Have you ever assumed your income was high enough to protect you from a healthcare crisis? Monique Underwood made that assumption for years — and it cost her.
I first connected with Monique through a social worker at the Bernalillo County Department of Workforce Solutions in Albuquerque, New Mexico. I had been reporting on how middle-income earners were falling through the cracks of the health coverage system, and the social worker — who asked not to be named — told me she’d recently met someone whose story I needed to hear. A flight attendant, she said. Makes good money. Still couldn’t afford her medication.
When I sat down with Monique Underwood at a coffee shop near the airport in late February 2026, she came prepared. She brought a folder of documents: insurance statements, pharmacy receipts, a letter from her airline’s HR department dated July 2025. She was precise, organized, and still visibly frustrated seven months after the change that turned her financial life sideways.
The Plan That Changed Everything
Monique, 49, has been a flight attendant with a regional carrier for eleven years. She and her husband — a high school basketball coach — together bring in roughly $94,000 a year, putting them solidly in the upper-middle-income bracket for Albuquerque. They own their home, carry no credit card debt, and have been diligently saving for their teenage son’s college tuition, which starts in fall 2026.
For most of her career, Monique’s employer provided a group health plan. Her monthly premium was $378, deducted directly from her paycheck. Her thyroid medication — levothyroxine — cost her a $45 copay every 30 days. It wasn’t glamorous, but it worked.
Then, in a July 2025 memo, her airline announced it was transitioning away from its group health plan. Instead of employer-sponsored coverage, workers would receive a monthly stipend of $300 and be directed to shop for individual plans on the federal Health Insurance Marketplace.
The plan Monique ultimately selected on the Marketplace — a mid-tier silver plan for herself and her husband — came to $847 per month. The $300 stipend offset some of that, but her net monthly cost jumped from $378 to $547. On paper, that’s $169 more per month. In a household already stretched by college savings goals and a mortgage, it was a significant blow.
The prescriptions were worse. Her new plan placed levothyroxine in a different formulary tier than her old coverage had. Her $45 monthly copay became $189.
“I Thought Problems Like This Happened to Other People”
Monique told me she felt something close to shame when she first realized she was going to struggle. She is, by her own description, the person in her family who handles the numbers. She tracks every category in a budget spreadsheet. She has a Roth IRA. She is not someone who loses track of money.
She described skipping one refill in September to cover her son’s orientation costs — roughly $340 — and then stretching a 30-day supply of levothyroxine to 38 days by cutting pills. Her doctor, she said, was not pleased when she mentioned this at a follow-up appointment in October.
When I asked whether she had looked into alternatives sooner, she paused. “I kept thinking it would stabilize,” she said. “That I’d figure out a workaround. It took me a while to accept that I needed to ask for help.”
Walking Into an Office She Never Expected to Enter
Monique arrived at the Bernalillo County assistance office in November 2025, not for SNAP or cash assistance, but because a neighbor — a nurse — told her the office had a navigator who helped people sort through Marketplace plan options and potential subsidies. She went on a Tuesday morning, during a layover before a return flight to Phoenix.
That’s where the social worker flagged her situation as one worth documenting. Monique initially declined to be interviewed. She agreed two months later, after her situation had begun to resolve, because — as she put it — “I don’t want another woman my age to wait as long as I did.”
The navigator at the county office walked Monique through a detail she had missed during open enrollment: because her household income fell below the threshold for full premium tax credits — but above Medicaid eligibility — she qualified for a partial Advanced Premium Tax Credit (APTC) that she had not applied for. Adjusting her enrollment to claim it reduced her net monthly premium from $547 to $421.
It wasn’t a dramatic rescue. But it was $126 per month back in her budget — and $1,512 per year.
The Broader Cost Landscape She’s Now Watching Closely
Monique is 49 and paying close attention to what healthcare costs look like at 65, when she becomes eligible for Medicare. What she’s seeing is not reassuring. According to the Centers for Medicare & Medicaid Services, the standard monthly Medicare Part B premium climbed to $202.90 in 2026 — a 9.7% increase from $185.00 in 2025. The annual Part B deductible rose to $283, up from $257.
As reported by CNBC, that jump affects not just future enrollees but current Medicare beneficiaries whose Part B premiums are typically deducted directly from their Social Security checks — meaning a premium increase can effectively cancel out a portion of any cost-of-living adjustment they receive.
Monique found this data on her own — she’d gone looking after the benefits change jolted her into researching her long-term healthcare trajectory. She noted that Medicare premiums may be tax deductible as a medical expense for those who itemize, according to AARP, though she’s not at that stage yet and was careful to say she’s not making any decisions based on a single article.
Where Things Stand Now — and What She Wishes She’d Done Differently
By the time we spoke in late February 2026, Monique had stabilized. She’s back on a consistent refill schedule for her thyroid medication. Her son’s college enrollment deposit — $500, to a state university in New Mexico — was submitted in January. Her husband is exploring a supplemental coverage option through his school district, which could bring the family back under a group plan umbrella as a secondary policy.
When I asked what she’d do differently, Monique didn’t hesitate. She said she would have reviewed the formulary — the list of covered drugs and their tier classifications — before selecting her Marketplace plan, not after. She would have walked into the county office in August, not November. And she would have checked her subsidy eligibility before assuming she made too much to qualify.
What stayed with me after leaving that coffee shop was not the numbers — though the numbers are stark — but the precision of her regret. She knew exactly what each delay had cost her. That’s what happens when an analytical person finally turns the spreadsheet on themselves.
Monique told me she’d already forwarded the county navigator’s contact information to three coworkers who are in the same post-group-plan limbo. She said she figures that’s worth more than the interview.
She’s probably right.
Sloane Avery Wren is a Senior Benefits Writer at First Person Finance. This article is a reported narrative and does not constitute financial, tax, or medical advice.
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