Kate Bivona and her husband don\u2019t know what they would do if either gets seriously sick or injured.<\/p>\n
Until recently, that wasn\u2019t the case. But beginning in January, the monthly cost of her Affordable Care Act insurance<\/a> jumped by about $300 \u2014 making it too expensive for them to afford. Bivona and her husband dropped down to a bronze plan, cutting their bill by more than half but leaving them with an $18,000 annual deductible.<\/p>\n \u201cWe would have to take out a loan,\u201d said Bivona, a 37-year-old musician in Arizona. \u201cWe don\u2019t have that kind of money, maybe a couple of thousand dollars in savings.\u201d<\/p>\n More enrollees are making the same calculation this year: lower premiums now<\/a>, far higher bills later if they need care. <\/p>\n 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.<\/p>\n The shift marks a sharp break from past years, when most people gravitated toward silver plans that balance higher monthly premiums with lower deductibles. Now, many people are opting for the cheapest option available<\/a> \u2014 not because they want to, but because it\u2019s all they can afford.<\/p>\n \u201cPeople are feeling very price sensitive,\u201d said Audrey Morse Gasteier, executive director of the Massachusetts Health Connector, the state\u2019s ACA marketplace. \u201cThe expiration of the enhanced premium tax credits are putting a lot of people in a position where they\u2019re kind of barely able to hang on in terms of affording coverage. And that\u2019s where we see bronze plans picking up more.\u201d<\/p>\n ACA plans are sold in four main tiers \u2014 bronze, silver, gold and platinum \u2014 which work on a sliding scale: lower monthly premiums come with higher out-of-pocket costs, while higher premiums mean lower deductibles and copays. (Catastrophic plans, which are limited mostly to people under 30, make up a small share of ACA enrollment.)<\/p>\n Bronze plans cover ACA benefits, including annual physicals, well-woman 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 coverage kicks in.<\/p>\n The average annual deductible for a bronze ACA plan in 2026 is roughly $7,500 for an individual, according to KFF, a nonpartisan health policy research group<\/a>.<\/p>\n \u201cThe idea of the bronze plan was that it would appeal to younger, healthier people,\u201d said Cynthia Cox, director of the program on the ACA at KFF. \u201cYou could get a lower premium, you would potentially have a higher out-of-pocket cost, but only if you had a significant health care expense.\u201d<\/p>\n Bivona and her husband fit that profile. Both are young and generally healthy, and she mostly uses her insurance for medications and the occasional doctor\u2019s appointment.<\/p>\n This year, though, the decision wasn\u2019t about what plan made the most sense \u2014 it was about what they could afford.<\/p>\n \u201cIt makes me so angry,\u201d she said.<\/p>\n Skipping or delaying care<\/p>\n Health policy experts warn that a broad move toward bronze plans could lead more people to delay care, skip treatment or take on debt to pay for medical expenses \u2014 even though they technically have health insurance. The consequences could be especially severe for people with chronic conditions who are forced into worse coverage<\/a>.<\/p>\n \u201cIf a person suffers from chronic disease or experiences a health emergency, these high-deductible plans push people into bankruptcy,\u201d said Larry Gostin, director of the O\u2019Neill Institute for National and Global Health Law at Georgetown University. \u201cAlso, with high deductibles, many people will hesitate to go for diagnosis and treatment. These delays can make patients sicker or even cause deaths.\u201d<\/p>\n