ObamaCare Plan 2026 Buyers Traded Down

It should come as no surprise that PPACA health plan buyers traded down from the higher tier, more expensive plans to lower tier plans with higher deductibles for the 2026 plan year.  This won't change, even if the Congress extends the pandemic super subsidies (and that is looking ever more unlikely).  Any subsidy extension would have to allow reopening of PPACA health care plan choices to affect this trend:

https://www.politico.com/news/2026/02/04/more-americans-are-picking-higher-deductible-obamacare-plans-possibly-risking-their-health-00763306

More Americans are picking higher-deductible Obamacare plans, possibly risking their health
The loss of enhanced subsidies and premium sticker shock are driving the trend, state officials and policy experts say.
By Robert King - February 4, 2026

More Americans are turning to cheaper Obamacare plans to avoid premium sticker shock, according to preliminary data from states.

But the switch comes with a caveat: thousands in extra out-of-pocket costs that policy researchers say may make people hesitate to get medical care when they are sick or injured.

“I think buying down this year is a reflection of affordability,” said Stacey Pogue, senior research fellow with Georgetown University’s McCourt School of Public Policy. “People who are doing it want to cling on to coverage.”

Rising consumer costs have become a pivotal issue in the battle for control of Congress in the midterm elections this fall, beginning when Democrats blamed Republicans for failing to agree on a plan to extend enhanced subsidies. The impasse triggered a record-length shutdown of the federal government last fall, further highlighting the issue.

Now Republicans and the White House are pushing for ways to address affordability across a range of categories, while Democrats are expected to make soaring premiums on the Affordable Care Act insurance exchanges a key plank of their campaign to retake Congress.

The subsidies’ expiration on Jan. 1 caused annual premiums to spike more than $1,000 on average for subsidized enrollees, according to one estimate from the health research organization KFF.

Signups for 2026 declined by 1.2 million — or five percent — to 22.9 million, compared to 24.1 million in 2025, according to a national enrollment snapshot released by the Centers for Medicare and Medicaid Services for 2026 Obamacare coverage.

The drop — which some experts are concerned will increase as the year unfolds — occurred primarily on the 30 state exchanges run by the federal government, totaling 9 percent. Several of the states running their own exchanges have seen increased enrollment, perhaps in part because they used their own money to compensate for the loss of subsidies for lower-income customers.

But even in those states, officials are noting a significant trend: More Americans are downgrading to so-called bronze tier plans that have lower premiums but higher deductibles — 40 percent higher, by about $2000, compared to the next highest silver tier plan, which offers coverage with a lower deductible and higher premiums.

California, for instance, saw its enrollment hold steady for 2026 with around 1.9 million people choosing coverage, just a 2 percent drop from last year.

However, both new and returning customers are overwhelmingly choosing lower-tier plans. In 2026, more than a third of new enrollees chose bronze plans, compared to less than a quarter last year. For people who stayed in the marketplace, but switched tier levels, 73 percent switched to a bronze plan, compared to 28 percent last year.

Maine also saw more consumers selecting bronze plans. Enrollment increased by more than 10 percentage points compared to the year before. Bronze plans now make up nearly 60 percent of all state plan selections, which include silver, gold and catastrophic plans, according to a press release from the state.

Rhode Island’s exchange saw a slight decrease in enrollment and an explosion of signups for bronze compared to 2025, according to state data shared with POLITICO.

The number of people who chose a bronze plan increased 140 percent, from 848 people for 2025 to 2,053 for 2026. Silver tier enrollments held steady, but gold and platinum tier plans — which have the highest premiums and lowest deductibles — saw declines of 16 percent and 18.6 percent, the state data shows.

CMS is likely to release more data on enrollment this summer, which will give more insight into how many Americans shifted into bronze or catastrophic plans.

What’s in the plan

Bronze plans must cover the same benefits as other plan tiers sold on the ACA’s insurance exchanges. The catch is they require patients to shoulder a greater amount of cost-sharing.

This year, the average bronze plan for an individual had a deductible of $7,476, about 40 percent more compared with $5,304 for a silver plan. In most instances, the full deductible must be paid before any co-pays go into effect.

Another option is catastrophic plans, which have even lower premiums but very high deductibles, averaging $10,600 for an individual and $21,200 for a family. However, these plans are not available in every state and can only be bought by people under 30 or those over 30 who have a hardship exemption.

Several experts say that Americans are making the switch to a lower-tier plan because it’s still better than nothing. But the calculation can come with costs for good health.

“If you have an expensive health care encounter or expensive illness, you will be responsible for paying that deductible entirely out of pocket,” said Emma Wager, senior policy analyst for the Affordable Care Act program for KFF.

Several studies have shown high-deductible plans can be a barrier to care. An April 2025 study published in the Journal of the American Medical Association of more than 300,000 adults showed people in high-deductible plans were less likely to use clinic, lab or prescription drug care across several chroniEc illnesses.

A 2023 study published in the journal Translational Behavioral Medicine analyzed the behavior of nearly 26,000 people with different insurance types. The group with high-deductible plans was less likely to visit physicians, get screenings or receive the flu vaccine, even though the latter two are usually free for preventative care.

Silver problems

There is a quandary for some low-income customers who may be stuck with higher premiums.

Low-income ACA customers who earn between 100 to 250 percent of the federal poverty level (or between $15,560 and $39,125 for an individual) can get a cost-sharing reduction that can dramatically lower their annual deductibles to as little as $80.

To receive a CSR, though, an ACA customer must buy a silver tier plan, even though the premiums are higher than they are for bronze plans. The average lowest cost bronze plan has a monthly premium of $456 compared with $611 for the average lowest silver tier plan. That cost can vary from state to state and could come down with the base ACA subsidy that remains intact.

Last year, roughly half — 53 percent — of all enrollees on the ACA marketplace got some form of CSR attached to silver plans, according to a KFF analysis.

Those individuals now have to weigh paying a much higher premium or risk the much higher bronze plan deductible.

HSA hurdles

Bronze and catastrophic plan holders are now eligible for a health savings account, which enables them to put tax-free money into an account that can be used for a variety of health needs. Those needs can include paying down deductibles, but they can not be used to help pay premiums.

However, an HSA is only as good as the amount of money devoted to it. Right now, bronze plan holders would have to contribute to their own HSAs — an unlikely scenario for people who have downgraded plans because of affordability.

Republicans have pushed for government-funded HSA accounts. One proposal from Sen. Bill Cassidy (R-La.) would convert enhanced subsidy funding into government-funded HSAs.

However, Democrats have been cool to such an approach. Congressional Republicans could decide to add the proposal in a party-line reconciliation bill, but have not finalized whether they will put such a megabill together yet this year.

The question of how many Americans move to bronze and catastrophic plans will continue to play out over the next few months, including what it means for the exchanges, which rely on a healthy population to help maintain the stability of the risk pools.

That stability could be upended if people drop out after using their health coverage and deciding a high deductible isn’t worth it.

“People who drop out are going to be the healthier people,”said Jason Levitis, senior fellow with the left-leaning think tank Urban Institute. “People who are sick and have large health expenses are going to have to find a way to pay their premiums. It is going to be bad for the market.”

States are also watching to see how many people pay their premiums this year or decide to drop out.

It could change the conversation about affordability on the exchanges, Pogue said.

“We saw a lot of attention on whether net premiums are going to be affordable, but moving forward there will be a lot of talk about whether people who cling to coverage are getting care available,” she said.