A young St Louis worker’s search for health insurance has highlighted the complexity of choosing cover through the US health insurance marketplace — and the value of free, independent guidance for first-time applicants.
DJ Mikunda, 22, has been without insurance since leaving home and starting work in 2023. He is now a manager at a petrol station and had previously found the options on the federal marketplace both expensive and difficult to navigate.
“You know what sounds like a good Friday night? It’s looking at health insurance,” he joked.
Mikunda was introduced to Jackie Shrago, an independent assister who has helped people understand marketplace plans since the early days of the Affordable Care Act.
“I feel like I’m a well-informed individual,” Mikunda said. “I try to stay updated on what a deductible is and what the premiums are and copays. And I’m still finding myself a little bit lost.”
How income affects health insurance costs
Shrago began by looking at Mikunda’s expected income, since earnings help determine whether an applicant qualifies for reduced monthly payments.
For people enrolling in 2027, individuals without children earning up to 400% of the federal poverty rate — or $63,480 — may qualify for a discount. A person in their mid-20s earning $50,000 could receive an average discount of 23%, while someone earning $30,000 could have nearly three-quarters of the cost covered, according to a KFF subsidy calculator.
Applicants are advised to estimate their income for the coming year as accurately as possible. If they earn more than expected, they could be required to repay some of the financial assistance when filing their taxes.
“The last thing you want is a surprise when you file your income taxes,” Shrago told Mikunda.
The choice also involves weighing monthly payments against possible medical costs. Mikunda expects to need regular appointments and prescription medicine because a chronic joint condition has gone largely untreated since he lost Medicaid cover after beginning work.
He may therefore decide that paying more each month for a plan offering greater help with treatment is worthwhile. The decision, he said, is about finding a “comfortable medium” between the cover required and what he can afford.
Free help available from independent assisters
People using the marketplace can search for local assistance by entering their postcode and selecting independent assisters. Unlike insurance agents and brokers, these advisers cannot charge for their services or receive payments from insurers.
Shrago urged applicants to begin early, allowing time to consider their choices rather than making an immediate decision. Assisters are often busiest shortly before the federal marketplace’s January 15 deadline.
“If you’re dealing with something that is uncertain enough and you feel really awkward about it, you don’t need to make a decision today,” she said. “Take your time and think about it.”
However, the pool of independent help has become smaller. The Trump administration cut funding for independent assisters and navigator charities by roughly 90% in 2025.
The Centers for Medicare & Medicaid Services said when announcing the reduction that the programme was inefficient, costing more than $1,000 for each person enrolled. In Ohio, the number of paid navigators serving residents fell from 50 to five at the start of open enrolment in 2025.
