John Galvin is delaying a necessary colonoscopy until December, when he becomes eligible for Medicare.
Rising Costs Force Difficult Choices
Galvin’s decision comes as his monthly health insurance premium through the Affordable Care Act (ACA) tripled this year to $2,460, representing roughly a third of his income. Coupled with a $2,700 deductible, the total cost of the colonoscopy could reach $3,000, a financial burden he is currently unable to meet.
Galvin is not alone. His wife, Nancy, is postponing a CT scan until she qualifies for Medicare coverage. This situation is unfolding for many nearing retirement age as enhanced federal subsidies expired at the end of December.
Those with incomes above 400% of the federal poverty level—$86,560 for a family of two—had previously received assistance with ACA premiums during the COVID-19 pandemic. Without this financial help, some are now considering delaying medical care until they reach age 65 and become eligible for Medicare.
Health policy consultant Jessica Schubel warned that delaying care could lead to “a lot of pent-up demand and unmet need,” potentially shifting costs to Medicare as conditions worsen.
ACA and the Road to Medicare
The ACA has played a significant role in expanding health coverage for those aged 50 to 64, reducing the uninsured rate for this age group by half, according to AARP. It has provided a safety net for small-business owners and those without employer-sponsored insurance.
The expiration of the subsidies has intensified financial pressures, with some individuals facing premium increases that amount to a quarter of their household income. Some are considering dropping their ACA plans altogether, according to health policy analyst Matt McGough.
The issue is likewise gaining political relevance, particularly as it impacts older Americans who consistently participate in midterm elections, according to Republican strategist Gregg Keller.
Financial Strain on Older Adults
Even before the subsidy expiration, rising costs of medical care, nursing homes and prescription drugs were major concerns for those over 50, a 2024 University of Michigan poll revealed.
ACA plans allow insurers to charge those in their 60s up to three times as much in premiums as those in their 20s. This, combined with the loss of subsidies, is creating a particularly challenging situation for older marketplace enrollees.
Marci Heinbaugh, a 63-year-old social services worker, saw her monthly premium payments more than double, rising from roughly $1,100 to $2,333, with a $10,150 out-of-pocket maximum. She is now considering going uninsured.
Experts suggest that those who drop coverage or delay care may save money in the short term, but could face higher costs—and taxpayers could bear a greater burden—if their health conditions worsen.
Frequently Asked Questions
What is causing the increase in ACA premiums?
The expiration of enhanced federal subsidies at the end of December is the primary driver of the increased premiums for those with incomes above 400% of the federal poverty level.
What age group is most affected by these premium increases?
Adults ages 50 through 64 made up around half of those ACA enrollees experiencing the largest price increases.
What is the income threshold for receiving ACA subsidies?
Those with incomes above 400% of the federal poverty level—$86,560 for a family of two—are no longer eligible for the enhanced subsidies.
As individuals like John and Nancy Galvin navigate these challenges, what role should government policy play in ensuring affordable healthcare access for those nearing retirement?
