By R.J. Morales | TX3DNews
COLLIN COUNTY, Texas — As pandemic-era Affordable Care Act (ACA) subsidies expired and insurance premiums climbed, some Collin County families faced difficult — and in some cases heartbreaking — choices during the most recent open enrollment period, according to local health insurance agents who work directly with consumers.
Agents say the latest enrollment cycle was marked by sharp premium increases, narrower provider networks, and confusion over who still qualified for financial assistance. Those pressures, they said, fell most heavily on self-employed residents, small business owners, and households earning too much to qualify for Medicaid but still struggling to afford coverage.
Bob Jabour, is an independent health insurance agent in Plano, said the season was among the most challenging he has seen since the Affordable Care Act launched.
“This was probably one of the most challenging years — if not the most challenging — since the first year we rolled out the ACA plans,” Jabour said.
Premium Increases Hit Household Budgets
According to Jabour, many individual and family plans saw premium increases in the range of 30% to 50%, with some older households facing monthly costs in the thousands.
“Prices went up dramatically this year,” he said. “I had one client whose premium went to about $3,400 a month. That’s more than most people’s mortgage payment.”
He emphasized that these were not high-end plans, but standard individual-market HMO coverage.
“This is just basic health insurance,” Jabour said.
Those increases forced families to make difficult tradeoffs as insurance consumed a growing share of household budgets.
Narrower Networks, Fewer Options
Beyond cost, agents pointed to shrinking provider networks as another challenge. Jabour said many consumers lost access to PPO plans, which typically allow broader doctor choice and out-of-state coverage.
“We lost the PPO networks, which is what most people want,” he said.
He added that some specialists no longer participate in marketplace plans.
“Some of the best specialists — neurologists, cardiologists, oncologists — choose not to participate,” Jabour said. “That limits access to quality care.”
Who Was Hit Hardest
Jabour said lower-income households that still qualified for traditional ACA subsidies were generally shielded from the steepest increases. The greatest impact, he said, fell on middle- and upper-middle-income families, particularly those earning roughly $80,000 to $120,000 a year.
“That mid-tier family is the one that really got hurt,” he said.
He attributed much of that shock to the expiration of enhanced subsidies introduced during the COVID-19 pandemic.
“People with higher incomes were getting subsidies they normally never would have received,” Jabour said. “Losing those at the same time rates went up was brutal.”
Families Making Painful Choices
Liz Michel, a North Texas health and life insurance agent, said she saw similar patterns across her client base — and, in some cases, more severe consequences.
She said some parents chose to insure their children while dropping coverage for themselves.
“Parents making the difficult choice to only cover their kids, but not themselves,” Michel said.
She also described the emotional toll on clients who lost coverage.
“I had one client through tears asking me, ‘How am I going to get my medication now? I need it to live,’” Michel said. “It was heartbreaking.”
Michel said many affected households fell into coverage gaps — earning too much for Medicaid but still unable to afford marketplace plans without enhanced subsidies.
“There was no financial relief for them,” she said.
January Deadlines Add Pressure
Timing compounded the impact. Jabour said coverage selected during open enrollment took effect January 1, meaning higher premiums immediately hit household budgets.
“Those new policies went into effect January first,” he said.
Consumers still have until January 15 to enroll or make changes without a qualifying life event, though changes made after December may not take effect until February.
“If someone picked the wrong plan, they still have a window,” Jabour said. “But they’re already facing the January first payment.”
A System Under Strain
Jabour said frustration is growing not just with insurers, but with policymakers across the political spectrum.
“Politicians don’t really understand the marketplace as it relates to most Americans,” he said, adding that health insurance policy is often debated by people who do not rely on marketplace coverage themselves.
Michel said the issue has been underreported locally in part because many Collin County residents receive employer-sponsored insurance. Those without it — including small business owners, 1099 workers, and teachers’ families — are being hit hardest.
She cited the cost of adding a spouse to a teacher health plan as one example.
“On average it was going to cost $1,000 a month just to add a spouse,” Michel said. “That’s $12,000 a year. Teachers are already underpaid.”
Long-Term Concerns
Both agents warned that rising costs could push more people out of coverage, shifting costs elsewhere in the system.
“If people drop insurance, we all end up paying for it,” Jabour said. “Hospitals don’t stop treating people.”
Michel said she is already seeing that pressure locally among self-employed residents, small business owners, and teachers’ families, and urged people to be educated about the coverage options available.
“There are three ways to get coverage: through your employer, through the Marketplace, or through private coverage,” Michel said.
Both agents said without predictable, affordable premiums, families will continue making risky short-term decisions.
“Insurance has to be something people can actually budget for,” Jabour said. “At this level, it’s not sustainable.”