Georgians with Affordable Care Act health insurance are evaluating their options as open enrollment winds down for plans beginning Jan. 1, 2026.
A majority of the roughly 1.5 million Georgians with coverage in the state would be affected if enhanced premium tax credits that have made Marketplace plans more affordable since 2021 expire at the end of the year.
Mary Campbell’s Duluth house is festive for Christmas, with decorated garlands and wreaths on the windows.
She sits on a bar stool in the kitchen with her dog Bailey at her feet. On the counter, her laptop is open to a website she’s already visited dozens of times since open enrollment started — Georgia’s state-based Marketplace exchange, Georgia Access.
“I haven’t picked an insurance yet. This is my current plan right here,” says Campbell, pointing to the screen. She’s an entrepreneur who has been self-employed for almost 19 years. She and her then-husband signed up for the ACA as soon as it opened more than a decade ago.
“So, that was a nice benefit, that we could both be entrepreneurs for the first time,” she says.
Campbell owns a store near the Mall of Georgia. She’s also a single mom of two teenagers, aged 15 and 19, who are on her insurance.
This year, for a high-deductible silver plan, Campbell pays about $1,000 a month in premiums, not including separate dental coverage. She says there aren’t many plans for next year that are doable for her budget and cover their needs.
She punches numbers into a calculator while scrolling with her other hand.
“So, if I want the same plan, I will pay $1,100 more a month. Without subsidies, it’s going to be $2,379,” she says. “If I want to keep my doctor, I have one option. And if I want my children to keep their pediatrician that they’ve had their entire lives, I have one insurance option.”
If the enhanced premium tax credits expire as planned, Campbell says she’ll have to downgrade to a bronze plan, which would cost less each month but has other higher out-of-pocket expenses and covers less.
“I’m going to be purchasing what amounts to a catastrophic plan and paying the same amount of money. If I’m being completely honest, if I didn’t have children, I would very likely not purchase insurance.”
But the 52-year-old says she can’t take that risk.
“I know all too well from having a son who had an experience where he was in the ICU for a week just four years ago,” she says, “the bill before insurance was roughly $236,000.”
Health policy group KFF estimates that people with ACA coverage would see monthly premium payments rise by 114% on average next year.
“Everyone has been calling because around Nov. 1, they have received their letters letting them know what their premium costs will be going up to,” says Deanna Williams, Enrollment Assister with the nonprofit Georgians for a Healthy Future, part of the state’s Certified Application Counselor (CAC) program.
Williams says she’s heard from dozens of people from around the state who are worried about being able to afford health care.
“If your premium is more than doubling and your income hasn’t increased, that’s something they’re trying to evaluate in their household. And then others are trying to say, well, the cost of this monthly premium is more than what I pay for rent and my bills included,” Williams says.
Nationwide, 1 in 4 people with ACA health coverage say they’re likely to go uninsured if their monthly premium payments double, according to the latest KFF survey, which also found 1 in 3 reporting they would “very likely” look for a cheaper plan.
Health coverage losses would hit rural communities, low-income people and seniors hardest, according to KFF data.
Steve, a metro Atlanta resident who doesn’t want to use his last name to protect his family’s privacy, pays for his parents’ health insurance through the ACA Marketplace. He helped them sign up in 2020.
“As a way to get them committed to their health and well-being,” he says.
His parents immigrated to the U.S. years ago and previously didn’t have coverage through their jobs.
“My father, for 20-plus years, works at a restaurant and my mom is an in-home caretaker for someone who has some mobility issues and whatnot. So they don’t have that kind of benefit afforded to them.”
His parents’ household income is about $40,000 a year. Steve says, so far, he’s able to afford their monthly premiums himself.
“In 2025, they’re on the silver plan for Oscar Health. The premium is at $68.53,” he says. “If I were to keep them on the same plan, their premium would go up to $656.65.”
Going without coverage isn’t an option, he says. His parents are in their early Sixties. His dad recently completed treatment for cancer and needs regular scans to stay healthy and cancer-free.
With or without the enhanced premium tax credits next year, Steve says he’s going to do what he can to keep them insured.
He’s planning to downgrade his parents to a bronze plan to keep them covered until they can qualify for Medicare.
“But, of course, the deductible for this bronze plan that right now I have them set for is at like $8,000 versus $800 on the silvery plan,” he says. “And hopefully their health doesn’t deteriorate, which you know it’s hard to tell since as you age, of course, you don’t know what else can happen.”
This is part 4 of the WABE News series: “Medical Wealth Gap: Filling the cracks in Atlanta’s safety net.“
