As prices rise, women seek affordable insurance for their families : Shots

As the clock ticked toward 2025, B agonized over her family's insurance options. She was looking for another permanent job with benefits, but had not found one yet. The premium prices she saw under the 2026 Affordable Care Act plans were alarming.

She had almost decided that she and her husband would give up insurance and only insure their children. But that would be risky.

“My husband works with basic tools all day,” she said, “so it’s like rolling the dice.”

(B asked to be identified by her initial because she is concerned that her insurance needs may affect her future job search.)

The family lives in Providence, Rhode Island. Her husband is a self-employed carpenter and she worked full time as a manager for a non-profit organization.

B. lost her job last spring. She turned to the Affordable Care Act marketplace. The family's gold plan cost them nearly $2,000 a month in premiums.

It was a lot, and they dug into their retirement savings to pay for it while B continued to look for a new position.

But Congress then failed to extend increased subsidies for those plans, despite ongoing political battles over the issue and a lengthy government shutdown.

As the subsidies expire, Family Plan B will cost even more—nearly $3,000 a month in the new year.

“I don't have an extra $900 in my household budget to pay for this,” she said.

Millions middle class Americans with ACA health insurance plans will face sharp increases in premiums in 2026—and difficult coverage choices when the new rates take effect Jan. 1. And often women have to solve the mystery of family insurance.

Women usually use more healthcare than men, in part due to their need for reproductive services, according to Elizabeth Tobin-TylerProfessor at Brown University School of Public Health.

Women also tend to be medical decision makers for the family, she said, especially for the children.

“In families, women play a disproportionately large role in what we call the mental load,” Tobin-Tyler said, and that includes “making decisions about health insurance.”

Brooklyn performer Cynthia FreemanA 61-year-old woman is trying to figure out how to keep the ACA health insurance plan she and her husband depend on.

“If we didn’t have health problems, I would just go back to where I was in my 40s and not have health insurance,” she said, “but we’re not in that position now.”

Freeman and her husband Brad Lawrenceare freelancers who specialize in storytelling and podcasting.

Lawrence, 52, quickly fell ill in October.

“I knew I was in trouble,” he said. “I went to the emergency room… and said, 'Hey, I've gained 25 pounds in 5 days and I'm having trouble breathing and my chest hurts.' And they stopped blinking.”

Doctors diagnosed him with kidney disease and he was hospitalized for four days.

Lawrence now has to take medication with average cost $760 per month without insurance.

In January, the cost of their current “silver” plan will increase by almost 75%, to $801 per month.

The market price suggests the couple's combined income will be about $60,000 in 2026 – 40% less than they made last year, since Lawrence is currently out of work.

“We can't survive on [$60,000]” said Freeman, “but at least we can start the year with these words, so we [are] capable receive some form of subsidy.”

Lawrence does plan to return to work. But if their household income exceeds $100,000 in 2026, as it did in 2024, they will no longer be eligible for any insurance subsidies and their premiums will exceed $2,000 per month. That's almost what they pay in rent.

To earn extra money, Freeman took a part-time job as a bartender.

Before the holidays Congress thoughtful several forms of relief for premium increases, but nothing has happened and significant deadlines have already passed.

Freeman is now considering taking a full-time job as a bartender at a hotel chain, which will provide health benefits.

“It’s one thing to have it as a small part-time job,” she said, “but it’s another thing when I’m over 60 and my best bet is to take a corporate job as a hotel bartender.”

For Nicole Boenisch, the prospect of soaring insurance premiums put her plans to get married on pause.

Benish, 45, owns a holistic wellness business in Providence, Rhode Island. For coverage, she pays $108 a month for a zero-deductible “silver” plan on the Rhode Island exchange market.

But the monthly cost will more than double in 2026, to $220 per month.

She and her fiancé planned to get married on December 19, her late mother's birthday. “And then,” she said, “we realized how radically this would change the cost of my insurance premium.”

As a married couple, their combined income will exceed 400% federal poverty leveland make Benish ineligible for any financial assistance under the insurance. To keep her current plan, her monthly premiums would triple, costing her more than $700 a month.

Benish considered the less expensive “bronze” plan, but it doesn't cover the vocal therapy she needs to treat. muscle tension dysphoriaa condition in which her voice may strain or break.

If they get married, another option is to switch to her fiancé's Massachusetts health insurance plan. This would mean losing all of its Rhode Island doctors, who would be out of network.

“We have a number of difficult decisions to make,” she said, “and none of the options are right for us.”

For B., the approaching deadline prompted her to continue exploring her options and weighing the pros and cons.

As Christmas approached, she still had not found a new full-time job with benefits. She has already received $12,000 from pension funds to pay her 2025 bets.

Until B. finds a new job, the projected family income for 2026 will be less than 250% federal poverty level. This means that children are eligible for free Medicaid coverage.

She will buy a plan for herself and her husband through the ACA marketplace, paying premiums of $1,200 a month.

“The bottom line is that none of this is affordable,” she said, “so we will save to pay for it.”

This story comes from NPR's health reporting partnership with KFF health news.