About 4% fewer Coloradans bought health insurance on the individual marketplace and paid their January premiums, but the head of the state’s exchange considers that a victory, given both projected drops and the reality in other parts of the country.

Connect for Health Colorado planned for a 25% decline in enrollment based on projections from the end of the enhanced Affordable Care Act subsidies put in place during the pandemic, CEO Kevin Patterson said. Instead, about 2% fewer people chose a plan, and 4% fewer paid their premiums for January within the grace period, he said.

The data about people who signed up for coverage starting in February isn’t available yet.

“I was pleasantly surprised,” he said.

The grace period gives customers 90 days to pay to start their coverage, though insurers only have to pay claims within the first month, meaning providers have no way of knowing if the plan will ultimately cover a patient’s care. After the grace period ends, insurance companies can end coverage after one missed payment.

The Colorado Division of Insurance estimated enrollments were down about 6% nationwide. Full information on the number of people who paid their premiums won’t be available until July, but experts looking at incomplete data have come up with estimated drops of 14% and 21%.

Large hospital systems around the country are reporting decreases in admissions of patients with individual market coverage and increases in uninsured patients, according to Becker’s Hospital Review. HCA, which owns the HealthOne hospitals in the Denver area as well as facilities in 17 other states, reported a 16% increase in admissions of uninsured patients in the first quarter compared to the end of last year.

Before 2021, subsidies cut off entirely at 400% of the poverty line, meaning an individual who earned above $63,840 would shoulder the entire cost of their premiums. The enhanced subsidies allowed people earning more than four times the poverty line to qualify for assistance, with the amount gradually decreasing with income.

People with lower incomes also received greater subsidies, allowing them to pay a smaller share of their premium costs. The enhanced subsidies expired at the end of December.

States varied in how much they tried to soften the blow, with Colorado on the more generous end. The state funded an $80-per-month subsidy for marketplace policyholders with incomes less than four times the poverty line, with an additional $29 a month for their covered dependents.

More than two-thirds of the 286,501 enrollees in Colorado received federal tax credits to offset some of the cost of their coverage. Three in five also received state-level assistance.

Still, marketplace enrollees in Colorado will pay a combined $19 million more in premiums per month this year than they did in 2025 because the enhanced tax credits expired, according to Connect for Health Colorado.

Premiums averaged $131 a month for people who received both state and federal assistance. For people who qualified for neither, the average premium was $616.

Health policy experts raised concerns that younger and healthier people would have sticker shock and be more likely to roll the dice by going uninsured. If that happened, the remaining people in the market would be more expensive to cover, driving premiums upward in the next year and prompting more people to drop out. If the cycle repeated enough times, it could send markets into a “death spiral.”

So far, the Colorado market doesn’t show any signs of that cycle, though, of course, information about enrollees’ pre-existing conditions isn’t known, Patterson said.

The number of enrollees over 55 and living in rural areas both dropped about 6%, which was higher than the dip for younger people and urban residents, Patterson said. Older and rural people on the marketplace are more likely to have higher incomes, meaning they faced a greater increase in premiums when the subsidies ended, he said.

Data from 16 other states that run their own marketplaces also showed sharper declines in customers over 55 than in younger people, according to the State Marketplace Network. The federally run exchange hasn’t yet released detailed enrollment information.

The distribution of plan levels on the Colorado marketplace remained essentially unchanged, with 40% selecting silver plans, 31% choosing bronze and 29% going for gold. People who didn’t receive subsidies were slightly more likely to choose bronze plans than in the previous years, however.

The plan levels come with trade-offs. Bronze plans have lower premiums and higher out-of-pocket costs if someone gets sick. Gold plans have higher monthly costs, but lower copays and deductibles, while silver plans fall in the middle.

Other states saw a pattern of consumers moving toward bronze plans, according to an analysis of sign-ups in state-run exchanges by HealthInsurance.org. About 40% chose a bronze plan for 2026, compared to 30% in 2025.

Generally, about 1% of enrollees drop their marketplace plans because they can’t pay their premiums, get jobs with insurance, or have some other change in circumstances, Patterson said. Cancellations will likely be higher this year, but no one is quite sure how many to expect, he said.

“Families are trying to prioritize basic needs, and they’re trying to fit in health insurance where they can,” he said. “We will be watching this, I think, pretty closely this year.”

Sign up for our weekly newsletter to get health news sent straight to your inbox.