Two-time cancer survivor Sherri Reeves knew she wouldn’t be able to keep her health insurance this year when her first bill arrived in the mail in January.
Reeves’ health insurance premium increased five-fold — jumping from about $100 to $500 a month — for 2026. The 62-year old retired teacher from Lexington made the difficult decision to drop her coverage.
“I couldn’t afford that and my living situation, and my day-to-day,” Reeves told Mississippi Today.
Reeves is one of thousands of Mississippians who chose not to stay enrolled in an Affordable Care Act health plan this year after enhanced federal tax credits, which made health insurance more affordable for 22 million Americans, expired in December. Active enrollment in the plans fell by about 70,000 people in Mississippi between February 2025 and February 2026, a nearly 25% drop, according to new federal data.
Health policy experts say the expiration of the enhanced subsidies has hit adults nearing retirement age especially hard. Because insurers can charge people in their 60s premiums three times higher than those in their 20s, many older adults saw some of the steepest price increases this year without the income-based subsidies. As a result, some older adults have dropped their coverage entirely, while others have chosen to delay care, opt for more restrictive coverage or tighten their budgets. They are more likely to have chronic health conditions that make going without insurance especially risky.
“Older adults are less buffered from those price increases,” said Lynne Cotter, a senior health policy research manager for the health policy research organization KFF’s ACA program. “And they’re going to feel them fully, which means that they might have to make other hard choices about how they spend their money.”
Congress first authorized the expanded subsidies in 2021 during the COVID-19 pandemic. Mississippi was one of the states that benefitted the most from the increased federal support. Between 2020 and 2025, the number of people enrolled in ACA marketplace plans increased by about 240,000. During the same period, the rate of people without insurance — one of the highest in the country — dropped by over 65,000.
Mississippi saw one of the largest increases in marketplace coverage in part because state lawmakers, for over a decade, have chosen not to expand Medicaid. Roughly two-thirds of the people who initially enrolled in marketplace coverage this year would meet the annual income eligibility requirement for Medicaid — between about $16,000 and $22,000 for a single person — had the state opted to expand coverage.
With the enhanced subsidies now gone, marketplace premiums for people renewing their coverage more than doubled on average, according to KFF. About 2.6 million fewer Americans were actively enrolled in plans in February compared to the same time the previous year. The Trump administration has attributed much of the decline to its crackdown on fraudulent enrollments.
Adults aged 50 to 64 made up about one-fifth of the Mississippians who chose a marketplace plan during open enrollment in 2026, according to Centers for Medicare and Medicaid Services data.
After dropping her coverage in January, Reeves went without health insurance for five months before she discovered she could gain coverage through the U.S. Department of Veterans Affairs because she serves as a caregiver for a veteran family member. While the plan does not have a monthly premium, it also does not cover appointments with all of her existing doctors and has higher copays for care.
Sherri Reeves reviews a medical bill at her home in Lexington on Friday, July 17, 2026. Reeves dropped her health insurance coverage after Congress declined to renew the enhanced premium tax credits, resulting in a dramatic increase in her premiums. Credit: Eric Shelton/Mississippi TodayTo afford her care, she has delayed doctor’s appointments to spread out costs and enrolled in payment plans. Before this year, she said, she was not used to owing doctors money.
“It’s been going through my brain about going back to work part time,” said Reeves, who retired in 2016 after she received her second breast cancer diagnosis because it was difficult to undergo treatment while working full time as a teacher. “I’m really thinking about it seriously.”
She is one of thousands of Americans with serious health concerns who faced difficult choices due to rising insurance costs. Last year, the American Cancer Society Cancer Action Network found in a survey of cancer patients and survivors that three out of four would not be able to afford a comprehensive health plan without the extension of the enhanced premium tax credits. A quarter said they were likely to become uninsured, and a third said they would switch to a plan with a lower monthly premium but higher out-of-pocket costs.
“The motivation to stay enrolled is very high when you’re experiencing a life-altering diagnosis such as cancer,” said Lucy Dagneau, senior director of state and local campaigns for the American Cancer Society Cancer Action Network.
Michael Minor is the executive director of Hernando-based Oak Hill Regional Community Development Corp., which runs Get Covered Mississippi, a statewide, faith-based coalition that has worked for over a decade to help connect Mississippians to coverage options through the marketplace, Medicaid and Children’s Health Insurance Program. Older adults make up a significant portion of the people the organization assists, Minor said.
He said this year, he’s received more calls than in years past from people who enrolled in what he calls “skimpy plans,” or those with lower premiums that may not cover people with preexisting conditions or ACA required services, such as maternity, prescription or mental health services. He said staff have also heard from older adults who had to go back to work or opt for more restrictive coverage.
While many marketplace enrollees still qualify for smaller federal tax credits, others with incomes at or above 400% of the federal poverty level lost eligibility entirely. These people must now pay the full cost of their health insurance premiums without federal support.
Nationwide, adults ages 50 to 64 make up about half of the enrollees affected by this change. This is because many older adults are at their peak income, Cotter said. Combined with higher insurance costs due to age, this creates what Cotter described as a “double whammy” of sharply increasing healthcare costs for some older adults.
Laura Tedder, a 63-year-old living in Raymond, worked as an attorney before she chose to retire early after her husband died. She purchased a health insurance plan through the marketplace. In 2025, it cost about $550 a month.
Her plan now costs about $1,500 a month because her income is just above the threshold for federal assistance. She said she spends roughly a third or a fourth of her fixed income on healthcare costs and is counting down the months until she turns 65 and becomes eligible for Medicare. She has 16 left to go.
To make ends meet, Tedder has sold personal items, stopped eating out, avoided buying brand names at the grocery store and limited outings to avoid paying for gas. She has delayed doctor’s appointments and has been putting off taking her dog to the vet for three months.
“I’ve cut everything as much as I possibly can,” she said. “I’m hanging on by my toenails.”
The loss of enhanced premium tax credits is expected to continue to drive up costs not only for older adults but also for younger people, as healthier enrollees leave the marketplace and leave behind a smaller, sicker pool of participants who are more costly to insure.
This effect is already evident in preliminary rate filings for 2027, Cotter said. ACA marketplace insurers have proposed a median premium increase of 14%, according to a KFF analysis of filings from 16 states and Washington, D.C.
Higher premiums will have ripple effects across the healthcare system, increasing costs for patients, insurers and hospitals, which are required under federal law to provide emergency care regardless of a patient’s insurance status, said Khaylah Scott, program manager for the Mississippi Health Advocacy Program.
“Everyone has a higher price to pay,” she said.
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