A host of Cleveland-area residents are battening down the hatches for higher health care costs next year.
There are artists, mental health providers and stay-at-home moms. There are those who no longer work in order to care for aging parents. There are small business employees suddenly responsible for their own health insurance.
All buy their health insurance on the Affordable Care Act marketplace, a federal exchange created in 2010 where companies can sell insurance plans directly to customers. It’s a tool for residents who don’t get health insurance from employers, whose income isn’t low enough to qualify for Medicaid or who aren’t old enough to get Medicare.
About 583,000 people in Ohio are enrolled in the marketplace. Many of them are expecting to pay more out of their own pocket for health care next year. Premiums for marketplace plans sold in the state are set to increase between 13% and 17% in 2026, according to data from KFF.
Costs are spiking for a few reasons: tariffs, inflation, more usage of expensive weight-loss drugs. But a major driver is that tax credits that help residents pay for marketplace insurance are set to expire at the end of the year, if Republicans and Democrats don’t extend them. (U.S. Senate Republicans voted to block an effort to extend them on Dec. 11.) Those tax credits set caps on how much an individual has to pay toward their monthly premium. And they’re available to all residents above the poverty line.
If they expire, a separate, less-generous set of tax credits will remain to help pay for monthly premiums. Residents with low enough incomes would no longer qualify for completely free plans. And those who make more than four times the poverty line (about $84,600 for a family of two) would not qualify for any tax credit at all.
Signal Cleveland spoke with four Cleveland-area residents to get a sense of what sort of cost increases they’re preparing for and how they will deal with it. Several are prepared to go without health insurance next year. That’s a reality that the state as a whole will have to deal with: if the tax credits expire, about 106,000 more residents will go uninsured, one estimate found.
The early retiree anxiously waiting to qualify for Medicare
Anne Griffith is anxiously awaiting her 65th birthday next summer.
It will qualify her for Medicare and put an end to the health care hellscape she’s found herself in since retiring early this year to take care of an aging parent. The decision to depart from her job as an executive assistant at the City of Cleveland Heights left her needing health insurance.
She tried COBRA (“outrageously expensive,” she said) before settling on a reasonably priced plan on the Affordable Care Act marketplace. It cost about $240 a month. It wasn’t a “Cadillac” plan, she said, but it was decent.
Griffith hoped to renew it for 2026. One challenge: The company she bought insurance from will no longer cover care at the Cleveland Clinic, where many of her longtime doctors are.
“If I was younger, I might consider just switching over,” Griffith said. “But I’ve been with some of my doctors for 30 or more years at this point.”
She ended up not finding a single plan that her primary care physician accepted. But she did find one that would include her other doctors at the Cleveland Clinic.
The challenge? That plan would cost around $1,700 out of pocket per month, if Congress doesn’t renew the tax credits, Griffith said. Even if the tax credits are renewed, the plan would still cost her about $640 a month.
She thinks she and her husband, who is already on Medicare, can swing either option for the several months before she turns 65. But they’ll almost certainly have to dip into their savings to do so.
It’s what they’ll have to do, Griffith said, because going without insurance is not an option for her. She’s had breast cancer, and she has medications she needs covered. Still, $1,700 a month may not even be enough to meet all her health care needs. Since the plan doesn’t cover her primary care doctor, she would have to pay out of pocket to see her.
“It gave me a headache and many swear words,” Griffith said of the experience buying health insurance this year. “Many, many swear words.”
A couple who plans to go uninsured
After nearly 20 years working in community mental health services, the Affordable Care Act marketplace allowed Mondie Gonzalez Reed to open her own private counseling service in Strongsville after the COVID pandemic.
Instead of relying on her employer for health insurance, she could get it on the marketplace – and it wasn’t much more expensive. Starting around 2021, Reed chose a plan for herself and her semi-retired husband.
In the last several years, her premium got higher and the insurance got “slightly crappier,” she said. For 2025, Gonzalez Reed chose one of the least expensive plans for her and her husband. It came with a $15,000 deductible – the amount that has to be paid before insurance kicks in – which she knew they were unlikely to meet.
That plan worked OK, she said, because she and her husband aren’t facing any ongoing medical issues. It gave her some peace of mind “if anything catastrophic would happen,” she said.
This fall, she went to check the options for 2026. In order to keep the same plan, their monthly premium would triple: from around $480 a month to around $1,560 a month. Lower-deductible plans would cost even more.
“It’s just not worth it,” she thought to herself.
She canceled their catastrophic plan. Next year, she and her husband will be uninsured.
They hope to set aside the $500 a month they’d formerly been spending on health insurance for any health needs that may arise. Because Gonzalez Reed owns a small business – her counseling practice – she might also look into opening a health savings account or flexible spending account.
She’s trying to fit in a bunch of doctors’ appointments before the year ends, but Reed doesn’t foresee having to rely on the emergency room or urgent care for all health care going forward.
Her primary care physician is at MetroHealth, which offers discounted care for residents who have to pay out of pocket. She plans to reach out to their financial assistance office to see what discount they’ll qualify for.
Still, without insurance, the couple will need to be more deliberate in deciding what health care they should get and invest in.
“We will have to make decisions about, you know – is it worth whatever care we need?” Gonzalez Reed said.
An artist sees higher, but manageable, insurance costs
When Aimee Lee first moved to Cleveland about 10 years ago, she didn’t buy health insurance. She was a young artist – her craft focuses on Korean papermaking – without many health issues.
That changed after she was diagnosed with an autoimmune disorder while traveling in Korea. When she came back to the States, she found a specialist at the Cleveland Clinic who could help her handle the condition. But when she called to ask about an appointment, she was told she would need to pay $800 up front since she didn’t have insurance.
That’s when Lee decided she should buy health insurance on the then-new federal Affordable Care Act marketplace. She found a great plan, she said, that was also affordable: her annual deductible was $100.
“I was like, ‘Are you kidding me? We’re in America?’” Lee said. “I didn’t even know this was possible.”
She found her health insurance indispensable. Soon after buying it, she got into a car crash, and the aftermath left her needing X-rays, MRIs and physical therapy. Plus, her art takes a significant toll on her body. Lee literally makes paper: stripping mulberry trees of their bark, boiling the fibers and turning it into paper through a labor-intensive process. She turns the strips of paper into cords that she uses to build baskets and craft dresses.
“I’ve been to many physical therapists, occupational therapists,” Lee said. “And the occupational therapist took one look at the photos of what I do and she was like, ‘All of this is bad. Don’t do any of this.’”
So when Lee heard the news about spiking health insurance costs next year, she prepared for the worst. She was surprised to find her monthly premium would only increase by about 50%, for the same plan.
“Sadly I was kind of like, ‘Oh, well, thank God it’s not more,’” Lee said.
Then, she got on the phone with her broker. Her broker was able to find Lee a different plan that would offer her the same coverage at a cost increase of about 10%, landing her monthly premium at around $220. Lee, it turned out, had an income low enough to keep qualifying for some tax credits. She’s still paying more than she’d like, she said. But she’s breathing a sigh of relief that she avoided the major price hikes she’d been expecting.
Lee’s advice for anyone looking to keep costs low? Call a broker.
“I really wouldn’t have been able to do this by myself,” Lee said. “Cause I’ve tried to do it myself before, and I cannot navigate that.”
A small business employee faces the marketplace alone
Susan Gaydos knows what it’s like to go without health insurance, and she’s prepared to do it again.
Gaydos works for a small manufacturing business. It’s small enough that, in the past, her boss allowed employees to buy any plan they wished on the Affordable Care Act marketplace. The company covered the cost of her monthly premium that wasn’t already paid for by tax credits, leaving Gaydos’ out of pocket costs at $0.
Her employer is changing course this year. The company has grown and needs to cover more employees’ insurance, so Gaydos said her boss is looking to buy a group plan instead. This time, the company will likely cover just half of the insurance bill. Gaydos hasn’t received a concrete estimate of the monthly premium for next year yet. But she doubts she’ll be able to afford it on her $28-an-hour wage.
“I don’t really have any room in my budget for an added cost,” she said.
Gaydos’ other option is to buy on the marketplace. That would cost about $420 a month, without her employer covering it – another item she doesn’t have the budget for.
So, unless her employer offers a very affordable plan, Gaydos guesses she’ll be uninsured next year. But Gaydos is in her 50s, and she wants to keep up her preventive care, like annual mammograms and well-woman exams.
When she first moved to Cleveland, about 15 years ago, she was uninsured and relied on nonprofit health clinics that offer free or reduced-cost care, often called federally qualified health care clinics. That might be what she uses again next year, she said.
“I kind of feel like it might be the future of healthcare if it gets too much more crazy,” Gaydos said.