Health insurance enrollment in California falls in 2026

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Despite the loss of federal subsidies that lowered costs for millions of people, California’s private health insurance market has remained largely stable 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.

But a closer look shows that Californians are making trade-offs to continue to have health insurance.

More and more members are choosing “Bronze Level” plans. These plans have lower monthly premiums but higher deductibles and co-pays; They cover 60% of medical expenses, leaving members responsible for the rest. One in three new enrollees chose “bronze level” plans by 2026, up from one in four last year, according to Covered California. In addition, 130,000 Californians who renewed their coverage moved from a silver-level plan or higher to a “bronze-level” plan.

“Many Californians value keeping their coverage, but have had to make sacrifices and downgrade plans. We see this as a commitment to the health and value that Covered California offers,” said Jessica Altman, CEO of Covered California.

While bronze-level plans can offer enrollees peace of mind, high deductibles and co-pays tend to deter people from seeking medical care, said Miranda Dietz, director of the UC Berkeley Workforce Center’s Health Care Program.

“These out-of-pocket costs affect people’s decisions about getting medical care, so that’s also a concern,” Dietz said.

People earning more than 400% of the federal poverty level ($62,600 for individuals and $128,600 for a family of 4) are no longer eligible for premium assistance after Congress decided not to extend the subsidies late last year, prompting many to choose plans with lower premiums or drop their Marketplace plans altogether.

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

Another question is whether those who have renewed their coverage or recently enrolled continue to pay their premiums. A clearer picture of who remains enrolled will be known around April, according to Covered California.

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

Affordability of care: a growing point of stress

It’s not known if people who canceled their Marketplace health plans are signing up for other types of insurance. Data from California covered over the past five years show that when people cancel their Marketplace plan, between 10 percent and 14 percent report becoming uninsured.

The Affordable Care Act’s expanded 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 benefited middle-income earners, allowing them access to financial assistance for the first time by capping premiums at 8.5% of their income. This help no longer exists and premiums increased by an average of 10%.

Low-income enrollees remain eligible for standard federal premium assistance available since the launch of the ACA marketplaces. They also benefit from state aid. California allocated $190 million in 2026 to provide state-funded tax credits to people earning up to 165 percent of the federal poverty level ($25,823 for individuals or $53,048 for a family of four), an average of about $45 per month per enrollee.

The end of expanded federal subsidies also comes at a time when, according to survey after survey, Healthcare costs are a growing stressor 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 not receiving medical 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 people have access to the care they need, when they need it, at an affordable cost. Visit www.chcf.org for more information.