Health insurance enrollment in California to decline in 2026

from Ana B. IbarraCalMatters

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Despite the loss of federal subsidies that cut costs by millions, California’s private health insurance market has remained nearly flat this enrollment season. A total of 1.9 million Californians renewed their plan or chose one for the first time, down 2.7 percent from last year.

However, a closer look shows that Californians are making concessions to afford to stay insured.

More enrollees are choosing “Bronze Level” plans. These plans have lower monthly premium costs but higher deductibles and co-pays; they cover 60% of medical costs – 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 who renewed their coverage switched from a plan with a silver or higher metal level to bronze.

“Many Californians see value in staying covered, but have had to make sacrifices and downgrade plans. We see this 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 can offer people some peace of mind, high deductibles and co-pays tend to discourage people from seeking care, said Miranda Dietz, director of the Health Care Program at UC Berkeley’s Labor Center.

“Those out-of-pocket costs really affect people’s decisions to get care, so that’s also concerning,” Dietz said.

People earning more than 400 percent of the federal poverty level — $62,600 for an individual and $128,600 for a family of four — are no longer eligible for premium assistance after Congress decided not to extend increased subsidies late last year, prompting many to opt for plans with lower premiums or drop their marketplace plans entirely.

Of the 224,000 middle-income enrollees due to renew, 22 percent have canceled their plans, according to Covered California. New registrations for people in this income group are down 59% compared to last year.

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

“Once you’re actually faced with the prospect of paying that premium and the stress it puts on your budget, it’s entirely possible that some of those people will drop out and the (enrollment) numbers will go down,” Dietz said.

Providing care: a point of increasing stress

It is not known whether people who canceled their marketplace health plans enrolled in other types of insurance. California data covered over the past five years shows that when people drop their Marketplace plan, 10 percent to 14 percent of them report becoming uninsured.

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

Lower-income enrollees remain eligible for a standard federal premium available after the ACA marketplaces start. They also benefit from state aid. California allocated $190 million in 2026 to provide state-funded tax credits for people earning up to 165 percent of the federal poverty level — $25,823 for an individual or $53,048 for a family of four — an average of about $45 a month per enrollee. The end of increased federal subsidies also comes as poll after poll shows health care costs are a growing stress for people. Seven in 10 Californians say health care costs put a financial strain on their household, according to a recent study from the California Health Foundation. Four in 10 have medical obligations and six in 10 report missing care. Meanwhile, eight in 10 Californians say ensuring affordable health care is an “extremely” or “very” important priority for state officials and lawmakers in 2026.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a cost they can afford. Visit www.chcf.org to learn more.

This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.