Kate Bivona and her husband don’t know what they would do if either gets seriously sick or injured.
Until recently, that wasn’t the case. But beginning in January, the monthly cost of her Affordable Care Act insurance jumped by about $300 — making it too expensive for them to afford. Bivona and her husband dropped down to a bronze plan, cutting their bill by more than half but leaving them with an $18,000 annual deductible.
“We would have to take out a loan,” said Bivona, a 37-year-old musician in Arizona. “We don’t have that kind of money, maybe a couple of thousand dollars in savings.”
More enrollees are making the same calculation this year: lower premiums now, far higher bills later if they need care.
Once a safety net for healthier adults, bronze plans are becoming the default choice for a growing share of ACA enrollees in 2026, according to state officials.
The shift marks a sharp break from past years, when most people gravitated toward silver plans that balance higher monthly premiums with lower deductibles. Now, many people are opting for the cheapest option available — not because they want to, but because it’s all they can afford.
“People are feeling very price sensitive,” said Audrey Morse Gasteier, executive director of the Massachusetts Health Connector, the state’s ACA marketplace. “The expiration of the enhanced premium tax credits are putting a lot of people in a position where they’re kind of barely able to hang on in terms of affording coverage. And that’s where we see bronze plans picking up more.”
ACA plans are sold in four main tiers — bronze, silver, gold and platinum — which work on a sliding scale: lower monthly premiums come with higher out-of-pocket costs, while higher premiums mean lower deductibles and copays. (Catastrophic plans, which are limited mostly to people under 30, make up a small share of ACA enrollment.)
Bronze plans cover ACA benefits, including annual physicals, well-woman visits, cancer screenings and prescription drugs. But as the lowest tier, they often require people to pay thousands of dollars out of pocket before most other coverage kicks in.
The average annual deductible for a bronze ACA plan in 2026 is roughly $7,500 for an individual, according to KFF, a nonpartisan health policy research group.
“The idea of the bronze plan was that it would appeal to younger, healthier people,” said Cynthia Cox, director of the program on the ACA at KFF. “You could get a lower premium, you would potentially have a higher out-of-pocket cost, but only if you had a significant health care expense.”
Bivona and her husband fit that profile. Both are young and generally healthy, and she mostly uses her insurance for medications and the occasional doctor’s appointment.
This year, though, the decision wasn’t about what plan made the most sense — it was about what they could afford.
“It makes me so angry,” she said.
Skipping or delaying care
Health policy experts warn that a broad move toward bronze plans could lead more people to delay care, skip treatment or take on debt to pay for medical expenses — even though they technically have health insurance. The consequences could be especially severe for people with chronic conditions who are forced into worse coverage.
“If a person suffers from chronic disease or experiences a health emergency, these high-deductible plans push people into bankruptcy,” said Larry Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University. “Also, with high deductibles, many people will hesitate to go for diagnosis and treatment. These delays can make patients sicker or even cause deaths.”
The change in plan selections stems from the expiration of the enhanced ACA subsidies at the end of last year, which pushed premiums higher and forced many people to prioritize monthly costs over more comprehensive coverage.
Initial federal open enrollment data shows Obamacare sign-ups are down more than 800,000 from last year. The federal data hasn’t yet broken down which plans people selected, leaving data from states — which do release plan selections — as the clearest picture of how coverage choices are changing.
In Rhode Island, the move toward bronze plans has been especially pronounced among new enrollees, state officials said.
As of early January, 38% of new enrollees had selected bronze plans for 2026, up from 15% two years earlier, while silver fell from 53% to 35% and gold dropped from 31% to 25%.
“Bronze plan selection is up significantly and silver and gold selection is down significantly for new customers,” Christina Spaight O’Reilly, communications director for Rhode Island’s ACA marketplace, wrote in an email.
In California, more than a third of new ACA enrollees have chosen bronze plans for 2026, up from about 1 in 5 last year, state officials said. Nearly three-quarters of renewing customers who switched plan tiers also moved to bronze coverage.
Officials in Kentucky, Idaho, Massachusetts, New York and Virginia also reported an increase in plan switching, with many enrollees moving to cheaper options. Data for Arizona, where Bivona lives, isn’t yet available because it’s federal.
Still, Cox of KFF said, it’s better to remain insured than to go without coverage altogether.
Even without the cash to meet a high deductible, she said, the coverage can still protect people from catastrophic medical bills, such as cancer treatment or serious injuries from a car accident.
“The people switching to a bronze plan this year may start to feel like they might as well be uninsured,” Cox said.