Kate Bivona and her husband don’t know what they might do if both will get severely sick or injured.
Till lately, that wasn’t the case. However starting in January, the month-to-month price of her Reasonably priced Care Act insurance coverage jumped by about $300 — making it too costly for them to afford. Bivona and her husband dropped right down to a bronze plan, chopping their invoice by greater than half however leaving them with an $18,000 annual deductible.
“We must take out a mortgage,” mentioned Bivona, a 37-year-old musician in Arizona. “We don’t have that sort of cash, perhaps a few thousand {dollars} in financial savings.”
Extra enrollees are making the identical calculation this yr: decrease premiums now, far increased payments later in the event that they want care.
As soon as a security web for more healthy adults, bronze plans have gotten the default selection for a rising share of ACA enrollees in 2026, based on state officers.
The shift marks a pointy break from previous years, when most individuals gravitated towards silver plans that stability increased month-to-month premiums with decrease deductibles. Now, many individuals are choosing the least expensive possibility obtainable — not as a result of they wish to, however as a result of it’s all they will afford.
“Individuals are feeling very worth delicate,” mentioned Audrey Morse Gasteier, govt director of the Massachusetts Well being Connector, the state’s ACA market. “The expiration of the improved premium tax credit are placing lots of people able the place they’re sort of barely capable of grasp on by way of affording protection. And that’s the place we see bronze plans selecting up extra.”
ACA plans are offered in 4 important tiers — bronze, silver, gold and platinum — which work on a sliding scale: decrease month-to-month premiums include increased out-of-pocket prices, whereas increased premiums imply decrease deductibles and copays. (Catastrophic plans, that are restricted largely to individuals beneath 30, make up a small share of ACA enrollment.)
Bronze plans cowl ACA advantages, together with annual physicals, well-woman visits, most cancers screenings and prescribed drugs. However because the lowest tier, they typically require individuals to pay 1000’s of {dollars} out of pocket earlier than most different protection kicks in.
The common annual deductible for a bronze ACA plan in 2026 is roughly $7,500 for a person, based on KFF, a nonpartisan well being coverage analysis group.
“The concept of the bronze plan was that it will attraction to youthful, more healthy individuals,” mentioned Cynthia Cox, director of this system on the ACA at KFF. “You could possibly get a decrease premium, you’ll doubtlessly have a better out-of-pocket price, however provided that you had a big well being care expense.”
Bivona and her husband match that profile. Each are younger and customarily wholesome, and he or she largely makes use of her insurance coverage for medicines and the occasional physician’s appointment.
This yr, although, the choice wasn’t about what plan made essentially the most sense — it was about what they might afford.
“It makes me so indignant,” she mentioned.
Skipping or delaying care
Well being coverage consultants warn {that a} broad transfer towards bronze plans could lead on extra individuals to delay care, skip therapy or tackle debt to pay for medical bills — although they technically have medical health insurance. The results could possibly be particularly extreme for individuals with continual circumstances who’re compelled into worse protection.
“If an individual suffers from continual illness or experiences a well being emergency, these high-deductible plans push individuals out of business,” mentioned Larry Gostin, director of the O’Neill Institute for Nationwide and International Well being Regulation at Georgetown College. “Additionally, with excessive deductibles, many individuals will hesitate to go for analysis and therapy. These delays could make sufferers sicker and even trigger deaths.”
The change in plan alternatives stems from the expiration of the improved ACA subsidies on the finish of final yr, which pushed premiums increased and compelled many individuals to prioritize month-to-month prices over extra complete protection.
Preliminary federal open enrollment information reveals Obamacare sign-ups are down greater than 800,000 from final yr. The federal information hasn’t but damaged down which plans individuals chosen, leaving information from states — which do launch plan alternatives — because the clearest image of how protection decisions are altering.
In Rhode Island, the transfer towards bronze plans has been particularly pronounced amongst new enrollees, state officers mentioned.
As of early January, 38% of latest enrollees had chosen bronze plans for 2026, up from 15% two years earlier, whereas silver fell from 53% to 35% and gold dropped from 31% to 25%.
“Bronze plan choice is up considerably and silver and gold choice is down considerably for brand spanking new prospects,” Christina Spaight O’Reilly, communications director for Rhode Island’s ACA market, wrote in an e-mail.
In California, greater than a 3rd of latest ACA enrollees have chosen bronze plans for 2026, up from about 1 in 5 final yr, state officers mentioned. Almost three-quarters of renewing prospects who switched plan tiers additionally moved to bronze protection.
Officers in Kentucky, Idaho, Massachusetts, New York and Virginia additionally reported a rise in plan switching, with many enrollees shifting to cheaper choices. Knowledge for Arizona, the place Bivona lives, isn’t but obtainable as a result of it’s federal.
Nonetheless, Cox of KFF mentioned, it’s higher to stay insured than to go with out protection altogether.
Even with out the money to fulfill a excessive deductible, she mentioned, the protection can nonetheless defend individuals from catastrophic medical payments, resembling most cancers therapy or severe accidents from a automotive accident.
“The individuals switching to a bronze plan this yr might begin to really feel like they could as effectively be uninsured,” Cox mentioned.
