Health insurance premiums set to soar for 29,000 Sonoma, Napa Covered California enrollees as subsidies near expiration

More than 23,000 residents in Sonoma County and 5,800 in Napa County could see their health insurance bills soar next year if Congress fails to extend pandemic-era premium subsidies, according to Covered California, the state's health insurance exchange.

Those residents, who purchase coverage through the state exchange, would face average premium increases of 89% in Sonoma County and 85% in Napa County once the enhanced federal tax credits expire.

In Sonoma County, the average net monthly premium — what people pay after tax credits — is about $239. Without the additional subsidies, it would rise by roughly $175. In Napa County, the average net premium of $244 would jump about $171.

The enhanced credits were part of a federal program first adopted during the COVID-19 pandemic and extended through 2025. They capped the amount most enrollees pay for insurance at no more than 8.5% of their household income, expanding eligibility to middle-income earners who previously made too much to qualify for aid. Unless Congress acts, those benefits end Dec. 31.

The fate of those subsidies has become a flashpoint in Washington, D.C., where Democrats are refusing to support a Republican-led funding bill that excludes an extension of the expiring tax credits — a standoff that has now produced the longest federal government shutdown in U.S. history.

If enhanced ACA tax credits expire

What's changing:

Pandemic-era federal subsidies that lowered health insurance costs for millions of Californians are set to end Dec. 31, 2025, unless Congress acts.

How the program worked:

* Capped premiums at 8.5% of household income.

* Expanded eligibility to those earning over 400% of the federal poverty level.

* Covered California says more than 90% of enrollees currently receive tax credits.

Impact in the North Bay:

* Sonoma County: 23,000 residents affected; premiums projected to rise 89% on average.

* Napa County: 5,800 residents affected; premiums projected to rise 85% on average.

* Residents losing all aid: 4,190 in Sonoma, 1,040 in Napa.

* Average monthly subsidy lost: about $500 per household.

Statewide impact:

* Roughly 400,000 Californians—1 in 5 exchange enrollees—could drop coverage.

* California has allocated $190 million in state funds to soften increases, but the federal support totals about $2.5 billion a year.

What to do:

* Shop early: Compare plan options at CoveredCA.com.

* Update your income: Ensure eligibility for any remaining tax credits.

* Enrollment window: Nov. 1 – Jan. 31, 2026.

Jessica Altman, executive director of Covered California, said in an interview this week that the average premium charged by insurers statewide is about $700 a month. More than 90% of enrollees receive federal tax credits, she said, which lower the average monthly bill to roughly $150. If those enhanced tax credits expire, the monthly premium would roughly double to $300.

Thousands would lose all subsidies

Before 2021, Affordable Care Act premium tax credits were given on a sliding scale to those making between 100% and 400% of poverty. During the pandemic, Congress beefed up those tax credits and eliminated the eligibility "cliff" that excluded middle-income earners making more than four times the poverty threshold.

That cliff was replaced with a rule that said no one should pay more than 8.5% of their income on health insurance, Altman said. That means that when the enhanced tax credits expire, middle-income residents will have to pay the full cost of their health insurance plans.

The numbers are significant.

In Sonoma County, 4,190 Covered California enrollees would lose all their subsidies and be forced to pay the full amount of their monthly premium. In Napa County, that number is 1,040 people.

On average, in Sonoma County this middle-income group receives a monthly subsidy of $506 to help pay for a premium that would otherwise cost $988. In Napa County, the average monthly subsidy is $482 for a premium that costs $968.

For North Bay residents, those changes could mean hundreds of dollars more each month in out-of-pocket costs.

"If you're that person making $70,000 a year who is going to lose eligibility for all of your tax credits, you're looking at a really large increase in what you pay each month," Altman said. "You're going from paying 8.5% of your income or less (annually) to paying the full premium."

Altman said there's still a chance Congress will come to some sort of agreement on the government shutdown that will result in an extension of the enhanced tax subsidies. She said Covered California began notifying its enrollees in mid-October how much their premiums would be going up after the enhanced tax credits expire.

"If there is a compromise and an extension out of Washington, we are absolutely ready to implement that as quickly as we possibly can," Altman said.

Local impacts and what's ahead

The Press Democrat this week asked readers how their monthly premiums are being affected. One reader said his premium is rising 12% on a plan that covers a family of four. Another reader said his premium is increasing by $2,500 a month.

There are currently 25,740 residents in Sonoma County enrolled in health insurance plans purchased through Covered California. That number is 6,440 in Napa County.

Altman said her agency estimates that about 400,000 of Covered California's 2 million enrollees statewide could drop their health insurance as a result of the expiring subsidies — roughly 1 in 5. Applied locally, that suggests more than 6,000 residents in Sonoma and Napa counties may abandon their exchange plans.

Altman said Covered California will still be the most affordable place for most of the agency's enrollees to get coverage if their "income situation stays where it is."

"A lot of people — if they're willing to shop, if they're willing to consider other options — do have health plans available on Covered California that cost less than the one that they're enrolled in today," she said.

Altman added that while average monthly premium increases in Napa and Sonoma counties could exceed $170, some residents will see much smaller hikes. The state also allocated $190 million to soften the blow, though she said that "cannot fill the federal hole — the enhanced tax credits are about $2.5 billion a year for California."

Since the enhanced premium tax credits were passed in 2021, enrollment increased by nearly 12% in both counties.

The open enrollment period for 2026 coverage began Nov. 1 and runs through Jan. 31, 2026. Altman said the state agency is trying to be "honest and truthful" about premium hikes and the elimination of enhanced tax credits.

"We're not naive," she said. "Any time you're looking at something getting more expensive — and something as important to people as their health care — this is going to be hard for a lot of people to understand and to make decisions on," she said.

"Of course, it isn't necessarily the final word," Altman added. "There is still a chance that…this government shutdown ends and there is some sort of compromise struck."

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On X (Twitter) @pressreno.