If you’ve experienced ACA sticker shock when shopping for health insurance, you’re not alone. Millions of Americans — especially those who earn just above the subsidy threshold — face premium prices that seem impossible to afford. Here’s why ACA premiums are so high, what the subsidy cliff means for Arizona residents, and what your alternatives are.
ACA Sticker Shock: Why Premiums Are So High
The annual Open Enrollment period for the Affordable Care Act (ACA) Marketplace is here, and for many Americans, this year is bringing an unpleasant surprise: sticker shock. While the ACA remains a vital source of coverage for millions, the underlying cost of health insurance is rising, and a major federal policy decision is poised to make things even more difficult for consumers in the near future.
The conversation this year revolves around two critical factors: rising premiums and the looming expiration of the enhanced federal subsidies.
The Current High Cost of Coverage
Health insurance premiums across the board are on the rise. Several factors contribute to this:
General Inflation and Healthcare Costs: The cost of medical services, drugs, and hospital care continues to climb, naturally pushing up the price of the insurance designed to cover them.
Insurer Rate Hikes: Insurers are proposing and receiving approval for some of the largest rate increases seen since the ACA’s early days.
Even with these increases, the true bombshell for many enrollees isn’t just the price of the plan itself—it’s what happens when you remove the financial cushion of the expanded tax credits.
The Critical Role of Enhanced Subsidies (and the Looming Cliff)
The federal government provides Premium Tax Credits (PTCs) to make Marketplace coverage affordable. This assistance is critical for the vast majority of ACA enrollees.
In 2021, Congress temporarily passed enhanced premium tax credits as part of the American Rescue Plan Act, which were later extended through the end of 2025 by the Inflation Reduction Act. These enhancements achieved two major things:
They eliminated the “Subsidy Cliff”: They removed the previous income cap (400% of the federal poverty level, or FPL) for subsidy eligibility. This meant that middle- and higher-income families who faced very high-cost premiums could still receive help, ensuring no one paid more than 8.5% of their household income for a benchmark Silver plan.
They made subsidies more generous: They lowered the percentage of income that all eligible households had to pay toward their premiums.
What Happens Next? The 2026 Subsidy Cliff
Unless Congress acts soon, the enhanced subsidies are scheduled to expire on December 31, 2025. This expiration will have dramatic consequences, reverting the system back to the original, less generous ACA subsidy structure for 2026.
According to health policy analysts, the changes will hit millions of Americans hard:
Household Income Category
Pre-Expiration Reality (Through 2025)
Post-Expiration Reality (Scheduled for 2026)
Above 400% FPL
Subsidies available if the benchmark plan costs more than 8.5% of income.
Lose ALL subsidies (The “Subsidy Cliff” returns).
Below 400% FPL
Pay a smaller percentage of income toward the premium.
Subsidy amounts will shrink; consumers will pay a higher percentage of their income toward the premium.
The average subsidized enrollee is projected to see their net annual premium payments more than double if the enhanced tax credits are allowed to expire. For a middle-aged couple earning just over the 400% FPL threshold, the annual premium shock could be in the tens of thousands of dollars.
Navigating Your Options in a High-Cost Environment
If you’re shopping on the Marketplace now, here is what you need to know:
The Enhanced Subsidies are Still in Effect for Your 2025 Plan: You can still benefit from the lower caps and expanded eligibility for this year’s coverage.
Shop Around, Every Year: Don’t auto-renew! Plans and prices change significantly year to year. You may find that a different plan—even from a different metal level (Bronze, Silver, Gold)—offers a lower net premium thanks to how the subsidy calculation works.
Know Your Income Estimate: Your subsidy is based on your expected household income for the year you are seeking coverage. A slight overestimate or underestimate can greatly affect your eligibility and monthly premium amount.
The clock is ticking on the enhanced subsidies. For the millions who rely on the Marketplace, the affordability of health insurance in the coming years rests on a looming legislative decision.
If you’ve experienced ACA sticker shock and been priced out of the marketplace, we can help find alternatives.
How to Avoid ACA Sticker Shock in Arizona
Struggling with ACA sticker shock? I compare ACA marketplace plans, off-exchange PPOs, and short-term options for Arizona residents — at no cost to you. Call Andy Orlikoff at (623) 742-3878 or fill out the contact form.
Every fall, millions of seniors face the same decision: Medigap vs Medicare Advantage — which is right for me? Despite Medicare Advantage’s heavy marketing, a significant number of seniors deliberately choose Medigap over Medicare Advantage. Here’s why.
The Core Reason Seniors Choose Medigap Over Medicare Advantage
The fundamental difference: Medicare Advantage is cheaper at enrollment but can cost far more when you’re sick. Medigap vs Medicare Advantage comes down to predictability. With Medigap Plan G, after the Part B deductible ($257 in 2026), you pay nothing for covered services all year. With Medicare Advantage, copays, coinsurance, and prior authorizations can add up to thousands.
Nurses, doctors, and hospital administrators — people who see how insurance affects patients — consistently prefer Medigap for themselves and their families. The reason: when a serious illness hits, Medicare Advantage plans frequently require prior authorization, restrict networks, and deny claims that Original Medicare would cover.
According to Medicare.gov, Medigap plans work alongside Original Medicare and cover most of the gaps Original Medicare leaves — without network restrictions or prior authorization requirements.
Five Reasons Seniors Choose Medigap Over Medicare Advantage
Any doctor, anywhere: Medigap works with any provider who accepts Medicare — no networks, no referrals
No prior authorization: Your doctor decides your care — not an insurance company algorithm
Mayo Clinic access: Mayo Clinic Arizona accepts Original Medicare and Medigap — not most Advantage plans
Predictable costs: One deductible per year, then nothing for covered services
Stable benefits: Medigap benefits don’t change annually — no ANOC to review every September
When Medicare Advantage Might Still Make Sense
If you can’t afford Medigap premiums or qualify for low-income assistance programs, Medicare Advantage may be your best available option. However, the one-way door risk remains: if you later want to choose Medigap over Medicare Advantage, you may need to pass medical underwriting.
Get a Free Comparison in Arizona
I’m Andy Orlikoff, an independent Medicare broker in Surprise, AZ. I help Arizona seniors understand the real Medigap vs Medicare Advantage tradeoffs — and I don’t sell Advantage plans.
As 2026 open enrollment approaches, millions of Americans are bracing for significant health insurance cost increases. Enhanced ACA subsidies that dramatically reduced premiums may expire, and the political debate over their renewal has left many consumers uncertain about what to expect. Here’s what Arizona residents need to know heading into 2026 open enrollment.
Why 2026 Open Enrollment Costs Are Rising
The enhanced premium tax credits introduced by the American Rescue Plan made marketplace coverage affordable for millions who previously couldn’t qualify. If those subsidies expire, premiums could spike dramatically for people who earn between 100% and 400% of the federal poverty level — the group that benefits most from ACA subsidies.
According to healthcare.gov, 2026 open enrollment runs November 1 through January 15. Changes made during this window take effect January 1, 2027.
What Arizona Residents Should Do Before 2026 Open Enrollment
Don’t assume your current plan is still the best option — carriers adjust premiums, networks, and benefits every year
Check your subsidy eligibility — income changes could mean larger or smaller subsidies than last year
Compare all plan types — ACA marketplace plans, off-exchange PPOs, and short-term options all have different price points
Use an independent broker — a broker compares all options at no extra cost to you
Off-Exchange Options Worth Considering
If you earn too much for meaningful ACA subsidies, 2026 open enrollment is a good time to compare off-exchange PPO plans. Some carriers offer private PPO plans with broader networks — including Mayo Clinic Arizona — at competitive prices for healthy individuals.
Free Help With 2026 Open Enrollment in Arizona
I’m Andy Orlikoff, an independent health insurance broker in Surprise, AZ. I help Arizona residents compare all their options during 2026 open enrollment — marketplace plans, off-exchange PPOs, and more. My help is always free.
A growing trend is changing how many Americans get health insurance: more employers are offering employer health insurance stipends instead of traditional group coverage. Rather than managing a group plan, employers give workers a monthly stipend to purchase their own individual coverage. Here’s how it works and what it means for Arizona workers and small business owners.
What Is an Employer Health Insurance Stipend?
An employer health insurance stipend — sometimes called a Health Reimbursement Arrangement (HRA) or Individual Coverage HRA (ICHRA) — lets employers give workers a set monthly amount to buy their own health insurance on the individual market. Workers choose their own plan, and the employer reimburses them up to the stipend amount.
According to the Department of Labor, Individual Coverage HRAs have made it easier for employers of all sizes to offer health benefits without managing a group plan.
Why More Employers Are Switching to Health Insurance Stipends
Cost control: Employers set a fixed budget — no surprise premium spikes
Administrative simplicity: No group plan to manage or renew annually
Worker flexibility: Employees choose coverage that fits their doctors and needs
Small business access: Even very small employers can offer meaningful health benefits
What Workers Should Know About Employer Health Insurance Stipends
If your employer offers an employer health insurance stipend, you’ll need to shop for individual coverage on your own. Key things to consider:
You can use the stipend toward ACA marketplace plans or off-exchange PPO plans
Your income may qualify you for additional ACA subsidies on top of the stipend
Choosing the right plan matters — network access, deductibles, and prescription coverage vary significantly
An independent broker can help you compare plans at no extra cost
Help Choosing Individual Coverage in Arizona
I’m Andy Orlikoff, an independent health insurance broker in Surprise, AZ. If your employer offers an employer health insurance stipend, I can help you find the right individual plan — ACA marketplace, off-exchange PPO, or short-term coverage — that maximizes your benefit.
Health insurance cost increases are hitting Arizona residents harder than at any point in the last 15 years. Rising healthcare utilization, expiring subsidies, and carrier withdrawals from the marketplace are all converging to drive premiums significantly higher. Here’s what’s driving the increases and what you can do about it.
According to healthcare.gov, your health insurance is about to get More Expensive—Here’s Why
If it feels like your health insurance costs are always going up, you’re not imagining it. According to a recent survey from Mercer, a consulting firm, health benefit costs are projected to increase by 6.5% in 2026—the highest jump in 15 years. This trend is a wake-up call for both employers and employees, as everyone’s wallets are about to feel the pinch.
What’s Driving the Price Hikes?
The rise in costs isn’t just due to one single factor; it’s a perfect storm of several powerful trends:
Advances in medical science: New, cutting-edge treatments for things like cancer and chronic conditions are often incredibly expensive. While these therapies offer hope and better health outcomes, their high cost contributes significantly to rising insurance premiums.
More people using more services: A recent increase in healthcare utilization is also a key factor. This includes people catching up on care they put off during the pandemic and the growing acceptance and use of virtual healthcare, which makes it easier than ever to access a doctor.
Inflation: The broader economic trend of inflation is hitting the healthcare industry hard. Rising wages for healthcare workers and the increased cost of medical supplies are all passed down to consumers and employers.
How Employers Are Responding
Facing these mounting costs, employers are looking for ways to manage their budgets. The survey found that a growing number of companies plan to make changes to their health plans in 2026. This often means raising deductibles and co-pays, which shifts more of the financial burden directly onto employees.
However, some employers are also exploring new strategies to curb costs without simply making their employees pay more. They are focusing on managing high-cost claims and using high-performance network plans, which guide employees toward a curated list of providers known for quality care and lower costs. At the same time, many companies are still prioritizing employee well-being by expanding access to mental health services.
What This Means for You
For most employees, these changes will mean a higher paycheck deduction for health coverage. On average, employees can expect to see their premium share rise by 6% to 7% in 2026.
This is why your next open enrollment period is more important than ever. It’s crucial to take a close look at all your options. You’ll need to balance the monthly premium with potential out-of-pocket costs like deductibles and co-pays. Choosing a high-performance network plan might seem restrictive, but it could save you a significant amount of money in the long run.
Don’t wait until the last minute. By understanding these upcoming changes, you can make an informed decision that protects both your health and your wallet.
I can help you with options.
Andy Orlikoff 623-742-3878
www.AZhealth.us
Facing significant health insurance cost increases? I compare all your options — ACA marketplace, off-exchange PPOs, short-term plans — at no cost. Call Andy Orlikoff at (623) 742-3878 or fill out the contact form.
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