Many ACA enrollees switched to cheaper bronze health care plans. Here’s why that could be risky.

Kate Bivona and her husband don’t know what they would do if they became seriously ill or injured.

Until recently, this was not the case. But starting in January, the monthly cost of their Affordable Care Act insurance jumped by about $300, making it too expensive for them. Bivona and her husband opted for a Bronze plan, cutting their bill by more than half but leaving them with an annual deductible of $18,000.

“You would have to take out a loan,” said Bivona, a 37-year-old musician living in Arizona. “We don’t have that kind of money, maybe a few thousand dollars in savings.”

More and more enrollees are making the same calculation this year: lower premiums now, much 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 change marks a sharp departure from previous years, when most people turned to silver plans that balance higher monthly premiums with lower deductibles. Today, many people opt for the cheapest option available, not because they want to, but because that’s all they can afford.

“People feel very price sensitive,” said Audrey Morse Gasteier, executive director of the Massachusetts Health Connector, the state’s ACA marketplace. “The expiration of enhanced premium tax credits puts a lot of people in a position where they are barely able to hang on in terms of financial coverage. And that’s where we see Bronze plans gaining more popularity.”

ACA plans are sold in four main tiers – bronze, silver, gold and platinum – which operate on a sliding scale: Lower monthly premiums mean higher fees, while higher premiums mean lower deductibles and co-pays. (Catastrophic plans, which are limited primarily to people under 30, account for a small share of ACA enrollment.)

Bronze plans cover ACA benefits, including annual physicals, doctor 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 coverages kick in.

The average annual deductible for an ACA bronze plan in 2026 is about $7,500 for an individual, according to KFF, a nonpartisan health policy research group.

“The idea of ​​the Bronze plan was that it would attract younger, healthier people,” said Cynthia Cox, ACA program director at KFF. “You could get a lower premium, you would potentially have a higher cost, but only if you had significant health care expenses. »

Bivona and her husband fit this profile. Both are young and generally healthy, and she uses her insurance mostly for medications and occasional doctor’s appointments.

This year, however, the decision wasn’t about which plan made the most sense, but rather what they could afford.

“It makes me so angry,” she said.

Skipping or delaying care

Health policy experts warn that a broad shift toward bronze plans could lead more people to delay care, skip treatment or go into debt to pay for medical costs — even if they technically have health insurance. The consequences could be particularly severe for people with chronic illnesses who are forced to opt for worse coverage.

“If someone has a chronic illness or faces a health emergency, these high-deductible plans drive them out of business,” said Larry Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University. “Additionally, with high deductibles, many people will be reluctant to seek diagnosis and treatment. These delays can make patients sicker or even lead to death.”

The change in plan selection stems from the expiration of enhanced ACA subsidies late last year, which drove up premiums and forced many people to prioritize monthly costs over more comprehensive coverage.

Early federal open enrollment data shows Obamacare enrollment is down more than 800,000 from last year. Federal data has not yet detailed which plans people select, leaving state data — which publishes plan selections — as the clearest picture of how coverage choices are changing.

In Rhode Island, the shift toward bronze plans has been particularly pronounced among new enrollees, state officials said.

As of early January, 38% of new enrollees had chosen bronze plans for 2026, up from 15% two years earlier, while silver fell from 53% to 35% and gold from 31% to 25%.

“The selection of Bronze plans has increased significantly and the selection of Silver and Gold plans has decreased significantly for new customers,” Christina Spaight O’Reilly, director of communications for the Rhode Island ACA market, wrote in an email.

In California, more than a third of new ACA enrollees chose bronze plans for 2026, up from about 1 in 5 last year, state officials said. Nearly three-quarters of renewing customers who changed plan levels also upgraded to Bronze coverage.

Officials in Kentucky, Idaho, Massachusetts, New York and Virginia also reported an increase in plan switching, with many enrollees turning to cheaper options. Data for Arizona, where Bivona lives, is not yet available because it is federal.

Still, KFF’s Cox said, it’s better to stay insured than to go without coverage altogether.

Even without the money to cover a high deductible, she said, the coverage can still protect people from catastrophic medical bills, like cancer treatment or serious injuries from a car accident.

“People moving to a bronze plan this year might start to feel like they might as well be uninsured,” Cox said.