Over the past several years, the health insurance landscape has experienced dramatic shifts—particularly within the Affordable Care Act (ACA) Marketplace. For many households, the temporary pandemic-era boost in ACA subsidies made coverage far more affordable than it had ever been. But now, as those enhancements fade and rates adjust, families and individuals are beginning to feel the financial impact.

This article is designed to help you understand what has changed, why it matters, and what realistic options are available. Our focus is education, clarity, and ensuring every community—including LGBTQ+ individuals and families—has reliable information to make informed choices.

The ACA Subsidy Shift: What Happened?

During COVID-19, the federal government expanded ACA subsidies (APTCs) to provide financial relief. Many families—especially middle-income households—saw dramatic decreases in monthly premiums. In some cases, families who normally paid thousands per year saw premiums drop to zero or close to zero.
Those enhancements were temporary.
As those boosted subsidies expire and carriers make their annual adjustments, the result is:

• Higher premiums across most carriers
• Significantly higher out-of-pocket maximums
• Reduced tax credits for many middle-income earners
• Some individuals losing subsidies entirely
• Business owners and self-employed individuals being hit the hardest

For many households, the ACA is still an excellent tool. But for others, especially those who no longer qualify for the same level of financial support, the new cost structure may create real hardship. This is the first major point students, families, and professionals should understand: The ACA is not disappearing, but it is becoming more expensive for many.

ACA vs. Private Plans: Understanding Your Options

A common misconception is that the ACA Marketplace is the only available type of health insurance. In reality, private, non-ACA plans continue to exist, but they function differently.

ACA Plans:

• No medical underwriting
• Cover all essential health benefits
• Offer subsidies based on income
• Often have higher deductibles and out-of-pocket maxes
• Rates are uniform regardless of health

Private Plans:

• Require medical qualification
• May offer lower premiums depending on health
• Often have lower deductibles
• Not tied to income
• May be beneficial for certain demographics (self-employed, higher-income, healthy individuals, etc.)

Private plans are not better—they are simply different. They can solve problems for some people that ACA plans cannot, and vice versa. The key is understanding which environment best fits your individual situation.
This is where many consumers feel overwhelmed. And rightly so—because the options multiply quickly depending on age, medication needs, income, health conditions, and family structure.

Why Inclusivity Matters in Health Insurance Education

Health insurance is not a one-size-fits-all system, and that becomes even more clear when considering the diverse needs within the LGBTQ+ community. Access to affirming providers, mental health coverage, specific prescription needs, and nontraditional family structures all play a role in choosing the right plan.
Some examples include:

• Ensuring partners, spouses, and nontraditional families are covered appropriately
• Understanding which plans offer better access to LGBTQ+ affirming care
• Reviewing prescription coverage for hormone therapy or other specialized medications
• Ensuring privacy and confidentiality when navigating sensitive healthcare needs
• Matching individuals with providers who understand LGBTQ+ health considerations

Education empowers communities. And when people feel respected and understood, they make more confident decisions about coverage.

Community Engagement Matters More Than Ever

Navigating these changes is not just a matter of reading a brochure or comparing prices online. Many individuals—especially seniors, business owners, and LGBTQ+ families—benefit from having access to real conversation, reliable information, and ongoing support.
That is why community engagement is important. Workshops, informational events, chamber activities, Pride Month educational sessions, and small-group Q&A gatherings help ensure the right information reaches the right people.
As a chamber member, Rob Macauley participates in community and business outreach to help families and local entrepreneurs understand changing healthcare costs. Scott Gulledge brings years of industry experience working directly with individuals, families, seniors, and business owners to help clarify options in a complicated system.
The more informed a community is, the stronger it becomes.

Key Takeaways for Anyone Reviewing Coverage This Year

1. Expect higher ACA premiums and changes in tax credits.
2. Review your plan annually—what worked last year may not be the best fit this year.
3. Private plans still exist and may offer meaningful relief for those who qualify.
4. Medicare, Marketplace, private, and supplemental plans all have different rules—understanding the distinctions is essential.
5. LGBTQ+ individuals and families should feel empowered to seek care that respects identity, privacy, and unique health needs.
6. Education is the most powerful tool when navigating these changes.

To Learn More

For questions, education, or guidance with ACA, Medicare, or private insurance options, contact:
Scott Gulledge & Rob Macauley
To learn more, contact us at:
📞 602-402-6001 (Rob)
📧 rmacauley@healthmarkets.com