Californians are staying insured — but settling for health coverage they may not use

Despite the loss of federal subsidies that lowered costs for millions, California’s private health insurance marketplace held nearly steady this enrollment season. In all, 1.9 million Californians renewed their plan or selected one for the first time — a 2.7% drop compared to last year.

A closer look, however, shows Californians are making concessions to afford staying insured.

More enrollees are opting for “bronze-level” plans. These plans have lower monthly premium costs but higher deductibles and copays; they cover 60% of medical expenses — leaving enrollees to pay the rest. One-in-three new enrollees chose bronze plans for 2026, compared to one-in-four last year, according to Covered California. And 130,000 Californians renewing their coverage switched from a silver or higher-metal tier plan to bronze.

“Many Californians see the value in remaining covered, but they had to make sacrifices and shift to lower-tier plans. We see it as a commitment to health and the value that Covered California provides,” Jessica Altman, Covered California’s executive director said in a statement.

While bronze-level plans may offer people some peace of mind, the high deductibles and copays tend to discourage people from seeking care, said Miranda Dietz, director of the Health Care Program at the UC Berkeley Labor Center.

“Those out-of-pocket costs do impact people’s decisions to get care, so that’s worrisome as well,” Dietz said.

People earning above 400% of the federal poverty level — $62,600 for an individual and $128,600 for a family of four — no longer qualify for premium assistance after Congress chose not to extend the enhanced subsidies at the end of last year, pushing many to opt for plans with cheaper premiums or drop their marketplace plans entirely.

Of the 224,000 middle-income enrollees set to renew, 22% cancelled their plans, according to Covered California. New sign ups for people in this income bracket decreased by 59% compared to last year.

Whether those who renewed coverage or newly signed up continue to pay their premiums is another question. A clearer picture of who stays enrolled will emerge around April, Covered California said.

“Once you actually face the prospect of paying that premium and the stress that puts on your budget, it’s entirely possible that some of those folks may fall off, and the [enrollment] numbers might go down,” Dietz said.

Affording care: A growing stress point 

It’s unknown whether people who cancelled their marketplace health plans are enrolling in other types of insurance. Covered California data from the last five years show that when people terminate their marketplace plan, 10% to 14% of them report becoming uninsured.

The Affordable Care Act’s enhanced premium subsidies, first enacted in 2021 as part of federal COVID-19 response, helped lower the insurance costs for millions of Americans. They especially helped middle-income earners by allowing them to qualify for financial assistance for the first time, capping premiums at 8.5% of income. That help is now gone, and premiums are up an average of 10%.

Lower-income enrollees remain eligible for standard federal premium aid available since ACA marketplaces launched. They also benefit from state help. California allocated $190 million in 2026 to provide state-funded tax credits for people who earn up to 165% of the federal poverty level — $25,823 for an individual or $53,048 for a family of four — averaging about $45 a month per enrollee.The end of the enhanced federal subsidies also come at a time when poll after poll shows health care costs are a growing stress point for people. Seven in 10 Californians say health care expenses place a financial strain on their household, according to a recent survey by the California Health Care Foundation. Four in 10 have medical debt and six in 10 report skipping care. Meanwhile, eight in 10 Californians say making health care affordable is an “extremely” or “very” important priority for state officials and lawmakers in 2026.