Easing Healthcare Costs in 2026 - And How DPC Membership Can Help

The Affordable Care Act’s (ACA) open enrollment season is officially underway, with monthly premium increases leaving millions of Americans wondering how they will be able to pay for health insurance this year. This year’s enrollment period is seeing the largest increase in costs since the law went into effect more than a decade ago.

More than 24 million Americans get their health insurance through the ACA. In 2026, a perfect storm of rising premiums and the expiration of enhanced subsidies that kept costs lower for middle-class families mean many people will face higher bills, shop around for cheaper plans, or take the potentially disastrous risk of foregoing insurance completely.

The subsidies that made premiums more affordable for the middle class started in 2021 and had allowed millions more Americans to afford health insurance. These subsidies were the issue at the heart of the recent government shutdown (with Republicans supporting letting them expire and Democrats originally not voting to reopen until the credits are extended, but ultimately relenting disappointingly by settling for a vote at an undetermined later date). And at the same time these subsidies are set to expire, insurers are raising rates for next year to keep up with the growing costs of hospital care, prescription drugs, and an increased demand for medical services. 

In 2025 about 90% (roughly 22.3 million) of ACA recipients received enhanced subsidies. The Congressional Budget Office projects that an average of 3.8 million people will drop their coverage and become uninsured every year over the next 8 years. And for those who keep their coverage, it’s likely that many will pay more than twice what they’re paying now.

In Maine, health insurance premiums are set to increase by 146%, so that a family of four making an income of $130,000 paying $11,050/year for health insurance in 2025 can expect to pay $27,163 in 2026. If the tax credits expire, people earning less than four times the federal poverty level — about $62,600 for an individual or $128,600 for a family of four — will still qualify for the standard ACA subsidies. But the amount of assistance they get will be significantly smaller than with the enhanced subsidies, and they will also see the higher premiums.

Some people with low incomes who qualified for plans with no monthly premium under the enhanced subsidies may lose that benefit, and there’s concern that many of them will drop coverage. There are estimates that roughly a million of this lowest income group of enrollees will likely become uninsured if the enhancements aren’t extended.

So what can people do to still get at least some degree of health care at an affordable price? This is where DPC can bridge the gap between what people will pay and what they actually receive. 

High Deductible Plans + DPC:

Many people will be able to weather the storm by potentially downgrading coverage from gold or silver plans to bronze. For healthy individuals with high deductible plans who are not likely to reach their deductible in any given year, a direct primary care membership can result in drastically reduced out of pocket costs per year. This can be due to cost savings in multiple different arenas. For example, some high deductible plans cover one preventive care visit per year, with any additional PCP office visits being subject to the deductible and costing hundreds of dollars out of pocket. This disincentivizing of primary care utilization also likely results in increased numbers of more costly urgent care and ER visits, which would not be the case in a model where one monthly membership price covers all primary care needs. Direct primary care practices also typically provide access to cash pay/wholesale pricing on labs, certain imaging and certain procedures, saving patients hundreds and sometimes thousands of dollars per year in otherwise “subject to deductible” costs. Additionally, starting in 2026 DPC memberships can be paid with pre-tax healthcare spending accounts (HSAs) of up to $150/month per individual or $300/month per family. 

Health Shares + DPC:

A health share is a healthcare cost-sharing arrangement where members contribute to a pool to cover each other's eligible medical expenses, serving as an alternative to traditional health insurance. These programs are not regulated as insurance, have lower monthly payments, and have their own rules on which pre-existing conditions are covered and how much of a specific expense will be shared. Members make monthly payments into a central pool used to pay for other members' medical costs (similar to a monthly premium). Members are responsible for a certain amount of their medical costs, often called a "personal responsibility" amount, before the health share will pay for an expense. (This can be thought of as similar to a deductible). When a member incurs a medical expense, they submit the bills to the health share for review to ensure it meets the program's "sharing qualifications". If the need is approved, the health share community helps to pay for the expense. Pros are that the monthly payment or premium is drastically lower than a commercial health insurance plan, and coupled with a DPC membership, is still significantly cheaper. Cons are that health shares are not subject to the same regulations as health insurances, which means they are not required to cover pre-existing conditions or accept all customers. It is also not a guarantee that certain costs will be covered. Many plans are affiliated with a specific religion and may exclude coverage for costs associated with pre-marital sex or drug use, for example. However some of the plans (such as Sedera and Zion Health) are secular and not subject to religious beliefs/requirements, although they still fall outside of the ACA regulations.

For many in the coming year, a health share to cover unexpected expenses coupled with a DPC membership will be a smart way to have high-value primary care and some reassurance of coverage in the case of unforeseen health events. 

Noninsured + DPC:

Although not recommended, many working families who cannot afford commercial health insurance will still be able to afford DPC pricing. Given that 80-90% of all health care needs in a given year are provided by primary care, DPC is a worthwhile spend where full coverage may be financially impossible. 

At the end of the day, we are all bracing for the onslaught of cost that 2026 will bring. At best it will cost a lot more money for the same or worse coverage and at worst will leave many of us, including our most challenged and vulnerable populations without adequate health care coverage. Direct primary care, erroneously viewed by some as an additional luxury affordable by the rich, in reality helps to bridge the gap by delivering relationship-based, consistent and high quality primary care to many who can no longer afford commercial health care plans, in a system fraught with price inflations inflicted by people who do not view health care as a basic human right, or even as something that should be made easily accessible to most people.

Written by: Joanna Rulf, DO