With ACA premium hikes, many are opting for no coverage or cheaper plans

More people appear to be moving away from Affordable Care Act coverage or switching to cheaper plans for 2026 compared to the same period last year, according to early enrollment data from several states.

State health officials from New York, Pennsylvania, Idaho, Colorado and California shared numbers from the first month of ACA open enrollment, which began Nov. 1 and ends Jan. 15 in most states. Idaho opened two weeks early.

It’s too early to know whether the trend will continue, officials said, noting that some people aren’t finalizing their plans until the final days of open enrollment — Dec. 15 for those who want their coverage to begin Jan. 1. But the preliminary numbers could reflect signs of financial hardship for people who can’t afford to pay hundreds of dollars more in monthly premiums once enhanced federal subsidies expire at the end of the year.

Those concerns were likely heightened Thursday after the Senate voted against a Democratic bill that would have extended the subsidies for three more years, making it unlikely that the tax credits will continue in 2026. Without them, millions of people would face double-digit premium increases.

“There’s still a lot to see, but there are certainly some warning signs in terms of the decisions consumers need to make in response to evolving federal policy,” said Jessica Altman, executive director of Covered California, a state-based marketplace for ACA coverage.

Last week, the Centers for Medicare and Medicaid Services released data showing that enrollment nationwide is slightly higher than last year. Experts caution that early snapshots – both state and federal – may not offer the complete picture.

Ellen Montz, former deputy administrator and director of the CMS Center for Consumer Information and Insurance Oversight, said there is even more uncertainty about the data this year because many people may wait to see what happens with the enhanced subsidies before finalizing their coverage decisions.

People may also worry about higher premiums and sign on earlier to buy cheaper plans, she said.

“This open enrollment is unlike any other we have ever experienced,” Montz said in an email. “In typical years, we would caution against drawing conclusions about enrollment totals from the first few weeks of data and this year that caution is even greater. »

Nearly 5.8 million people chose an ACA plan in the first 29 days of open enrollment, according to CMS data, an increase of nearly 400,000 from the same period last year. About 4.8 million people renewed their coverage.

Early state alerts

In Pennsylvania — where monthly premiums are expected to rise more than 100% next year — enrollment of new ACA enrollees is about 20% lower than the past two years, according to Devon Trolley, executive director of Pennie, the state’s health insurance marketplace.

She said the number of people who dropped coverage has more than doubled from last year’s entire open enrollment period — about 40,000 people so far this year, compared to 19,000 last year.

Overall, about 30,000 fewer people signed up for ACA coverage compared to last year.

“I think there’s a lot of uncertainty about what to do, given the ongoing discussions at the federal level,” Trolley said. “I think some people are terminating their coverage and may come back if the enhanced tax credits are extended.”

In Idaho, which began open enrollment Oct. 15, state health officials are seeing a shift from gold and silver plans to bronze, which offer lower monthly premiums but a higher deductible.

Bronze plan selections are up about 5% from the same time last year, said Pat Kelly, executive director of Your Health Idaho, the state’s ACA marketplace. Most of this change – around 4.5 percentage points – comes from silver plans, and 1 percentage point comes from gold.

“This increase in bronze is a strong indicator of affordability concerns,” he said.

People are also dropping their media coverage, Kelly said. Calls to cancel plans mention affordability about three times as often as the same time last year. About 25,000 Idahoans are expected to drop their coverage by the end of open enrollment.

But Kelly added that most people who drop their coverage are replaced by new sign-ups, although he said it’s still unclear exactly what’s driving this trend.

Trolley said she worries that some people will sign up now because they don’t want to go without coverage, only to abandon their plans in the coming months when they realize they can’t afford it.

“We could see some pretty significant drops in February and March because people are trying to pay their premium but realize they can’t do it,” she said.

Montz, the former CMS official, said a clear picture of enrollment may not emerge until HealthCare.gov automatically renews people’s plans on Dec. 15, and people have several weeks to decide whether to cancel those renewals.

“When these numbers are finally released by the administration, I would expect that we will see much greater disenrollments than ever before,” she said.

Coverage is too expensive

In New York, enrollment is trending down about 8% compared to the same time last year, said Danielle Holahan, New York State’s executive director.

The state has not yet analyzed data on people dropping coverage or switching to cheaper plans, although Holahan said they are seeing more people not renewing their coverage.

A large portion of New Yorkers, she added, are already enrolled in bronze plans. New York state officials hope registrations will increase as the Dec. 15 deadline approaches.

“We’re seeing a lot of volume on our website and call center, where people are shopping and looking to learn about their plan options,” Holahan said, “and, we suspect, experiencing sticker shock.”

Covered California’s Altman said registrations are down significantly, more than 30 percent compared to the same time last year.

“They’re looking at their options and saying it’s too expensive,” she said.

State officials are also seeing a “strong movement” toward bronze projects, with more than a third of new ACA enrollees choosing bronze, up from about 1 in 5 last year, she said.

People are also dropping their coverage: about 74,000 cancellations so far, compared to 68,000 at the same time last year. But Altman said that number is still “pretty stable” and will likely stabilize as the state gets closer to the end of open enrollment.

Colorado is also seeing declining enrollment, about 5% lower than the same time last year, said Nina Schwartz, policy and external affairs manager at Connect for Health Colorado, the state’s ACA marketplace.

“Some customers who were previously enrolled in a plan in the Gold or Silver metal tiers are selecting plans in the Bronze metal tier for plan year 2026,” she said in an email.