Mary Jo Armstrong and her ex-husband, William, didn't exactly remarry for love. They remarried for health insurance.

After 18 years of marriage and a divorce, finalized in 2014, the Upper Burrell, Pennsylvania, couple found themselves side-by-side again Dec. 18. Joining them — not in a church or courthouse, but over a Microsoft Teams call — was Buff Jackson from the Allegheny County Department of Court Records.

Eight witnesses — including their twin daughters, coincidentally celebrating their birthday that day — looked on as they confirmed their marriage license application, choosing the self-uniting option to make it official. The video call took place during Mary Jo's lunch break, and the plan was to mark the occasion with a lighthearted exchange of vows later that evening during happy hour at the Hayloft in West Deer.

The reason for remarrying, however, was anything but playful: Mary Jo's monthly health insurance premiums were about to skyrocket from $350 to $1,400 — almost 50% of her monthly income, and it was the best solution they could muster.

The newly-reweds are far from alone in their financial dilemma. Mary Jo Armstrong meets people facing similar tough choices daily: As a health insurance broker in Natrona Heights, she's been helping clients navigate challenges very similar to her own for months.

Pennsylvanians who buy coverage through the health insurance marketplace are facing two primary forces affecting their premiums in 2026.

First, insurers are raising the base cost of plans. According to the state's Department of Insurance, premiums in the individual market will increase by an average 21.5% for Pennsylvanians, although the exact increase will vary depending on the plan, region and enrollee characteristics. The state has posted a full list of 2026 individual and small-group rate changes on its website.

Second, many consumers could see a much larger jump in what they pay each month if, and likely when, enhanced federal subsidies expire. Pennie, the state's official health insurance marketplace, estimates that enrollees would see, on average, a 102% increase in their out-of-pocket premiums, largely because the extra financial assistance would disappear.

A last-minute effort to extend the enhanced Affordable Care Act subsidies before they expire at midnight Dec. 31 is considered highly unlikely, as lawmakers have already left Washington for the holiday break without a deal. Lawmakers on both sides of the aisle have raised concerns about the situation, but debates over different potential solutions are likely to wait until January.

As these two market forces converge on prices, health insurance brokers across Western Pennsylvania say anxiety among clients is intensifying.

Not only are consumers expressing worry over the subsidies expiring, but they're also nervous that the ACA could be eliminated entirely, said Alyssa Young, a health insurance broker at Baker Consulting Services in Ford City.

Those concerns are surfacing during an open enrollment season already marked by tight deadlines and difficult choices.

Open enrollment ended Dec. 15 for those who wanted their insurance to kick in on Jan. 1, and Jan. 15 looms as the final open enrollment deadline for selecting a 2026 plan.

Cases of financial strain

In Pennsylvania, health insurance brokers are state-licensed professionals who help individuals and families compare and enroll in the ACA marketplace and other health plans via Pennie. The brokers do not charge consumers for their services and are instead compensated through a flat commission paid by the insurance companies.

Premium increases themselves aren't new, Young said: "Year after year, premiums do increase."

But this year's predicted jumps are trending higher than those in previous years.

"When people are having to choose between health insurance or rent payments or their groceries, they're going to take a gamble with their health," she said.

Young urged consumers who feel overwhelmed by plan options to seek professional guidance. "It's not a one-size-fits-all," she said, noting that insurance jargon and plan details can be confusing for people navigating the marketplace on their own.

At Mary Jo Cares in Natrona Heights, Armstrong said, clients over the past couple weeks have been sharing far more tales of financial strain than she and her staff have heard before.

In one case, a couple relies on a single income of about $100,000. To keep the insurance they had in 2025, their premium was set to jump to $3,300 a month — roughly 40% of the household's income.

In another situation, a couple had been paying $180 a month. As the husband transitioned to Medicare, the marketplace plan would only be needed to cover his wife, yet the monthly premium would balloon to $550.

"I've been having anxiety attacks because I had to tell five clients that their price was over $2,000 (monthly)," Armstrong said.

The solution to her own attempt to keep costs low started with her then ex-husband asking his employer if she could join his health insurance plan as part of a domestic partnership.

When the employer declined, the two — who, even while divorced, have been living together for about seven years to share expenses — ultimately decided to retie the knot when they realized rejoining his company-sponsored plan was the only affordable option left.

Getting the income estimates right

Disappearing federal subsidies aren't the only force impacting costs for clients.

Armstrong said changes written into the tax and policy legislation passed this summer known as the One Big Beautiful Bill are also having an effect on affordability.

One of the biggest changes, she said, is the removal of premium caps for many consumers.

Previously, individuals and families earning no more than 400% of the federal poverty level had their ACA premiums capped at 8.5% of their income.

There was a sliding scale for those who exceeded that income level.

Under the new rules, those above that threshold must pay full price.

According to the American Medical Association, most marketplace subsidies are delivered as advance premium tax credits — meaning enrollees estimate their income at the beginning of the year and receive financial assistance based on that projection.

If their income ends up being higher than expected, they may be required to repay some or all of those credits at tax time.

The new federal legislation also effectively ends a continuous special enrollment period for people earning less than 150% of the federal poverty level.

Starting in 2026, individuals who sign up during a special enrollment period based solely on income — rather than a qualifying life event such as job loss, marriage or the birth of a child — will no longer be eligible for premium tax credits.

Seeing a professional health insurance broker is one way to work to guard against unpleasant surprises, brokers say — particularly when income thresholds are involved. If a household's income exceeds the cutoff by even a dollar, the family may be required to pay back thousands of dollars in subsidies.

Kittanning broker John Daloisio said the true financial wallop for many consumers hasn't arrived yet.

"The real shocker will arrive in April 2027, when that 2026 tax bill hits," he said. "That's when it's going to blow up for some people."

Some of the changes included in the legislation do not go into effect until then.

Meanwhile, some of the changes mark a return to pre-COVID days.

Before 2020, tax credits dropped to zero the moment a household's modified adjusted gross income rose above 400% of the federal poverty level. Households one dollar over that amount would lose all discounts on their ACA health insurance and receive zero tax credits.

The laws changed during the pandemic, and what previously was a cliff for those who miscalculated their future income became a downward slope for five years. This protection is what is set to expire at year's end if Congress takes no action.

Daloisio worries about people who feel they have no option but to drop coverage altogether.

"I'd estimate about six clients told me, 'We just can't afford that. We're just going to go without insurance.'"

Extrapolated across his roughly 150 clients — and then across Pennsylvania or the country — that represents a significant number of people gambling on their health care needs, he said.

One couple Daloisio was assisting were facing an insurance premium jump from $200 a month in 2025 to $2,000 monthly for the same plan next year. "The spouse just got diagnosed for Alzheimer's. They're definitely going to need insurance."

His advice: Educate yourself about rule changes and income cutoffs, and estimate future income as accurately as possible.

Some consumers underestimate how much coverage they'll need, while others select expensive plans and end up not using many of the benefits they're paying for.

Across the board, brokers say the biggest challenges that clients face are "estimating their income, balancing what they can afford and figuring out what their health needs are," Daloisio said.

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