How to Manage Rising Health Insurance Costs, According to a Financial Navigator
Updated on October 23, 2025
Health insurance coverage has changed a lot this year — and not for the better. Between cuts to Medicaid, changes to Marketplace plans, and an ongoing battle over subsidies for ACA plans that has shut down the government, everyone’s coverage will be affected in some way. But exactly how is still unclear, even as open enrollment season is starting. If you’re living with breast cancer, how can you make sure you stay covered?
Dan Sherman, MA, LPC, is founder and president of The NaVectis Group, a consulting company in Grand Rapids, Michigan that trains healthcare providers to assist patients with financial issues related to their care. He’s also a financial navigator who has worked for more than 25 years helping people with cancer afford their care. To help make sense of this continually evolving situation, we asked him for his insights and advice on how to prepare for changes to your insurance.
Do you think it’s getting harder for people with breast cancer to maintain affordable health insurance coverage?
Yes, it's going to get worse from multiple angles. For cancer patients, one of the main concerns is losing their coverage. When they are going through cancer treatment, some people have trouble maintaining employment and staying insured through their employer.
For many of those people, their main option has been Health Insurance Marketplace plans.
But now, the premiums for Marketplace plans are going to get much more expensive — if Congress allows the enhanced tax credits for Marketplace plans to expire. Out-of-pocket costs for premiums will increase, on average, by more than 75 percent. Some will increase by 200 or 300 percent.
“If you see an enormous price increase in your insurance premiums, my recommendation is: Do not give up.”
The other issue is that in the next couple of years it will become harder to enroll in Marketplace plans for other reasons, too. There are more criteria for who qualifies and who doesn’t, and an increased burden of documentation and paperwork. The enrollment period is being shortened by one month, there are more limits on special enrollment periods, and auto-enrollment will be mostly phased out. Unfortunately, these changes will result in fewer people successfully enrolling in the Marketplace.
For people who can no longer enroll in Marketplace plans, what will their options be?
They won’t have a lot of options. Many of them aren’t going to qualify for Medicaid instead, based on their income. I’m concerned that more people will fall through the cracks of not qualifying for either type of insurance. Some may be able to enroll in a family member’s insurance plan. But many will likely become uninsured.
I’ve seen people get pushed into really difficult situations. They might strategically work less and make less income just so they can qualify for Medicaid. Or if their spouse is the primary income earner, the person with cancer might separate or divorce so that their income goes down and then they can qualify for Medicaid.
There’s also the issue that many lawfully present immigrants will no longer be eligible for Medicare, Medicaid, or subsidized Marketplace plans even though they’ve paid federal taxes, social security taxes, and Medicare taxes for years.
When will people who have (or want) Marketplace plans learn what the cost for 2026 premiums will be?
Notifications to current enrollees have already been sent out. And beginning on November 1, 2025, you’ll be able to see the price increases for 2026 plans on all the Marketplace websites. At that point, if you see an enormous price increase in your insurance premiums, my recommendation is: Do not give up. Keep checking the prices online on a weekly basis, right up until the end of open enrollment on January 15, 2026. Congress might agree to extend the subsidies in late November or December. If that happens, you'll see big drops in the health insurance premiums on the Marketplace website.
What if Congress extends the subsidies after open enrollment?
There’s a chance that an agreement to extend the subsidies could happen sometime in early 2026. The problem for consumers is that open enrollment for Marketplace plans ends on January 15, 2026. A lot of people might decide not to sign up because of the high premiums and be uninsured for a year. Under the current rules, they won’t have the option of signing up outside of the open enrollment dates.
What do you think about the recent policy changes that make more people eligible for “catastrophic” plans sold on the Marketplaces in some states? Are these plans, which have lower monthly premiums but a higher annual deduction, a good option?
As long as a catastrophic policy is being sold on the Marketplace, it will not include pre-existing conditions clauses (meaning that having a history of cancer won’t exclude you from buying one).
“Start preparing now. The more time you have to prepare, the better.”
However, my cynical view is that the administration is offering these plans so that they can claim they’re providing coverage options in the Marketplace with lower premiums. They’re expanding access to these plans for individuals who don’t qualify for premium subsidies in the Marketplace. But these plans are horrific. They have huge deductibles that must be met before coverage for cancer treatments kicks in. They do have lower monthly premiums. And buying one is better than being uninsured. But I would be very cautious about doing so if you have other options.
I predict that some people that enroll in these catastrophic plans will be in financial trouble if they’re diagnosed with an illness like cancer. On the other hand, there are ways to offset these large deductibles for patients diagnosed with cancer, including by applying for financial assistance through the hospital, drug companies, and charitable foundations.
What’s important for people to know about changes to Medicaid?
For people who qualify for Medicaid based on their income, things are going to get more complicated. Most of the changes aren’t happening until 2027, but some are taking effect sooner.
There are more criteria that limit who qualifies for Medicaid: fewer people overall will be eligible for Medicaid coverage. And now people will be required to re-certify that they qualify twice a year, rather than once a year. The paperwork burden of that will be very significant. Some will lose insurance because they don’t keep up with it or because they can’t provide the documents.
If you’re self-employed, for example, you have to prove your income. But it’s hard to do that when you’re self-employed — your income might fluctuate from month to month. It will be a difficult burden for many people to overcome.
There’s also a psychological side to these changes: The message that our politicians are sending is that people on Medicaid are unwilling to work and they’re lazy. There are going to be new work requirements for some Medicaid enrollees — they’ll need to show they spent 80 hours a month on work-related activities, training, or community service. And the message that is being sent is that they are a burden to society. What is it like for an individual who goes on Medicaid and the culture around you is saying you are a burden…that you’re lazy and not working and not doing enough? What message are we sending these individuals? That’s another burden our patients are going through. My heart aches for my fellow humans who find themselves in this situation.
Are other types of health insurance plans, like employer-provided ones, likely to become more expensive because of cuts to Medicaid and ACA plans?
Yes, and one of the reasons why is that hospital systems and providers are likely going to have more patients who don’t have insurance and who can’t afford to pay for their care. That’s going to force hospitals to increase their charges so they can stay alive. That, in turn, will force insurance companies to increase their premiums to cover those costs for the people enrolled in their plans. It’s a ripple effect.
Another reason premiums will likely go up is that many of the people who leave the Marketplace due to high prices will be healthy individuals. A higher percentage of less healthy people staying in the Marketplace will require insurance companies to spend more. So they’ll raise their premiums across the board.
Also, rural hospitals often have a higher population of patients on Medicaid. A situation in which more patients are losing their Medicaid coverage is not going to be sustainable for rural hospitals.
What can people do if they’re worried about becoming uninsured or underinsured?
My recommendation to people is: start preparing now. The more time you have to prepare, the better. People who’ve had breast cancer need the coverage. Going without coverage is not a good solution.
If you’re enrolled in a Marketplace plan now, meet with a financial navigator at the cancer center where you received your treatment, or find one through a nonprofit that offers free financial guidance to people with cancer. One example is the Cancer Support Community. You could also meet with a trusted local health insurance agent to explore your options. But either way, prepare yourself for sharp increases in premiums. And don’t assume that you’ll be automatically re-enrolled in a plan that is affordable for you. If your premiums double, do you have other coverage options? This may not be an option for many people, but can you set any money aside to help with these extra costs? Can you increase the income coming into your household to help afford this?
What other resources are there to help people with breast cancer with the costs of their care, and other expenses?
Connecting people to charitable resources is important, and that’s another thing that a financial navigator can help with. Many pharmaceutical companies have programs to help people with commercial health insurance or no health insurance get the medicines they need at a lower cost or for free. There are organizations that assist with costs for medications and health insurance premiums. Five charitable foundations can assist with medication costs for people on Medicare. Some also help cover health insurance premiums. They are: Pan Foundation, Patient Advocate Foundation, HealthWell Foundation, CancerCare, and the Assistance Fund.
There are also charitable organizations that help with other types of expenses, like mortgage and car payments, which could indirectly help you afford the increases in the premiums. For example, I’m on the board of the Pink Fund, which assists people in active treatment (who meet eligibility guidelines) with utility bills, mortgage or rent, car or car insurance payments, and health insurance premiums. Pink Aid is another organization that can assist people in active treatment (who meet eligibility guidelines) with those kinds of expenses.
Any final thoughts, predictions, or words of encouragement?
I believe that someday society will lower financial burdens for people diagnosed with a major illness. But in the meantime, I’m concerned that we’ll have some difficult days ahead. I want to encourage people with breast cancer to allow themselves to seek help with their finances. Please remember that you are not alone in experiencing financial distress. There are many others just like you out there.
