Congress didn’t throw a lifeline on health care. Why you should act now

Many consumers who buy their own medical coverage through Covered California have been waiting and watching to see whether Congress will save them from higher 2026 premiums, but the time for waiting is over, said Jessica Altman, who leads the state-based health insurance marketplace.

As The Sacramento Bee reported, the Republican-led House passed a health care plan Wednesday that doesn’t include the expiring enhanced premium tax credits that drew millions of Americans to sign up for health plans on Affordable Care Act marketplaces after they were introduced in 2011.

Enrollment soared to more than 24 million people, up from a little more than 11 million, said Altman, Covered California’s CEO, and despite this testament to the need, it’s very unlikely Congress will prevent the premiums increase before Jan. 1. However, Democrats and a small contingent of Republicans made a procedural move to force a January vote on an extension of the enhanced premiums subsidies.

Altman said she hopes this stalemate won’t deter consumers from educating themselves and making a decision about plans. By shopping around, she said, many California residents will find that they can avoid the steep premium increases that they have either read about in the media or been apprised of in letters from her agency.

Do not get bogged down by assumptions that your premium will double or triple, Altman said, because the impact of losing the enhanced credits can vary significantly by income, age and location.

While a renewing customer might have a plan that’s now beyond their reach, she said, they could find others on the marketplace that are closer to the premiums they’re currently paying. Covered California stands ready to act quickly if Congress votes in new subsidies.

“We will make sure, if we do see action from Congress, that people have a window of time to make a different decision,” Altman said. That window, she said, may allow people to get enrolled or to use any subsidies to switch to a plan with lower deductibles and reduced out-of-pocket expenses.

All Covered California plans offer an important financial protection: They set a maximum on annual out-of-pocket expenses that consumers will have to pay if they or their family experience a catastrophic health event.

In silver plans, for instance, that’s $9,800 for an individual and $19,600 for a family, Altman said, and large health care providers often will allow consumers to set up interest-free payment plans to incrementally pay off these debts over years.

If you want coverage that starts Jan. 1, enroll by Dec. 31.

“Call us by 11:59 p.m. on Dec. 31,” Altman said. “If you call us by then, we treat you as though got in line in time. And so even if we actually process things in the next day or two into January, ... you have met the deadline. We will make sure you get there.”

Covered California’s open enrollment period doesn’t end until Jan. 31, but those who sign up for a plan next month won’t have their coverage started until Feb. 1.

You can get help by calling 800-300-1506 or going to coveredca.com. At the website, you can compare plans and choose the one they can afford based on the prices in front of them now.

You can also have a paper application mailed to you in one of 11 different languages, or find the office of an enrolled agent who can meet with you face to face. And, there’s a “help on demand” tool that allows you to request that someone fluent in the language of your choice call you at a set time.

If you are comfortable with online technology and want to finish the application on your own, Altman recommends you go to coveredca.com and click “get started” to fill out the application.

If you’re nervous about sticker shock and want to preview prices, go to the shop and compare tool at the website, enter your basic information and get a picture of costs for different plans. Once you enter your information, you should get an estimate within minutes without having to dig through paperwork.

If you’re overwhelmed or have an unusual situation, Altman said, know that you don’t have to do this on your own. Covered California employs in-house navigators and partners with external enrolled agents at nonprofits and in insurance offices to ensure residents have support.

If you have a chronic condition, the Covered California site has links to health plan formularies and in-network providers. You’ll also find information on out-of-pocket costs there.

To complete the application, you will need:

• Identity information for everyone on the plan (name, date of birth, social security number).

• Immigration status information for non-citizens.

• Income information, including any papers needed to help estimate 2026 income.

If your renewal notice looks brutal, you usually have three levers to pull:

Shop within your current insurer first: Covered California says many households can find a cheaper option inside the same carrier by changing tiers. For instance, a carrier may offer an HMO with a lower premium than a PPO that offers more flexibility on when you can see specialists and where you can get care.

Consider a lower metal tier but understand the trade-off. Bronze tends to mean lower monthly premiums and higher deductibles and out-of-pocket costs. Silver, gold and platinum generally cost more per month but can reduce costs when you need care.

If you’re expecting big-ticket surgery or treatments next year, the higher premiums may be a way of avoiding big out-of-pocket expenses, so talk with a navigator or enrolled agent if you need help.

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