Maria Delgado, a self-employed graphic designer in Houston, opened her HealthCare.gov renewal notice in November and felt her stomach drop. The silver plan she had carried for three years would cost $620 a month in 2026, nearly double what she paid the year before. She switched to a bronze plan with a high deductible. “I know the deductible is scary, but I could not afford that premium just to keep the same coverage,” she said.
Delgado is far from alone. Federal CMS public use enrollment files released after the 2026 open enrollment period closed show that the average benchmark silver premium on HealthCare.gov rose roughly 26% compared with 2025. At the same time, bronze-tier selections surged to about 40% of all plan picks, up from around 30% the prior year. Millions of Americans, facing the sharpest premium increases in a decade, chose the cheapest coverage available and accepted the financial risk that comes with it.
Why premiums spiked
The single biggest driver was the expiration of enhanced premium tax credits. First created under the American Rescue Plan in 2021 and extended through 2025 by the Inflation Reduction Act, those subsidies had kept net monthly costs near zero for many lower-income households, even as gross premiums climbed quietly in the background. When the credits lapsed on December 31, 2025, enrollees confronted the full sticker price for the first time in years.
Insurers had already filed double-digit rate requests for 2026, citing rising medical costs, increased use of high-cost specialty drugs like GLP-1 medications, and uncertainty about how the post-subsidy risk pool would behave. State regulators trimmed some requests. In New York, the Department of Financial Services approved final rates below what carriers initially sought but still well above 2025 levels. The pattern repeated across large markets: even after regulatory review, approved increases were steep enough to force difficult choices at the kitchen table.
Federal rule changes added pressure. CMS adjusted cost-sharing limits and actuarial value ranges in its 2026 Benefit and Payment Parameters rule, which governs how insurers design plans at every metal level. Those technical shifts determine how lean a bronze plan can be while still qualifying as minimum essential coverage. Under the rule’s updated parameters, some bronze offerings in 2026 carry individual deductibles above $8,000, meaning enrollees who downgraded to save on premiums now face serious out-of-pocket exposure if they actually need care.
Where the bronze migration hit hardest
The CMS enrollment files include county-level data tracking how enrollees shifted between metal tiers from 2025 to 2026. The pattern is clear: counties with the largest year-over-year premium increases tended to see the greatest movement toward bronze plans. In parts of rural Texas, southern Georgia, and central Florida, bronze selections jumped notably, consistent with a price-driven downgrade.
Silver plans, which had long dominated marketplace enrollment because subsidies are anchored to the silver benchmark, lost ground as the math changed. Without enhanced tax credits narrowing the gap, the monthly cost difference between silver and bronze became too wide for many households to justify. Navigators in several states reported similar conversations throughout the enrollment window, describing families that reluctantly accepted higher deductibles as the only way to stay insured.
What the data does not capture
Plan selection is only half the story. The CMS files record which plans people chose and what they pay in premiums, but they do not track what happens next: whether enrollees delay doctor visits because of high deductibles, whether emergency room use rises among bronze-plan holders, or whether chronic conditions go unmanaged. Health policy researchers have long warned that high-deductible coverage can function as “coverage in name only” for people who cannot afford to use it. Whether that plays out at scale in 2026 will not show up in federal data for months.
There are also gaps in the data itself. The federal marketplace files cover the 32 states using HealthCare.gov but exclude state-based exchanges like Covered California and New York’s marketplace. No single national table of final approved rates exists across all 50 states, making precise comparisons difficult.
Will Congress restore subsidies before 2027?
As of April 2026, several bills to restore some version of the enhanced premium tax credits have been introduced in both chambers, but none has advanced to a floor vote. Without legislative action, the current pricing environment will carry into the 2027 plan year. Insurers are already signaling they expect further rate increases if healthier, younger enrollees drop coverage rather than pay higher unsubsidized premiums, a cycle that would shrink the risk pool and push costs even higher for those who remain.
For the roughly 21 million people enrolled through ACA marketplaces this year, the trade-off is immediate and personal: a lower monthly bill in exchange for the financial exposure of a high-deductible bronze plan. The enrollment data confirms that millions made that calculation. What it cannot yet answer is how many will pay a steeper price when they actually need to use their insurance.
