Peterson-KFF Health System Tracker analysis of 2026 enrollment data shows that 40% of U.S. households lack sufficient assets to cover a typical private plan deductible. A Bronze plan's average $7,186 deductible means most of those households would face serious financial exposure if they needed significant care. In North Carolina, the question of Bronze vs. Silver is not just about monthly premiums, it is about financial risk.
2026 Silver Plan Deductible by Income (with Cost-Sharing Reductions)
Source: Peterson-KFF Health System Tracker, "Higher Premium Payments or Higher Deductibles: The Tradeoffs ACA Enrollees Face," January 2026.
Source: Peterson-KFF Health System Tracker, "How does cost affect access to healthcare?" March 2026.
The Numbers: What Each Tier Costs in 2026
Based on Peterson-KFF Health System Tracker analysis of 2026 ACA marketplace enrollment data, national averages are:
| Plan tier | Avg. gross monthly premium | Avg. deductible (single) |
|---|---|---|
| Bronze | $456 | $7,186 |
| Silver (no CSR, above 250% FPL) | $625 | $5,304 |
| Silver + CSR (200–250% FPL) | $625 | $3,727 |
| Silver + CSR (150–200% FPL) | $625 | $790 |
| Silver + CSR (below 150% FPL) | $625 | $80 |
Actual North Carolina premiums vary by carrier and county. Source: Peterson-KFF Health System Tracker, "Higher Premium Payments or Higher Deductibles: The Tradeoffs ACA Enrollees Face," January 2026.
Bronze costs $169/month less than Silver in gross premium. But at income below 150% FPL, the CSR Silver deductible ($80) is $7,106 lower than Bronze ($7,186). Even one urgent care visit, one prescription fill, or one specialist copay will cost more on Bronze than on Silver for someone who qualifies for that CSR tier.
Who Qualifies for Cost-Sharing Reductions in North Carolina
CSRs are a federal benefit available exclusively on Silver plans for households between 100% and 250% FPL. For 2026, the income thresholds for a single adult are approximately:
- Below 150% FPL: Income below ~$23,475 → Silver deductible averages $80
- 150–200% FPL: Income $23,475–$31,300 → Silver deductible averages $790
- 200–250% FPL: Income $31,300–$39,125 → Silver deductible averages $3,727
- Above 250% FPL: No CSR → Silver deductible averages $5,304 (still $1,882 lower than Bronze)
In 2025, 53% of all marketplace enrollees nationally received CSRs. That means a majority of marketplace shoppers qualify for the enhanced Silver plans. Choosing Bronze instead of Silver if you qualify for CSRs means forfeiting a federal benefit that dramatically reduces your out-of-pocket costs when you actually need care.
To receive CSRs, you must enroll in a Silver plan. Enrolling in Bronze, Gold, or Platinum makes you ineligible regardless of income.
When Bronze Makes Sense in North Carolina
Above 250% FPL, you do not qualify for CSRs. The comparison then is $169/month more in Silver premium vs. a $1,882 lower Silver deductible. Whether Silver is worth it depends on your expected healthcare use:
- If you use only preventive care (which is free on both tiers): Bronze saves you $2,028/year in premium with minimal added risk.
- If you have any regular prescriptions, ongoing specialist visits, or planned procedures: run the full-year total cost. Silver’s lower deductible and out-of-pocket maximum often saves more than it costs in higher premium.
- The 2026 out-of-pocket maximum is $9,450 for a single individual on any ACA plan. Bronze enrollees hit that cap after spending $7,186 in deductible. Silver enrollees hit it after spending $5,304 (or as little as $80).
What National Enrollment Data Shows
In 2025, 56% of marketplace enrollees chose Silver and 30% chose Bronze. The Silver majority reflects the prevalence of CSR-eligible enrollees for whom Silver is almost always the right choice. The 30% in Bronze includes both people above 250% FPL who correctly chose Bronze and those who chose Bronze for the premium without knowing about CSR eligibility.
The Hidden Risk: Having Insurance But Still Forgoing Care
Peterson-KFF data shows that even with insurance, cost barriers remain real. 15% of insured adults delayed or forgone care due to cost in 2024 including 8% who skipped needed medical care and 7% who did without mental health care. A Bronze plan with a $7,186 deductible can leave insured enrollees effectively underinsured for non-catastrophic but still significant medical needs.
Don't Forget Dental: A Separate Cost Barrier
Peterson-KFF data shows that 21% of U.S. adults delayed or went without dental care due to cost in 2023 rising to 47% among uninsured adults and 19% among insured. ACA marketplace plans do not typically include adult dental coverage; it is sold separately as a standalone dental plan or bundled dental-medical option. When comparing Bronze and Silver total costs, account for dental as a separate line item.
Medicaid in North Carolina
North Carolina has expanded Medicaid under the ACA. Adults with household income up to 138% of the federal poverty level (approximately $21,597 for a single adult in 2026) may qualify for Medicaid regardless of employment status. Medicaid has no Open Enrollment window, you can apply year-round. If your income is above the Medicaid threshold, you may qualify for premium tax credits on a marketplace plan. An independent broker can help determine which program fits your situation.
Call (713) 575-9904 for a free Bronze vs. Silver comparison for your North Carolina ZIP code, income, and health situation.