutdown continues, with no end in sight. One of the biggest sticking points in Washington is the Affordable Care Act (ACA) and its premium subsidies. Lawmakers remain divided over whether to renew the enhanced premium tax credits, which have helped millions afford health insurance in recent years.

With ACA subsidies on the line, rising healthcare expenses and looming Medicare premium hikes, Americans are facing a perfect storm when it comes to the cost of care. To help unpack what it all means for your health coverage – and your wallet – we turned to Jae Oh, Alliance for Lifetime Income Education Fellow, Certified Financial Planner and author, as well as Marcia Mantell, a Retirement Management Advisor and founder of Mantell Retirement Consulting, Inc.

WHAT’S AT STAKE AS THE SHUTDOWN DRAGS ON

More than 20 million Americans currently get insurance through the ACA, and about half rely on premium tax credits to make their coverage affordable. “We have a sticker price for the retail price of health insurance, and then you’ve got a credit, which is a tax credit,” explains Oh. “That tax credit is received monthly in advance, not when you file for your taxes.”

If lawmakers fail to renew the enhanced credits – set to expire December 31, 2025 –  consumers could see premiums double as early as January. The hardest hit? Low to middle-income consumers and early retirees who aren’t yet eligible for Medicare. “It’s going to depend on where you live and your income relative to that federal poverty level…be prepared for sticker shock,” says Mantell.

NAVIGATING OPEN ENROLLMENT IN UNCERTAIN TIMES

With so much in flux – and open enrollment already underway for many – reviewing your options this fall is critical.

For ACA shoppers, careful comparison is key. Your best first step is to use your state’s marketplace site (search for your state at healthcare.gov) to review updated plans and confirm your doctors are still in-network. “The most complicated portion for [everyone to understand is that] the insurance that they have or that they want [is accepted by] your doctors and hospitals,” advises Oh.

If you want to use a health insurance “Navigator,” a federally-funded helper who can guide you through options, be prepared for longer wait times for assistance. The Navigator program has seen its funding cut by 90%. To search for one in our area, start here.

For those with employer coverage, expect rising costs and limited choices. New data shows that the average premium per person totaled $9,300 in 2025 and is expected to go up about 6% in 2026. Much of that was borne by the employer, but the increase will still be felt. Oh says that makes it particularly important to shop carefully. There’s a temptation to buy — or try to buy — the best coverage you’re offered. But many healthy consumers might not need that. Try instead to match your plan’s value to their actual risk. You may think a high-deductible health plan paired with a Health Savings Account (HSA) is just a smart pick for young, healthy consumers. But Mantell says it can also be a good solution for workers in their 50s and early 60s. “It lowers your income tax obligation, you save tax-free, and you can take the money out if you need it for some health insurance or some health coverage, and it comes out tax-free as well,” she explains. “It’s a very powerful account.”

If as you evaluate your employer-offered solutions, the share you’re required to pay as is too high, you may still be eligible for a subsidized plan via the Affordable Care Act. To do so, you’d need to apply for a hardship exemption.

MEDICARE 2026: PREPARE FOR RISING PRICES

The same pressures fueling employer premium increases – fewer insurers, expensive new drugs and general inflation – are pushing Medicare costs upward as well.

Here’s what beneficiaries can expect.

• Part A (hospital coverage): Costs are climbing due to hospital inflation, technology and staffing shortages. “It’s more expensive to be in the hospital,” Mantell shares. “Everything is up. It’s all the components that put hospitalization and skilled nursing under cost pressure.”
• Part B (doctor and outpatient services): Outpatient costs are projected to rise around 11% year over year, fueled by more costly treatments, Mantell blames the modern miracle of medicine. “It’s amazing that we have all these medicines that keep us living longer, but they come with a price tag.”
• Part C (Medicare Advantage): With these pre-packaged plans, many PPOs, or Preferred Provider Organizations, are being eliminated or reducing network coverage, narrowing options for beneficiaries.
• Part D (prescription drugs): The new $2,100 out-of-pocket cap is good news for those with expensive medications; however, insurers are raising premiums to recoup losses.
• Medigap coverage: As Part A and Part B costs rise, Medigap premiums will follow suit.

“What real people are going to see is, overall, this massive increase in their outlay of cash, whether they’re sick for a day, or not at all,” says Mantell. “That’s what’s hitting people, on top of the confusion about the budget bill.”

THE MEDICARE SAVINGS PLAYBOOK

While rising prices are unavoidable, there are steps you can take to minimize the impact, starting with reshopping your plan. “You’ll want to check every detail every year,” says Oh. “That is the way our world works. I don’t think we’re going back to a situation where you can set it and forget it.” For help comparing your current coverage with other options, one helpful resource is the Plan Finder tool on Medicare.gov.

In addition, budgeting to use protected income can be a great way to cover essential healthcare costs. “Whether it’s Social Security, an annuity, or a pension, this is your guaranteed stream of income,” says Mantell. “You know you need to pay for food, housing and healthcare. Those three buckets really should line up with your guaranteed sources of income.”

THE BOTTOM LINE

Whether you’re a retiree on Medicare or a family buying coverage on the exchange, re-evaluating your plan this fall is essential – especially for older Americans. As Mantell puts it, “You can’t not have health insurance when you’re older. But you can make smarter choices — if you take the time to look.”

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