Congress is back in session this week, and healthcare is expected to be on the agenda again following the expiry of the Affordable Care Act's enhanced subsidies on Jan. 1.
Whether or not legislators can find a solution to address rising insurance premiums in the coming year remains to be seen, according to a report from NBC News. However, proposals from prominent Republicans late last year leaned on health savings accounts and catastrophic plans as options for enrollees on the marketplaces who are facing a cost spike.
A new analysis from KFF finds that while these plans do tend to carry lower premiums than bronze plan options on the exchanges, catastrophic plans have the highest deductibles by far at a maximum of $10,600.
Bronze plans also tend to carry high deductibles, averaging about $7,000. Enrollment in catastrophic plans has generally been low—accounting for less than 1% of enrollments in 2025—but with premiums rising for those who received the enhanced tax credits, they may become a more attractive option, according to the report.
However, the KFF researchers warn that consumers may lack an understanding of what these plan options mean in the long-term even though the premium levels may be more appealing.
"Lack of understanding of plan options can have far-reaching effects on consumer finances," they wrote. "Price-sensitive consumers shopping for bronze and catastrophic plans can face difficult tradeoffs. While these plans typically have lower premiums than other Marketplace plans, these plans come with higher deductibles."
The brief also notes that while premiums for catastrophic plans are largely the lowest, they've also increased significantly for 2025. While the expiring tax credits were part of the calculation for insurers in their rate filings for 2026, they were also including program integrity measures and a general trend toward higher medical costs in their calculations.
The average premium fora 27-year old in a catastrophic plan in 2026 is $346 each month, up 29% compared to 2025 premium levels. By comparison, the lowest average lowest-cost unsubsidized bronze plan carried a $369 monthly premium for a 27-year-old.
There is notable variation, though, between counties, per the report. For example, in more than half of Oklahoma counties, an unsubsidized bronze plan costs more than $200 less per month compared to the catastrophic plan options.
Access to these plans can also be restrictive, the analysts said. Catastrophic plans are only available to individuals who are under age 30, or those 30 or older who qualify for a hardship or affordability exemption.
The Trump administration has made it easier for people to determine whether they can enroll in these plans by streamlining the paperwork necessary and surfacing them automatically on Healthcare.gov for individuals that have an income below 100% of the poverty level or above 400% of the poverty level (potentially qualifying for the hardship exemption).
The massive reconciliation package, HR-1, also enhanced the availability of HSAs for exchange plans, which may make it easier for some to manage the very high deductibles for catastrophic plans, according to the report.
Insurers submitted rates for 2026 before these changes were unveiled, and that could impact costs in future years.
"The Trump administration’s expansion of catastrophic plan hardship exemptions was not announced until September, after many insurers had already submitted their proposed rates for the 2026 plan year," the researchers said.
"As a result, its effect on pricing for bronze and catastrophic plans is unclear and may affect the relative pricing of bronze and catastrophic plans in future years, with more data on which to base premiums," they said.
In addition, the number of insurers who offer catastrophic plans is limited, according to the report. Payers are required to offer at least one silver and one gold plan in all regions where it operates on the marketplaces, but are not mandated to offer bronze plans in most states.
The report found that catastrophic plans were available in 36 states and the District of Columbia in 2026, decreasing from 40 states and D.C. in 2025. In tandem, the number of enrollees with access to a catastrophic plan decreased from 87% to 76% in that same window.