It’s a turbulent time for low and middle-income Tri-Counties residents who could be facing spikes in health care costs due to what could be the end of federal tax credits.
The state’s Covered California insurance marketplace is working to help people navigate the situation, as they face a December 31 open enrollment deadline for full-year 2026 insurance coverage.
"Covered California, heading into this open enrollment, is covering a record nearly two million Californians. About 90,000 of them live in the Ventura, Santa Barbara, and San Luis Obispo County region," said Jessica Altman, Executive Director of Covered California.
She explained that the organization’s role in helping people find affordable health care coverage.
"We're a marketplace. That's in our name. To be clear, we're not an insurance company, and we are not an insurance agent. We're a free service provided by the State of California to help show you what health insurance options are available to you, and to help you compare them, so you can understand the differences, and pick the one that's best for you."
She added that they're the only place where you can obtain tax credits to lower the cost of coverage. She also talked about who Covered California helps.
"These are people who usually don't have another source to get covered. They're people who are working, but don't have the privilege of an employer offering them coverage. They're sole proprietors, they're in the gig economy, they're working part-time, they're contractors. These are the people who look to Covered California as their source of coverage in California."
Federal credits have been a key component in keeping insurance affordable for some people. As things stand now, the program will expire at the end of this year. It was the central issue in the congressional battle that led to the government shutdown earlier this year.
"In recent years, we've had the greatest level of affordability of coverage since we opened our doors," said Altman. "That's because Congress provided something we call the Enhanced Premium Tax Credits. From the beginning, since the Affordable Care Act, Covered California offered tax credits that lowered the monthly cost of coverage (the premium) for people who are enrolled. But a few years ago, Congress made that more generous to address the fact that some people, even with the original tax credits, still found coverage unaffordable."
The Covered California official talked about how the credits helped.
"They took people already receiving a tax credit, the lowest income people on Covered California, just above eligibility for Medi Cal, and made the credits more generous, and then provided tax credits for middle-income consumers for the first time."
So, while there are hopes for a deal to keep the credits, the current situation is that they will expire at the end of the month.
What will it mean for those who relied on them?
"Most people on Covered California will still be eligible for tax credits, but they'll be less generous. Middle-income enrollees will lose eligibility for their tax credits and will have to face the full cost of the premium. This year is a confusing year, and people are seeing costs higher than the costs they've been paying if they are renewing their coverage. It's important people are informed, and take the time to explore their options."
Altman said that for some people, maintaining insurance coverage after losing the credits may mean making some tradeoffs.
"Most people who are enrolled in Covered California have plans available to them that have lower monthly costs than the plan that they are in," said Altman. "It may mean a tradeoff, like a lower premium with a higher deductible,"
She added that other alternatives include switching from a PPO to an HMO, or sometimes changing insurance companies.
Altman is urging people using Covered California to do some research to determine how to cope with the situation. She says they are also working to increase enrollment. There are an estimated million people statewide who are eligible for Covered California assistance, but remain uninsured.
People can enroll anytime for health coverage through Covered California, but December 31 is the open enrollment deadline for people seeking full-year coverage for 2026.
