For Mikayla Tencer, being self-employed already meant juggling higher taxes, irregular income and the constant pressure of finding her own health insurance. This year, it also meant rethinking how often you could afford to see a doctor.
The 29-year-old content creator from San Francisco paid $168 a month last year for a Blue Shield health plan through Covered California. This year, without the enhanced federal subsidies that expired at the end of December, that same plan would have cost $299 a month, with higher copays.
“People assume that because I'm young, I can choose the cheapest plan and not worry about it,” Tencer said. “But I need regular care, especially for mental health.”
Tencer is among tens of thousands of middle-class Californians facing steep increases in health insurance costs after Congress allowed enhanced federal subsidies for Affordable Care Act plans to expire on December 31.
Those additional subsidies were enacted in 2021 as part of temporary pandemic-era relief, boosting financial help for people buying coverage on state insurance marketplaces like Covered California. The law also expanded eligibility to people earning more than 400% of the federal poverty level, about $62,600 for a single person and $128,600 for a family of four.
With the expiration of enhanced subsidies, people above that income threshold no longer receive federal assistance, and many of those who still qualify are seeing much higher premiums and out-of-pocket costs. In addition to the loss of additional federal benefits, Covered California's average premium this year increased 10.3% due to rapidly rising medical costs.
To reduce her monthly bill, Tencer switched to the cheaper Covered California option, which lowered her premium to about $161 a month. But the savings came with new costs. Primary care and mental health visits now have copays of $60, up from $35.
When she showed up for a psychiatric appointment to manage her ADHD and generalized anxiety disorder, she said, she learned her doctor was out of network.
“That visit before would have cost $35,” he said. “Now it's $180 out of pocket.”
Because of higher costs, Tencer said he has reduced therapy from weekly to biweekly sessions.
“First of all, the subsidies allowed me to be self-employed,” Tencer said. “Without them, I'm seriously thinking about applying for full-time jobs, even though the market is terrible.”
For another self-employed Californian, the increase was even more dramatic.
Krista, a 42-year-old photographer and videographer in Santa Cruz County, relies on expensive monthly intravenous treatments for a rare blood disorder. He asked that his full name not be used, but shared his insurance and medical documents with The Times.
Last year, he paid about $285 a month for a Covered California plan. In late December, he received a notice showing his premium would increase to more than $1,200 per month. The increase was due to the loss of federal subsidies, as well as a 23% increase in the premium charged by Blue Shield.
“It terrified me. I thought, how am I going to retire?” she asked. “What's the point?”
Krista eventually signed up for a plan that cost about $522 a month, almost double what she had been paying, with a $5,000 deductible. He said he can't switch to a cheaper plan because his clinic bills insurance for his treatment at about $30,000 a month, according to medical statements.
To reduce costs and preserve the ability to save for retirement and eventually afford a place of her own, Krista decided to move into a mobile home on private land. The decision came the same week she received notices showing a rent increase and a sharp increase in her health insurance premiums.
Krista said she had been planning for more than a year to find a long-term living situation that would allow her to live independently, rather than continuing to pay more for an apartment.
“No one asks to be sick,” Krista said. “No one should have their life ruined because they are diagnosed with an illness or break a leg.”
Jessica Altman, executive director of Covered California, said about 160,000 Californians lost their subsidies when enhanced federal assistance expired because their income was more than 400% of the federal poverty level.
Although overall enrollment in Covered California this year has remained stable, Altman said, he worries that more people will drop coverage as bills with higher premiums arrive in the mail.
Those fears are already manifesting.
Jayme Wernicke, a 34-year-old receptionist and single mother in Chico who makes about $49,000 a year, said she was transferred from Medi-Cal to a Covered California Anthem Blue Cross plan in late 2023. Her premium rose from about $30 a month to $60, then jumped to about $230 after subsidies expired.
“To me, increasing my health insurance by almost 400% is crazy,” Wernicke said.
Her employer, a small family business, does not offer health insurance. His plan does not include dental or vision care and, he said, barely covers medical costs.
“At a certain point, it seems completely contradictory,” he said. “Either way, I'm losing.”
Wernicke dropped his own coverage and plans to pay for care in cash, figuring the state tax penalty is less than the cost of the premiums. His daughter remains insured.
Two other California residents told the Times they also decided to go without coverage because they could no longer afford it. They declined to provide their full names, citing concerns about the financial and professional consequences.
Under California law, residents without coverage face an annual fine of at least $900 per adult and $450 per child.
One of them, a 29-year-old freelance publicist from Los Angeles, needs medication for epilepsy. Last year, she paid about $535 a month for a silver plan through Covered California. This year, the same plan would have cost $823.
After earning about $55,000 last year, he estimated that paying for health care out of pocket would cost much less. His epilepsy medication costs about $175 every three months without insurance, and his annual doctor visits add up to about $250.
“All of that combined is still a lot less than paying hundreds of dollars each month,” he said.
Another, April, a 58-year-old small business owner in San Francisco, canceled her insurance in December after her quoted premium increased to $1,151 per month for a bronze plan and $1,723 for a silver plan, just for her. Last year, April said she paid $566 for both herself and her daughter. This year, her daughter's premium alone jumped from $155 to $424.
The bronze plan also included a $3,500 deductible for lab tests and specialist visits, meaning she would have had to pay thousands of dollars out of pocket before coverage took effect, on top of the higher monthly premium.
“The subsidies were absolutely what allowed me to sustain my business,” April said. “They were helping me sustain my financial world and have affordable care.”
He rushed to complete medical tests before canceling coverage and expects to go a year without insurance.
“The scariest part is not having catastrophic coverage,” he said. “If something happens, it could be millions of dollars.”
Tencer, the content creator in San Francisco, believes that for the nation to be healthier, affordable healthcare must be universal.
“Our government should provide it.” she said. “People can't go to the doctor for routine checkups, they can't get screenings early, and they can't access the resources they need.”
