Medicaid/CHIP Monthly Enrollment Tracker

Name: Total Enrollment in Medicaid/CHIP, February 2020 to July 2026
Creator: KFF

Published: Oct 30, 2026

Section:

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Note: The data presented below are updated monthly as new Medicaid/CHIP enrollment data become available.

This tracker presents the most recent data on monthly Medicaid and Children’s Health Insurance Program (CHIP) enrollment reported by the Centers for Medicare & Medicaid Services (CMS) as part of the Performance Indicator Project. It includes data for Medicaid and CHIP and reports enrollment data for children and adults. The data are generally the most recent data available and are useful for reporting trends in Medicaid enrollment. However, the data only capture full-benefit enrollees, excluding those who receive limited benefits, such as those who receive family planning services only, and consequently, do not provide a full count of the total population enrolled in Medicaid. Additionally, these data cannot be used to monitor changes in enrollment by eligibility pathway, including for adults in the Medicaid expansion group.

The 2025 reconciliation law included significant changes to Medicaid, including requiring adults in the expansion group and in certain 1115 waiver programs to meet new work and reporting requirements starting January 2027. These changes are expected to reduce Medicaid enrollment over the next 10 years relative to what would have been expected under current law. Enrollment data for the full Medicaid population is available here, and for more information on how implementation of Medicaid work requirements is affecting Medicaid expansion enrollment, please see Tracking Implementation of the 2025 Reconciliation Law Medicaid Work Requirements.

Medicaid/CHIP Historical Enrollment Trends

Medicaid/CHIP Current Enrollment Trends

The figures below show Medicaid and CHIP enrollment from February 2020 through the most current month of available data. Figures include enrollment for adults and children in Medicaid/CHIP and for Medicaid only and CHIP only. Key enrollment data and trends as of July 2026 include:

There were 72.9 million people enrolled in Medicaid/CHIP nationally (Figure 1). Medicaid enrollment declined by 5.1 million or 7% from July 2025 through July 2026 (Table 1).
Total Medicaid/CHIP enrollment has decreased in 49 states and DC since July 2025. Enrollment changes since July 2025 vary from a 1% increase in Iowa to a 18% decrease in Indiana (Figure 2).
Child enrollment in Medicaid/CHIP has decreased in 49 states and DC from July 2025 through July 2026. Adult enrollment has decreased in all but 5 states (IA, MO, NC, OK, SD)(Figure 2).
There were 65.7 million people enrolled in Medicaid and 7.2 million people enrolled in CHIP (Figure 1). Since July 2025, Medicaid enrollment has decreased in 49 states and DC while CHIP enrollment has increased in 17 states (AL, CA, CT, DE, FL, HI, IL, MO, NJ, NC, ND, OK, SC, TN, VT, WA, WY).
Total Medicaid/CHIP enrollment was 2% higher in July 2026 compared to enrollment in February 2020, prior to the pandemic. However, in the 49 states and DC with complete enrollment data by age, the number of children enrolled in Medicaid/CHIP declined by 1,110,000 or 3% from February 2020 to July 2026 (Figure 2 and Table 1).

Figure 1

Annual Percent Change in Medicaid/CHIP Enrollment (July 2025 to July 2026) (Column Chart)

Total Medicaid/CHIP Enrollment, Selected Time Periods (Table)

Note: The data on unwinding renewal outcomes presented below were last updated on September 12, 2024; since most states have now completed the Medicaid unwinding, the information will not be updated again.

As of September 12, 2024 and with nearly complete unwinding data for most states:

Over 25 million people were disenrolled (31% of completed renewals) and over 56 million people had their coverage renewed (69% of completed renewals).
Disenrollment rates varied across states from 57% in Montana to 12% in North Carolina, driven by a variety of factors including differences in renewal policies and procedures as well as eligibility expansions in some states.
Among those who were disenrolled, nearly seven in ten (69%) were disenrolled for paperwork or procedural reasons while three in ten (31%) were determined ineligible.
Among those whose coverage was renewed during the unwinding, 61% were renewed on an ex parte, or automated, basis, meaning the individual did not have to take any action to maintain coverage.

State Data on Renewal Outcomes

The data on unwinding-related renewal outcomes presented in this section rely primarily on monthly reports that states were required to submit to the Centers for Medicare & Medicaid Services (CMS) during the unwinding period. The data also reflect updates to the monthly reports that states submit three months after the original report submission to account for the resolution of pending cases and any other changes in renewal metrics. For 13 states, data were pulled from dashboards or reports published on state websites that provide more complete information, and for a few additional states, updated monthly reports were pulled from state websites because they were more timely than what is reported on the CMS website.

To view archived data for specific states, click on the State Data - Archived tab.

As of September 12, 2024, States Have Reported Renewal Outcomes for Nearly Nine Out of Ten People Who Were Enrolled in Medicaid/CHIP Prior to the Start of the Unwinding (Donut Chart)

Medicaid Disenrollments

As of September 12, 2024, at least 25,198,000 Medicaid enrollees had been disenrolled during the unwinding of the continuous enrollment provision. Overall, 31% of people with a completed renewal were disenrolled in reporting states while 69%, or 56.4 million enrollees, had their coverage renewed.
There is wide variation in disenrollment rates across reporting states, ranging from 57% in Montana to 12% in North Carolina. A variety of factors contribute to these differences, including differences in renewal policies and system capacity. Some states adopted policies that promote continued coverage among those who remain eligible and/or have automated eligibility systems that can more easily and accurately process renewals while other states have adopted fewer of these policies and have more manually-driven systems. In addition, North Carolina and South Dakota adopted Medicaid expansion and other states increased eligibility levels for certain populations (e.g., children, parents, etc.) during the unwinding, which may have lowered disenrollment rates in these states.

At Least 25,198,000 Medicaid Enrollees Have Been Disenrolled and 56,378,000 Have Had Their Coverage Renewed, as of September 12, 2024 (Stacked Bars)

Across all states with available data, 69% of all people disenrolled had their coverage terminated for procedural reasons. However, these rates vary based on how they are calculated (see note below). Procedural disenrollments are cases where people are disenrolled because they did not complete the renewal process and can occur when the state has outdated contact information or because the enrollee does not understand or otherwise does not complete renewal packets within a specific timeframe. High procedural disenrollment rates are concerning because many people who are disenrolled for these paperwork reasons may still be eligible for Medicaid coverage.

(Note: The first tab in the figure below calculates procedural disenrollment rates using total disenrollments as the denominator. The second tab shows these rates using total completed renewals, which include people whose coverage was terminated as well as those whose coverage was renewed, as the denominator. And finally, the third tab calculates the rates as a share of all renewals due, which include completed renewals and pending cases.)

Of All People Who Were Disenrolled, 69% Were Terminated for Procedural Reasons, as of September 12, 2024 (Stacked Bars)

Medicaid Renewals

Of the people whose coverage has been renewed as of September 12, 2024, 61% were renewed on an ex parte basis while 39% were renewed through a renewal form, though rates vary across states. Under federal rules, states are required to first try to complete administrative (or “ex parte”) renewals by verifying ongoing eligibility through available data sources, such as state wage databases, before sending a renewal form or requesting documentation from an enrollee. Ex parte renewal rates varied across states from 90% or more in Arizona, North Carolina, and Rhode Island to less than 20% in Pennsylvania and Texas.

Overall, 61% of People who Retained Medicaid Coverage Were Renewed Through Ex Parte Processes, as of September 12, 2024 (Stacked Bars)

Federal Data on Renewal Outcomes

The data presented here are cumulative unwinding metrics published by CMS. These counts and percentages may differ from the above data, which present renewal metrics reported on state websites when state-reported data are more complete.

Figure 1 below shows cumulative renewal data reported by CMS during states’ unwinding periods. Renewal data for the months after the end of states’ unwinding period are excluded. The data reflect updated unwinding data reported by states three months after the original monthly reports as they become available.

Cumulative Medicaid Renewal Outcomes for Reporting States Through August 2024 (Stacked Bars)

For questions about this tracker, please contact KFFTracker@kff.org

Note: The state data presented below were last updated on September 12, 2024; since most states have now completed the Medicaid unwinding, the information will not be updated again.

The data presented here provide state-level data on enrollment trends and renewal outcomes during the unwinding period. Figure 1 shows total Medicaid enrollment by month starting in January 2023 and, once disenrollments resumed in a state, the cumulative percent change in Medicaid enrollment relative to the month before Medicaid disenrollments started (this baseline month will differ across states). Figure 2 shows renewal metrics for each month of a state’s unwinding period (or cumulative data for the unwinding period for some states).

For total national Medicaid enrollment, click on the Enrollment Data tab.

Resources on unwinding data

Resources on state policies and preparations for the unwinding

Resources on pre-pandemic enrollment patterns and coverage transitions

KFF’s unwinding explainer

10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision

Implementation of Immigrant Eligibility Restrictions for ACA Marketplace Subsidies Under the 2025 Reconciliation Law: Issues to Consider

Authors: Akash Pillai, Drishti Pillai, and Samantha Artiga

Published: Oct 30, 2026

Introduction

The 2025 reconciliation law includes new eligibility restrictions for many lawfully present immigrants for federally funded health programs, including subsidized Affordable Care Act (ACA) Marketplace, Medicaid and the Children’s Health Insurance Program (CHIP), and Medicare coverage. Undocumented immigrants are already ineligible for federally funded health coverage under longstanding policy.

Beginning January 1, 2027, the 2025 reconciliation law will limit eligibility for Marketplace subsidies, including for all premium tax credits (PTCs) and cost-sharing reductions (CSRs), to lawfully present immigrants who are lawful permanent residents (LPRs or “green card” holders), Cuban and Haitian entrants, and people residing in the U.S. under Compacts of Free Association (COFA). These restrictions will eliminate eligibility for Marketplace coverage subsidies for many groups of lawfully present immigrants, including refugees and asylees without a green card and individuals on work visas, among others. The Congressional Budget Office (CBO) estimates that this provision will reduce federal spending by $91.4 billion and lead to an additional one million individuals becoming uninsured by 2035, with most of the coverage losses occurring in 2027, the year the provision takes effect. The law also eliminated access to subsidized Marketplace coverage for all lawfully present immigrants earning less than 100% of the federal poverty level (FPL) who were not eligible for Medicaid due to immigration status, including those in the five-year waiting period for coverage, beginning January 1, 2026. The CBO estimates that this provision will lead to an additional 200,000 individuals becoming uninsured and reduce federal spending by $27.3 billion over the 2026 to 2035 time period.

The Centers for Medicare and Medicaid Services (CMS) released guidance on how the federally facilitated exchange (FFE) will verify immigrant eligibility for subsidies during the 2027 plan year Marketplace Open Enrollment Period, which starts November 1, 2026. State-based exchanges (SBEs) are also required to implement the immigrant eligibility restrictions for subsidies, but outreach and immigration status verification procedures may vary from the FFE. Lawfully present immigrants who are no longer eligible for subsidies under the new restrictions can purchase Marketplace coverage at full cost. However, unsubsidized coverage will likely be unaffordable for many amid rising ACA Marketplace premiums due in part to the expiration of enhanced premium tax credits and other federal policy changes. Beyond those losing coverage due to ineligibility and cost, there may also be coverage losses among individuals who remain eligible for subsidies but have challenges understanding or responding to notices requesting information and documentation to verify their eligibility. This brief provides an overview of implementation of the immigrant eligibility changes for Marketplace subsidies and issues to consider for affected individuals and states.

Marketplace Subsidy Immigrant Eligibility Changes

Starting January 1, 2027, the 2025 reconciliation law will restrict eligibility for PTCs and income-based CSRs to LPRs or “green card” holders, Cuban and Haitian entrants, and people residing in the U.S. under COFA (Table 1). The guidance refers to these groups as “eligible noncitizens.” The law eliminates eligibility for Marketplace subsidies for many other groups of lawfully present immigrants, including refugees and asylees without a green card and individuals on work visas, among others. The law also eliminated access to Marketplace subsidies for lawfully present immigrants earning less than 100% FPL who were not eligible for Medicaid due to immigration status, including those in the five-year waiting period for Medicaid coverage, beginning January 1, 2026. Lawfully present immigrants who do not have an “eligible noncitizen” status still may purchase a qualified health plan (QHP) through the Marketplace at full cost without subsidies if otherwise eligible. However, the coverage will likely be unaffordable for many without subsidies. Prior to the 2025 reconciliation law, undocumented immigrants were already ineligible for federally funded health coverage. Deferred Action for Childhood Arrivals (DACA) recipients are also ineligible to purchase ACA Marketplace coverage under recent federal regulation changes and the 2025 reconciliation law.

Noncitizen Status Eligibility for Subsidized ACA Marketplace Coverage (Table)

Implementation of Immigrant Eligibility Changes in the FFE

Starting with plan year 2027, the FFE will conduct eligibility determinations for current noncitizen enrollees and new applicants consistent with the new rules for Marketplace subsidies. In the 29 states that use the FFE or a state-based marketplace on the federal platform, the Open Enrollment Period for the 2027 plan year begins November 1, 2026. CMS encourages current noncitizen Marketplace enrollees to ensure their applications are updated with their most recent immigration status by the last day to enroll in or change plans. New noncitizen applicants applying for coverage through the FFE will be asked to attest to whether they have eligible noncitizen status when applying for subsidies or if they have a different lawfully present status that is not eligible for subsidies. Enrollees and applicants may need to provide updated documents or document information, such as their passport number, Permanent Resident Card, Employment Authorization Document (EAD), among others to help the FFE verify their immigration status.

The FFE will use immigration-document information and automated data matching to verify whether current noncitizen enrollees and new applicants meet the new subsidy eligibility requirements. The FFE will automatically verify immigration status through the Department of Homeland Security (DHS) Systematic Alien Verification for Entitlements (SAVE) system using existing information. Current noncitizen enrollees will continue to receive subsidies if the FFE can verify eligible noncitizen status using the information available in their enrollee profile or through a new SAVE verification, provided the enrollee remains otherwise eligible. New applicants determined to have an eligible noncitizen status will also be able to enroll in a plan with subsidies if they meet all other eligibility requirements. While CMS did not discuss potential issues with the SAVE system in this guidance, in previous guidance to states regarding immigrant eligibility restrictions in Medicaid, it noted that SAVE provides “point in time” verification and does not update prior verification responses when there is a change in immigration status or category. As such, potentially affected enrollees may have applied for and been granted adjustment to LPR status or may have another eligible status that is not reflected in SAVE.

Noncitizen enrollees and applicants who attest to having an eligible noncitizen status, but whose status cannot be automatically verified by the FFE, will receive a 95-day period to submit documentation from when the notice of the verification is sent by the FFE. Individuals may be eligible to enroll in subsidized Marketplace coverage during this time. Eligible documentation may include a Permanent Resident Card (also known as a “green card”), an EAD, or an arrival/departure record (I-94/I-94A). In addition to requesting documentation to resolve issues verifying eligible noncitizen status for subsidies, the FFE may also request additional documentation if it cannot verify that an individual is lawfully present. Enrollees will be required to repay any PTC received during the 95-day period in future tax filings if they are found to be ineligible for subsidies. Other proposed changes from the Internal Revenue Service (IRS) to implement provisions of the 2025 reconciliation law would eliminate income-based caps on such repayment amounts.

Current noncitizen Marketplace enrollees who do not take any action to update their applications by the plan selection deadline for coverage and whose eligible noncitizen status cannot be verified by the FFE will lose subsidies effective January 1, 2027. Re-enrolling consumers whom the FFE determines as no longer lawfully present will lose eligibility for Marketplace coverage entirely effective January 1, 2027. CMS does not provide any information as to whether determinations of individuals as no longer lawfully present will be used for immigration enforcement purposes.

The FFE will automatically re-enroll current enrollees who are determined lawfully present but ineligible for subsidies into a Marketplace plan without subsidies, and they will be responsible for paying the unsubsidized monthly premiums unless they cancel coverage. Enrollees can cancel their coverage through their online Marketplace account or by contacting the Marketplace Call Center. If enrollees do not cancel their plan, they will be responsible for paying the unsubsidized monthly premiums if they are auto-enrolled into a QHP without subsidies. If the enrollee does not pay the unsubsidized monthly premium, the enrollee would be subject to the grace period policy set by the plan issuer or applicable state laws, in contrast to the three-month grace period provided to those receiving subsidized coverage. Individuals who lose coverage due to nonpayment of premiums would have to wait until the next Open Enrollment Period to re-enroll in Marketplace coverage unless they qualify for a Special Enrollment Period. Individuals may also be able to appeal coverage cancellation decisions by plan issuers due to nonpayment of premiums.

The FFE updated Marketplace websites and platforms and is sending targeted notices about immigrant eligibility changes. Prior to the start of the 2027 plan year Open Enrollment Period, applications on HealthCare.gov and Enhanced Direct Enrollment partner platforms were updated to highlight that only U.S. citizens and certain lawfully present noncitizen statuses qualify for financial assistance. The FFE is sending several targeted notices to affected enrollees, including the following:

Current enrollees whose eligible noncitizen status cannot be verified through DHS SAVE will receive tailored Marketplace Open Enrollment Notices (MOEN) explaining that they will lose PTCs and CSRs unless they update their application and submit documentation to confirm their eligible noncitizen status.
Enrollees whom the FFE determines as no longer eligible for Marketplace subsidies will receive a Marketplace Eligibility Determination Notice explaining that they are ineligible for PTCs and CSRs due to their immigration status and their appeal rights.
Enrollees whom the FFE determines as no longer eligible for Marketplace coverage due to immigration status will receive a notice explaining that their Marketplace enrollment will end, their appeal rights, and additional options available to them. If an enrollee in a multi-member household is found no longer eligible for Marketplace coverage, the FFE will designate another eligible household member as the primary plan subscriber.

SBEs used by 22 states, including DC, may use different outreach and verification procedures compared with the FFE. CMS notes that the guidance is specific to the FFE and that noncitizen enrollees and applicants in states that operate their own exchange should follow guidance issued by their SBE. States with SBEs are required to verify eligible noncitizen status for subsidies for all noncitizen enrollees and applicants during the 2027 plan year Open Enrollment Period, though states have varying Open Enrollment timelines. CMS indicates that SBEs will have access to the same immigration status verification system (Federal Data Services Hub Verify Lawful Presence service) used by the FFE and have a direct connection to DHS SAVE, in addition to technical assistance from CMS.

Issues to Consider

Lawfully present immigrants without an eligible noncitizen status would still be eligible to purchase Marketplace coverage at full cost, but it would likely be unaffordable. Premiums have increased due in part to the expiration of enhanced PTCs and other policy changes, which have coincided with Marketplace enrollment declines, and premiums are expected to keep rising in 2027. If an enrollee loses coverage due to nonpayment of premiums, they may be responsible for any medical bills incurred during the period of nonpayment. Providers may also request that individuals pay the full cost of care out of pocket, or they may not provide care until the premiums are paid.

Some individuals who remain eligible for subsidized Marketplace coverage may still lose coverage due to challenges verifying eligibility or fear and confusion. CMS noted in previous guidance to states regarding immigrant eligibility restrictions in Medicaid that SAVE may not be accurate as it provides “point in time” verification and may not reflect that potentially affected enrollees have since applied for and been granted adjustment to an eligible noncitizen status. As such, some individuals may have an eligible noncitizen status even if it is not verified through a data match through SAVE. However, they would need to submit documentation to verify that eligibility. Individuals may have difficulty understanding new eligibility rules and whether they remain eligible for subsidies. Eligible enrollees may also face challenges submitting required documentation to verify eligible noncitizen status. Confusion and fears about enrolling in coverage may be amplified by other immigration policies like public charge and other increased federal immigration enforcement actions.

Individuals who become uninsured will be left with limited options for comprehensive coverage and care. Individuals who become uninsured may visit community health centers for free or sliding fee scale health care services, but they may have access to a limited scope of services. Some states offer fully state-funded coverage programs for immigrants regardless of status, which may be a coverage option for those losing eligibility for subsidized Marketplace coverage. However, several states have recently scaled back state-funded coverage programs for immigrants or have reached enrollment caps due to budget pressures and higher than expected demand. New Mexico is using state funds to provide coverage with premium subsidies through a state-based exchange to lawfully present noncitizens losing subsidized ACA Marketplace coverage, as well as DACA recipients.

Broader changes to Marketplace coverage may also impact immigrant families. As noted, the elimination of caps on repayment amounts means that all enrollees, including immigrant enrollees, who received excess PTCs will need to repay excess amounts without any limit. Additionally, beginning in the 2028 tax year, all individuals who are eligible for PTCs will not be able to receive them until the Exchange verifies their eligibility, including household income, health coverage status or eligibility for coverage, place of residence, family size, and immigration status. As such, individuals will no longer be able to receive PTCs while this information is being verified and can choose to pay full price for their premium while the verification is in process or pending their plan selection. This could have a disproportionate effect on immigrants and may leave families with mixed immigration status to make a difficult decision between covering some family members but not others.

States operating SBEs may face increased administrative burden to conduct outreach, reverify enrollees, and update systems and other materials to reflect new immigrant eligibility rules. State pressures may be compounded since they are implementing these changes at the same time they are implementing Medicaid immigrant eligibility restrictions as well as work requirements and more frequent eligibility redeterminations for ACA expansion adults.

9 Things to Watch for the 2027 ACA Open Enrollment Period

Authors: Matt McGough, Rayna Wallace, Justin Lo, Kaye Pestaina, and Cynthia Cox

Published: Oct 30, 2026

The Affordable Care Act (ACA) Marketplace 2027 Open Enrollment period starts November 1, 2026, in most states. In 2026, the enhanced premium tax credits expired, provisions of the 2025 budget reconciliation law (the “One Big Beautiful Bill Act”) began to take effect, and Trump administration regulations began to change Marketplace coverage, with effects expected to carry into 2027 enrollment. Further changes in the ACA Marketplaces are again expected in 2027.

Here are the nine things to know for the 2027 Open Enrollment period:

1. Premiums are going up by double-digits, but most people get a subsidy.

While insurers proposed a median premium increase of 15%, the average increase in finalized benchmark silver premiums for 2027 is 13%, marking a second consecutive year of double-digit proposed increases (these premiums rose by 26% from 2025 to 2026). In states that use the Healthcare.gov platform, benchmark silver premiums are increasing 11%, whereas states that run their own enrollment platforms are seeing premium increases of 16%. From 2025 to 2026, HealthCare.gov states saw a 30% increase, whereas state-based Marketplaces saw a roughly 17% increase in benchmark premiums.

ACA Marketplace Benchmark Silver Premiums Are Expected to Increase by Double Digits for the Second Straight Year in 2027 (Column Chart)

In their rate filings, insurers point to a higher-than-usual increase in the underlying cost of care, which is not unique to the ACA Marketplaces; some employer plans have also seen steep cost increases.

ACA Marketplace insurers also cite the expiration of the enhanced premium tax credits and the resulting changes in the risk pool as factors contributing to higher premiums. KFF’s analysis of insurer filings found that insurers estimated risk pool changes added about four percentage points on average to premiums in 2026 and expect a similar, additional effect in 2027.

Most enrollees get a subsidy that will cushion the impact of these increases in 2027. However, people with incomes above 400% of the federal poverty level (FPL) will be particularly hard hit because they no longer qualify for premium tax credits and must pay the full cost of coverage. Sharp premium increases in 2027 follow even steeper increases going into 2026. These higher costs may lead additional healthier enrollees to drop coverage, further worsening the risk pool and putting additional upward pressure on premiums.

ACA Marketplace Benchmark Silver Premiums Have Increased by 42% on Average Between 2025 and 2027 (Table)

2. Marketplace enrollment is declining following the expiration of enhanced premium tax credits, and may continue to fall for other reasons.

Enrollment in the ACA Marketplaces declined following the expiration of the enhanced premium tax credits. During the 2026 Open Enrollment Period, Marketplace plan selections fell by 1.2 million from 2025. By February 2026, effectuated Marketplace enrollment (i.e., people who pay their premiums and remain enrolled) was down 12% (or 2.6 million people) from the previous year to 19.2 million people. More recent Marketplace-specific enrollment data are not yet available, but enrollment data for the individual market suggest the decline may have continued through the first half of 2026. Data for the broader individual market, which includes both Marketplace coverage and plans purchased directly from insurers or brokers, show a continued decline. Individual market enrollment fell 18% by June 2026, from 25.2 million to 20.5 million people—a loss of more than 4.6 million.

Looking ahead to 2027, several insurers have said they expect the market to continue to deteriorate in 2027 as a continued result of the enhanced premium tax credits ending. Some enrollees who were able to keep coverage in 2026 may no longer be able to make ends meet.

As discussed more below, anti-fraud efforts and changes to eligibility for tax credits affecting certain immigrants will also have a downward effect on Marketplace enrollment. In its latest projections, the Congressional Budget Office (CBO) estimated ACA Marketplace enrollment would fall from a peak of 22.4 million in 2025 to 13.1 million in 2027.

3. Insurer exits outnumber new entrants.

The number of insurers participating in the ACA Marketplaces is expected to decrease again in 2027, with more insurers announcing plans to exit the Marketplace than to enter. As of October 29, 2026, 11 carriers had announced plans to exit at least one state for 2027, while seven carriers had announced plans to enter a new state. Shrinking Marketplace enrollment after the expiration of the enhanced premium tax credits has reduced the potential market for insurers and raised concerns about the future of the risk pool. The changes will vary across states, but in some areas, consumers will have fewer insurers to choose from in 2027. Cigna, for example, is leaving the individual market in all 11 states where it currently participates.

Insurer exits can reduce competition and leave consumers with fewer choices of plans and provider networks and disrupt coverage for some enrollees.

4. Some state-based Exchanges have backfilled lost enhanced federal tax credits.

Some states that operate their own Exchanges are using state-funded subsidies to help offset the expiration of the enhanced premium tax credits, with several continuing or expanding assistance in 2027. New Mexico went furthest in 2026, fully backfilling the lost federal assistance for Marketplace enrollees. While enrollment declined nationally, New Mexico saw Marketplace enrollment grow during the 2026 Open Enrollment Period. The state is continuing its assistance in 2027.

Other states provided more limited assistance in 2026 and may expand eligibility in 2027. California, for example, is continuing state-funded premium subsidies but is expanding its program to partially backfill lost enhanced tax credits for households with incomes between 165% and 200% FPL. Previously, only households with incomes between 138% and 165% FPL were eligible for state assistance to replace any portion of the expired enhanced tax credits. Several other states have also maintained subsidy programs such as New Jersey, while Rhode Island and Virginia moved to create new state-specific subsidies for the 2027 plan year. These state efforts may help some consumers afford coverage despite the loss of federal assistance, but the amount of support available varies by state and income.

5. Recent federal actions to address fraud may affect enrollment counts and make it more difficult for enrollees needing brokers’ services in 2027.

Recent initiatives to combat Marketplace broker fraud could impact counts of the number of enrollees this Open Enrollment cycle, the availability of enrollment assistance, and certain agent and broker practices in 2027. Some provisions that attempt to address fraud by placing new requirements on consumers have been temporarily paused due to court action (discussed more below).

In September 2026, HHS reported they cancelled coverage for approximately 760,000 individuals who CMS says were “phantom” enrollees, meaning a broker or agent may have signed them up without their knowledge. HHS sent a list of about 1.2 million people to insurers to review. These individuals had been signed up by an agent or broker, had no premium payment and were missing a Social Security number or immigration document that could be verified in real time. If insurers were unable to make contact with these individuals or verify they had incurred claims, CMS cancelled the coverage. There are reports that some enrollees have had their coverage reinstated suggesting that the criteria CMS used to identify potential fraud may have also flagged legitimate enrollees. Others who lost coverage through these efforts may not have their coverage restored.

Additionally, HHS is implementing new safeguards on certain agents, brokers, and web-broker practices that put consumers at risk of inappropriate or fraudulent enrollments. This follows investigations of brokers and other related entities moving enrollees to different plans or enrolling them in Marketplace coverage without their knowledge. For instance, the HHS Notice of Benefit and Payment Parameters for 2027 updates standards of conduct for agents, brokers, and web-brokers regarding prohibited marketing tactics, including but not limited to providing cash, monetary rebates, or cash equivalents to persuade consumers to enroll in coverage; falsely claiming that consumers will always qualify for zero-dollar insurance or zero-dollar premiums; and providing false information on enrollment timelines and deadlines. Agents, brokers, and web-brokers must submit marketing materials to HHS upon request in response to monitoring, auditing, or enforcement activities. Agents, brokers, and web-brokers that contract with a third party or other entity to produce marketing materials must ensure that those entities follow the requirements that apply to agents, brokers, and web-brokers.

In September 2026, HHS announced an even more stringent restriction that temporarily pauses the registration of new agents and brokers in the federally facilitated Marketplace and for Marketplaces that operate on the federal platform until February 2027. CMS estimates that approximately 19,000 new agents and brokers would have registered absent the temporary restriction. Combined with the reductions in Navigator funding for 2026 announced in February 2025, consumers may have less access to enrollment assistance in 2027.

6. Some lawfully present immigrants will no longer qualify for subsidized Marketplace coverage in 2027.

Currently, subsidized ACA Marketplace coverage is available to lawfully present immigrants. Lawfully present immigrants include lawful permanent residents (LPRs or green card holders), people on work visas, and humanitarian immigrants such as refugees, victims of human trafficking, asylees, among others. Undocumented immigrants are not eligible to purchase ACA Marketplace coverage, even at full cost. While immigration statuses eligible to purchase ACA Marketplace coverage have not changed for 2027, the 2025 budget reconciliation law limits eligibility for tax credits in the Marketplace to only certain groups of lawfully present immigrants including:

Lawful permanent residents
Cuban and Haitian entrants, as defined in section 501(e) of the Refugee Education Assistance Act of 1980
Any lawful residents living in the U.S. under the Compact of Free Association

Other lawfully present immigrants such as refugees, victims of human trafficking, and asylees, can still purchase Marketplace coverage but will no longer be eligible for premium tax credits. Without subsidies, many may be unable to afford their premiums and could drop coverage. CBO estimates that one million more individuals will be uninsured as a result of this provision by 2035.

7. Enrollees will face the elimination of repayment limits.

Beginning in the 2026 tax year, limits that previously capped how much some Marketplace enrollees had to repay in excess premium tax credits were eliminated as enacted through the budget reconciliation law (“The One Big Beautiful Bill Act”). Because the first tax filings under the new rules will not happen until early 2027, enrollees will choose 2027 plans without having seen how uncapped repayment works in practice. Those whose incomes end up higher than projected may face larger tax bills than they expect, and accurately estimating income and updating it when circumstances change will be especially important for people near income thresholds for premium tax credits or cost-sharing reductions.

Some enrollees may be able to lower their modified adjusted gross income (MAGI) through contributions to accounts such as health savings accounts (HSAs) or traditional individual retirement accounts (IRAs). These contributions could increase premium tax credits or help people near 250% FPL qualify for cost-sharing reductions (CSRs). However, HSA contributions are available only to people enrolled in HSA-eligible plans, and not everyone has the funds to contribute. Because Marketplace assistance is based on projected annual income, enrollees considering this approach may also need to update their income estimates during the year.

8. Consumers who are denied or removed from Medicaid coverage for not meeting work requirements will also be ineligible for premium tax credits.

Starting in 2027, in states required to implement Medicaid work requirements, consumers who lose or are denied Medicaid coverage solely for not meeting work requirements will also be ineligible for subsidized Marketplace plans in these states. Prior to the budget reconciliation law, a consumer who was denied Medicaid coverage or disenrolled from Medicaid could sign up for Marketplace coverage as long as they met Marketplace eligibility requirements. Because income eligibility for Medicaid references a monthly income whereas Marketplace premium tax credits are based on an estimated annual income, consumers may be concurrently eligible for both, especially in Medicaid expansion states. While this is likely a small group of people, it may include individuals who recently lost a job and who would likely not meet the Medicaid work requirements.

When the budget reconciliation law was signed, only Georgia had Medicaid work requirements in place; the law now requires 43 states and the District of Columbia to implement work requirements by the start of 2027. Exclusion from ACA tax credits based on failing Medicaid work requirements will apply to adults in Medicaid expansion states and those that are covered under Medicaid Section 1115 waiver programs to expand coverage. People who lose Medicaid coverage as a result of these requirements, including those who are working or qualify for an exemption but fail to navigate reporting rules, may face challenges finding affordable coverage because they will remain ineligible for premium tax credits until they are no longer eligible for Medicaid for reasons other than not meeting work requirements (such as a change in income).

9. Litigation has halted implementation of some Marketplace requirements for 2027.

Litigation challenging two final regulations that make substantial changes to Marketplace requirements – the 2025 program integrity rule and the HHS Notice of Benefit and Payment Parameters for 2027 – have halted implementation of many new rules for the time being. Four key cases are working their way through the courts: The 2025 program integrity rule was challenged in City of Columbus et al. v. Kennedy (Columbus I ) and California et al. v. Kennedy (California I). Litigation over the 2027 Payment Notice is also ongoing in City of Columbus et al. v. Kennedy (Columbus II) and California et al. v. Kennedy (California II), with some provisions of the 2027 Payment Notice stayed as the litigation continues.

The state of play after several court decisions over the past year include the following:

Failure to reconcile requirement: For plan year 2027, consumers will not be disqualified from receiving premium tax credits if they fail to file and reconcile prior years’ premium tax credits. So, for example, an enrollee who failed to file their tax return and reconcile for the 2025 tax year in 2026, will not lose subsidies for 2027 coverage.
Expansion of eligibility for catastrophic plans: A 2025 announcement expanded who can enroll in catastrophic plans, allowing individuals who were not eligible for premium tax credits or other cost-sharing help because their projected income was below the federal poverty level or above 250% FPL to sign up for catastrophic coverage. This expanded eligibility has been temporarily paused due to a June decision in Columbus II. This means only a narrow group of people including individuals under age 30, those whose Marketplace or employer coverage would cost more than 8.5% of their income, and those who qualify for a hardship exemption can enroll in these plans during open enrollment.
Other requirements are not in place for now or have been vacated. Due to litigation, CMS has stated that it will not implement a long list of final requirements. This includes certain income verification requirements, network adequacy requirements, and the elimination of standardized health plans. In addition, other requirements, including an Administration rule that would prohibit states from including gender-affirming care as an essential health benefit and a rule that would have shortened the Open Enrollment Period to nine weeks, have been vacated.

Medicare Part D Premiums and Cost Sharing in 2027

The average premium for Part D stand-alone drug plans will increase substantially if current enrollees do not switch to lower-premium plans.

Authors: Juliette Cubanski, Meredith Freed, and Nancy Ochieng

Published: Oct 30, 2026

As Medicare’s open enrollment period for 2027 gets underway, Medicare beneficiaries have an opportunity to examine their coverage options and make changes. For Medicare Part D prescription drug coverage, the average beneficiary has 28 Medicare Advantage prescription drug plans (MA-PDs) and 9 stand-alone prescription drug plans (PDPs) to choose from, with varying costs associated with these different options. This analysis examines premiums and cost-sharing requirements for Part D coverage in 2027 and how these costs have changed over time, based on Medicare plan landscape and benefits data from the Centers for Medicare & Medicaid Services (CMS).

Takeaways

The estimated average enrollment-weighted monthly premium for Medicare Part D stand-alone PDPs is projected to be $51 in 2027, a 50% increase from $34 in 2026 (based on June 2026 enrollment), assuming current enrollees keep their same plan for 2027. While CMS projected a modest $1 increase in the national average premium, from $35 to $36 (based on September 2026 enrollment), they did not explain the method used in the calculation. It’s possible CMS assumed switching to lower-cost plans, which would produce a lower enrollment-weighted average premium for 2027 than our estimate of $51, and it is likely that the actual average PDP premium for 2027 will be lower than $51 after accounting for plan choices by new enrollees and switching by current enrollees during open enrollment. If PDP enrollees who are not receiving Part D Low-Income Subsidies (LIS) keep their current plan in 2027, more than half (55% or 7.5 million) will pay premiums of less than $20 per month but nearly 30% (3.9 million) will pay at least $100 per month.
Monthly premiums for drug coverage are estimated to be more than 5 times higher for PDPs compared to MA-PDs in 2027 – $51 versus $9. The average monthly Part D premium is projected to increase by $17 for PDPs but by less than $2 for MA-PDs. MA-PD sponsors can use rebate dollars from Medicare payments to buy down their Part D premiums, as well as provide extra benefits, but these funds are not available to sponsors for PDPs. The MA-PD premium is also heavily weighted by zero premium plans, with nearly 8 in 10 MA-PD enrollees paying no premium for drug coverage in 2026.
Three-fourths of PDP enrollees without low-income subsidies (76% or 10.4 million) will pay a higher monthly premium in 2027 if they make no changes during open enrollment, compared to 56% of enrollees who faced a higher premium for their plan in 2026. This includes 4.1 million PDP enrollees without LIS who are enrolled in zero premium PDPs in 2026 and who will face higher premiums next year because no zero premium PDPs are available in 2027. Among the 10.4 million PDP enrollees facing a premium increase, 2.4 million will see their monthly premium increase by more than $50 if they stay in their same plan for 2027. By comparison, only 38,000 enrollees faced a premium increase larger than $50 per month in 2026. The Trump administration’s decision to discontinue the Part D Premium Stabilization Demonstration after 2026 ended the additional premium subsidies that were provided to PDP sponsors and the cap on the maximum allowable monthly PDP premium increase, which was set at $50 for 2026. (Monthly premiums could increase by more than $50 in 2026 for PDPs that did not participate in the demonstration.)
Average monthly premiums for the 8 national PDPs are projected to range from around $6 to $204 in 2027. Among national PDPs, the two lowest-premium plans are Centene’s Wellcare Value Script Rx, an enhanced PDP with an average premium of $6.50 for 2027 (up from $5.80 in 2026) and Wellcare Classic, a basic PDP with an average premium of $10.90 for 2027 (up from $8.60 in 2026). The national PDPs with the highest average monthly premiums are United’s AARP Medicare Rx Preferred ($204.50, up from $126.00 in 2026) and Humana Premier Rx Plan ($137.40, up from $119.60 in 2026).
Most Part D enrollees will face a deductible for drug coverage in 2027, including 85% of MA-PD enrollees (up from 80% in 2026) and virtually all PDP enrollees (99.8%, up from 96% in 2026), based on current enrollment. The average Part D deductible in 2027 will be $643 for PDP enrollees (up from $540 in 2026) and $489 for MA-PD enrollees (up from $360 in 2026). The standard Part D deductible in 2027 is $700, up from $615 in 2026.
Most Part D enrollees will face coinsurance rather than copayments for both preferred brands and non-preferred drugs, which can mean less predictable out-of-pocket costs. For preferred brands, most MA-PD enrollees (83%) will face median coinsurance of 20%, and virtually all PDP enrollees (99.8%) will face median coinsurance of 25%. For non-preferred drugs, 89% of MA-PD enrollees will face median coinsurance of 29% and all PDP enrollees will face median coinsurance of 35%. For 2027, the 50% of PDP enrollees enrolled in Centene’s Wellcare PDPs will face coinsurance of 15% for drugs on a new injectable drug tier. For specialty tier drugs (those that cost more than $1,080 per month), median coinsurance will be 25% for PDP enrollees and 26% for MA-PD enrollees.

Premiums

The Average Monthly Premium for Medicare Part D Stand-Alone PDPs Is Projected to Be $51 in 2027, a 50% Increase From $34 in 2026, Based on Current Enrollment

If PDP enrollees keep their current plan, the average monthly PDP premium will increase from $34 in 2026 to $51 in 2027. While CMS projected a modest $1 increase in the national average premium (from $35 to $36, based on September 2026 enrollment), they did not explain the method used in the calculation. It’s possible CMS assumed switching to lower-cost plans, which would produce a lower enrollment-weighted average premium for 2027 than our estimate of $51. After accounting for plan choices by new enrollees and switching by current enrollees during open enrollment, it is likely that the actual average PDP premium for 2027 will be lower than $51 (Figure 1).

The Average Monthly Premium for Medicare Part D Stand-Alone Prescription Drug Plans Is Projected to Be in 2027, But Will Likely Be Lower After Plan Changes During Open Enrollment (Grouped column chart)

For comparison, at the beginning of open enrollment in October 2025, the average monthly premium for PDP coverage was estimated to increase from $37 in 2025 to $44 for 2026, based on enrollment at that time, but after accounting for changes during open enrollment, the actual weighted average premium in 2026 was $34, as existing enrollees switched to and new enrollees joined lower-premium plans.

If the 13.6 million PDP enrollees without Part D Low-Income Subsidies (LIS) in 2026 keep their current plan for 2027, more than half (55% or 7.5 million) will pay premiums of less than $20 per month, but none will pay zero monthly premium and nearly 30% (3.9 million) will pay $100 per month or more. In 2026, 30% of these enrollees are paying zero monthly premium and 20% are paying $100 per month or more (Figure 2).

If PDP Enrollees Keep Their Current Plan for 2027, More Than Half (55%) Will Pay Less Than Per Month, While Nearly 30% Will Pay 0 or More (Split Bars)

PDP Enrollees Will Pay Higher Monthly Premiums Than MA-PD Enrollees in 2027 – an Estimated $51 versus $9, on Average

The estimated average monthly PDP premium for 2027 is more than 5 times larger than the average monthly premium for drug coverage in MA-PDs – $51 versus $9 (Figure 3). Between 2026 and 2027, the average monthly premium is increasing by $17 (50%) for PDPs and $2 (20%) for MA-PDs. MA-PD sponsors can use rebate dollars from Medicare payments to lower or eliminate their Part D premiums and offer extra benefits, but there is no equivalent rebate system for PDPs. According to MedPAC, Medicare Advantage monthly rebates per enrollee have more than doubled since 2018, from $95 to $199 in 2026, and of the $199 total monthly rebate amount in 2026, $51 was used to reduce MA-PD Part D premiums. The MA-PD premium is also heavily weighted by zero premium plans, with nearly 8 in 10 MA-PD enrollees paying no premium for drug coverage in 2026.

The Average Monthly Premium for Drug Coverage Is Substantially Higher for Medicare Part D Stand-Alone Prescription Drug Plans Compared to Medicare Advantage Drug Plans (Split Bars)

Three-Fourths of PDP Enrollees Without Low-Income Subsidies Will See an Increase in Their Monthly Premium in 2027 if They Make No Changes During Open Enrollment

Out of 13.6 million PDP enrollees without LIS in 2026, 10.4 million (76%) will pay a higher monthly premium in 2027 if they keep their current plan. This includes 4.1 million enrollees in PDPs that charge no monthly premium in 2026, who will pay higher premiums in 2027 because there are no zero premium PDPs available in 2027. Of the 10.4 million non-LIS PDP enrollees facing higher premiums for their current plan, 2.4 million will see their monthly premium increase by more than $50 if they stay in their same plan for 2027. Among the 24% (3.2 million) of non-LIS PDP enrollees facing a premium reduction, most (2.6 million) will see a decrease of $5 or less (Figure 4).

Three-Fourths (76%) of PDP Enrollees Without Low-Income Subsidies Will See An Increase In Their Monthly Premium in 2027 If They Make No Changes During Open Enrollment (Stacked Bars)

By comparison, 56% of PDP enrollees were facing a premium increase for their same plan for 2026, but less than 1% (38,000 enrollees) faced a premium increase larger than $50 per month. The Trump administration’s decision to discontinue the Part D Premium Stabilization Demonstration after 2026 ended the additional premium subsidies that were provided to PDP sponsors and the cap on the maximum allowable monthly PDP premium increase, which was set at $50 for 2026. (Monthly premiums could increase by more than $50 for PDPs that did not participate in the demonstration.)

Average Monthly Premiums for the 8 National PDPs Are Projected to Range from Around $6 to $204 in 2027

Part D premiums for 2027 vary widely across plans, as well as across regions for the same plan, as in previous years (Figure 5). Among the 8 PDPs that will be available in all 34 PDP regions in 2027, the two lowest-premium plans are Centene’s Wellcare Value Script, an enhanced PDP with an average premium of $6.50 for 2027 and Wellcare Classic, a basic PDP with an average premium of $10.90 for 2027. Both PDPs were available for zero monthly premium in many areas in 2026, but no zero premium PDPs are available in 2027. Among the most expensive national PDPs are United’s AARP Medicare Rx Preferred and Humana Premier Rx Plan, with average monthly premiums for 2027 of $204.50 and $137.40, respectively.

Average Monthly Premiums for Stand-Alone Prescription Drug Plans in 2027 Are Projected to Range from a High of 4 to a Low of Around (Bar Chart)

Monthly premiums for several national PDPs vary widely around each plan’s average. For 6 of the 8 national PDPs, there is a difference of $90 or more across the 34 PDP regions between the plan’s lowest and highest premiums. For example, the average monthly premium for AARP Medicare Rx Preferred is $204, but ranges from $136.70 to $264.50 across regions. The monthly premium for AARP Medicare Rx Saver averages $98 but ranges from $10.30 to $235.30 across regions. And for Humana Basic Rx, the average premium is $16 but ranges across regions from $6.30 to $169.60.

Medicare Part D enrollees in national PDPs will face a range of premium changes if they keep their current plan in 2027. Enrollees in United’s AARP branded PDPs face significant premiums increases if they don’t switch plans for 2027 – $78.50 for AARP Medicare Rx Preferred (a 62% increase) and $48.10 for AARP Medicare Rx Saver (a 97% increase) (Figure 6).

Part D Enrollees in the National PDPs in 2026 Will Face a Range of Premium Changes for 2027 If They Make No Changes During Open Enrollment (Split Bars)

Most Part D Enrollees Will Pay a Drug Deductible in 2027, Including 85% of MA-PD Enrollees and Virtually All PDP Enrollees

The share of MA-PD enrollees in plans that charge a deductible for Part D coverage will increase from 80% in 2026 to 85% in 2027 if they do not switch plans. Nearly all stand-alone PDP enrollees (99.8%) will also be enrolled in plans that charge a deductible for drug coverage in 2027, up from 96% in 2026 (Figure 7). (Some enrollees in these plans receive low-income subsidies that cover their deductible.)

Most Part D Enrollees Will Be in Plans That Charge a Deductible for Drug Coverage in 2027, Including Virtually All Stand-Alone Drug Plan Enrollees (99.8%) and 85% of Medicare Advantage Drug Plan Enrollees (Stacked Bars)

The weighted average Part D deductible in 2027 will be $643 for PDP enrollees and $489 for MA-PD enrollees (the standard Part D deductible is increasing from $615 in 2026 to $700 in 2027). Although the average Part D deductible is higher for PDP enrollees, MA-PD enrollees are facing a larger increase in the average deductible than PDP enrollees between 2026 and 2027 – an increase of $128 (36%) for MA-PD enrollees versus $103 (19%) for PDP enrollees (Figure 8).

Average Deductibles for Part D Coverage Will Be Higher in 2027 Than in 2026 (Split Bars)

Most Part D Enrollees Will Face Coinsurance Rather Than Copayments for Preferred Brands and Non-Preferred Drugs in 2027

Part D enrollees face much higher cost-sharing amounts for brands and non-preferred drugs (which can include both brands and generics) than for drugs on a generic tier, and most Part D enrollees face coinsurance rather than copayments for drugs on formulary tiers other than generics. Coinsurance can mean less predictable out-of-pocket costs than copayments. The typical five-tier formulary design in Part D includes tiers for preferred generics, generics, preferred brands, non-preferred drugs, and specialty drugs.

Most Part D enrollees now face coinsurance for both preferred brands and non-preferred drugs, with the share of MA-PD enrollees facing coinsurance for preferred brands increasing from 54% in 2026 to 83% in 2027, and 89% of MA-PD enrollees facing coinsurance for non-preferred drugs, similar to 2026. Nearly all PDP enrollees will face coinsurance for preferred brands and non-preferred drugs in 2027, the same as in 2026.

Among all Part D plans, median standard cost sharing in 2027 for different types of drugs is (Figure 9):

Generics: For preferred generics, enrollees face copayments of $4 in PDPs and $0 in MA-PDs, and for other generics, copayments of $20 in PDPs and $5 in MA-PDs.
Preferred brands: For preferred brands, virtually all PDP enrollees face a median coinsurance of 25%; 83% of MA-PD enrollees face a coinsurance of 20% and 17% face a median copayment of $47.
Non-preferred drugs: For non-preferred drugs, which can include both brands and generics, all PDP enrollees face a median coinsurance of 35%; 89% of MA-PD enrollees face a median coinsurance rate of 29% and 11% of MA-PD enrollees face a median copayment of $100.
Specialty drugs: Median coinsurance for specialty drugs is 25% for PDP enrollees and 26% for MA-PD enrollees.

Most Medicare Part D Enrollees Will Face Coinsurance Rather Than Copayments for Preferred Brands and Non-Preferred Drugs in 2027 (Split Bars)

Part D enrollees in the PDPs that were available on a national basis in 2026 face median copayments ranging from $0 to $5 for preferred generics in 2027, while median copays for drugs on the standard generic tier will range from $1 to $20 (Figure 10). Median coinsurance ranges from 16% to 25% for preferred brands; from 30% to 50% for non-preferred drugs, and from 25% to 30% for specialty drugs. New for 2027, Centene has added an injectable drug tier with coinsurance of 15% and combined the two generics tiers into one for its Part D plans, with a copayment of $20 in its two Wellcare PDPs.

Medicare Part D Stand-Alone Drug Plan Enrollees Typically Face Coinsurance Rather Than Copayments for Drugs on Formulary Tiers Other Than Generics in 2027 (Split Bars)

News Release

The Average Monthly Premium for Medicare Part D Stand-Alone Plans Is Projected to Increase by 50% From $34 to $51 in 2027 Unless Enrollees Switch to Lower-Cost Plans

Published: Oct 30, 2026

A new KFF analysis finds that the average monthly premium for Medicare Part D coverage in stand-alone prescription drug plans (PDPs) will increase to $51 in 2027, up 50% from $34 in 2026, if current enrollees don’t switch into lower-premium plans during open enrollment, which runs through December 7.  

The analysis of premium and cost-sharing requirements for Part D coverage in 2027 also finds that the projected average monthly premium of $51 for PDPs is more than five times higher than the drug coverage premium in Medicare Advantage plans that offer Part D coverage (MA-PDs), which is projected to average $9 per month next year. The estimated $17 increase in the average monthly PDP contrasts with an expected increase of less than $2 in monthly premiums for drug coverage through MA-PDs. 

“With some plans increasing premiums substantially, the stakes are higher this year for people with Medicare stand-alone drug coverage if they sit on the sidelines during open enrollment,” said Juliette Cubanski, a vice president and director of the Program on Medicare Policy at KFF. “There are relatively low-premium PDP options, but people facing large premium increases need to take action if they want to avoid paying significantly more.”

Most PDP enrollees who are not receiving extra financial subsidies provided to low-income enrollees will pay higher premiums in 2027 if they don’t switch to cheaper plans, including more than 4 million enrollees who are currently enrolled in PDPs that charge zero premium. This is because there are no zero premium PDPs available in 2027.

Average monthly premiums for the eight national PDPs are projected to range from around $6 to $204 in 2027. The lowest-premium national PDP is Centene’s Wellcare Value Script Rx, with an average premium of $6.50 for 2027, up from $5.80 in 2026. The highest-premium national PDP is United’s AARP Medicare Rx Preferred, with an average monthly premium of $204.50, up from $126.00 in 2026.    

The analysis also finds that most Part D enrollees will face a deductible of several hundred dollars for drug coverage in 2027, including 85% of MA-PD enrollees (up from 80% in 2026) and virtually all PDP enrollees (99.8%, up from 96% in 2026), based on enrollees keeping their current plans. In 2027, Part D plans are allowed to charge a deductible up to $700, an increase from $615 in 2026, but can charge a lower amount. On average, the Part D deductible in 2027 will be $643 for PDP enrollees (up from $540 in 2026) and $489 for MA-PD enrollees (up from $360 in 2026).  

Most Part D enrollees also will face coinsurance rather than copayments for both preferred brands and non-preferred drugs, which can mean less predictable out-of-pocket costs. 

Contact

Chris Lee

clee@kff.org

What’s in a Name? From Today’s Medicare to Medicare for All

Author: Larry Levitt

Published: Oct 29, 2026

In this JAMA Health Forum post, KFF’s Larry Levitt explains how proposals to create Medicare-for-All promise more generous benefits than the existing Medicare program, with no premiums or cost-sharing, but could end up looking more like Medicare if it became the subject of a serious national debate about the tradeoffs involved to implement it.

Tracking Insurer Participation Changes in the ACA Marketplaces in 2027

Authors: Jared Ortaliza, Justin Lo, Lynne Cotter, Matt McGough, and Cynthia Cox

Published: Oct 28, 2026

Editorial Note: Originally published on June 11, 2026, this brief has been updated to reflect additional information about carriers’ plans for 2027.

As of October 28, 2026, 11 carriers have announced that they will exit the ACA Marketplaces in plan year 2027, either in some or all states that they are currently offering plans; seven carriers have announced they will enter new state Marketplaces. These changes in insurer participation follow the expiration of the enhanced premium tax credits at the end of 2025, which drove sign-ups to fall by over a million from the 2025 to 2026 Open Enrollment Periods—with further membership declines in the ACA Marketplaces expected as the year progresses. ACA Marketplace enrollment declines affect the size of the potential market for insurers, and, potentially, the risk pool—to the extent that healthier than average enrollees are more likely to drop coverage.

As people leave the Marketplace, insurers may reassess the profitability of their Marketplace participation and decide to pull out in the future. Cigna has decided to leave the individual market in 2027 to focus on other segments given the lack of potential to grow their ACA Marketplace business. Cigna, which reported first-quarter on-exchange enrollment of over 350,000 individuals, will exit the 11 states in which it currently participates both on- and off-exchange. In some cases, multiple insurers are announcing exits in the same state. In some states, with fewer insurers participating in the ACA Marketplaces, remaining insurers will have less competition and consumers will be left with fewer choices.

Changes in Insurer Participation for 2027 (Table)

Explaining Health Care Reform: Questions About Health Insurance Subsidies

Published: Oct 28, 2026

Health insurance is expensive and can be difficult to afford for people with lower or moderate incomes. The Affordable Care Act (ACA) provides sliding-scale subsidies that lower premiums and requires that insurers offer plans with reduced out-of-pocket (OOP) costs for eligible individuals purchasing their own health coverage.

This brief provides an overview of the financial assistance provided under the ACA for people purchasing coverage on their own through health insurance Marketplaces (also called exchanges).

Health Insurance Marketplace Subsidies

There are two types of financial assistance available to Marketplace enrollees. The first type, called the premium tax credit, reduces enrollees’ monthly payments for insurance coverage. The second type of financial assistance, the cost-sharing reduction (CSR), reduces enrollees’ deductibles and other out-of-pocket costs when they go to the doctor or have a hospital stay. To receive either type of financial assistance, qualifying individuals and families must enroll in a plan offered through a health insurance Marketplace.

Premium Tax Credits

Premium tax credits can be applied to Marketplace plans in any of four “metal” levels of coverage: bronze, silver, gold, and platinum. Bronze plans tend to have the lowest premiums but have the highest deductibles and other cost sharing, leaving the enrollee to pay more out-of-pocket when they receive covered health care services, while platinum plans have the highest premiums but very low out-of-pocket costs.

Also offered on the Marketplace are catastrophic health plans, which can have even lower premiums and higher cost sharing compared to bronze plans. Catastrophic plans are generally only available to individuals younger than 30, and premium tax credits cannot be applied to these plans.

Who is eligible for the premium tax credit?

To receive a premium tax credit for 2027 coverage, a Marketplace enrollee must meet the following criteria:

Have a household income at least equal to 100% of the Federal Poverty Level (FPL) but not more than 400% FPL. Incomes for the 2027 benefit year are determined by 2026 poverty guidelines (Table 1). From 2021 through the end of 2025, the American Rescue Plan Act and the Inflation Reduction Act expanded eligibility for premium tax credits to Marketplace enrollees making above 400% of poverty. This was temporary and expired at the end of 2025.
Not have access to an employer plan (including a family member’s employer) that both meets minimum value and is considered affordable. For 2027, the threshold that determines if an employer plan is affordable is if the premium is equal to or less than 10.22% of one’s household income.
Not be eligible for coverage through Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).
Have U.S. citizenship, lawful permanent resident (LPR or Green Card holder), Cuban or Haitian entrant, or Compact of Free Association (COFA) migrant.
If married, must file taxes jointly.

Income: For the purposes of the premium tax credit, household income is defined as the Modified Adjusted Gross Income (MAGI) of the taxpayer, spouse, and dependents who are required to file a tax return. The MAGI calculation includes income sources such as wages, salary, foreign income, interest, dividends, and Social Security.

Federal Poverty Guidelines for 2027 Coverage Year (Table)

Employer coverage: Employer coverage is considered affordable if the required premium contribution is no more than 10.22% of household income in 2027. The Marketplace will look at both the required employee contribution for self-only and (if applicable) for family coverage. If the required employee contribution for self-only coverage is affordable, but the required employee contribution is more than 10.22% of household income for family coverage, the dependents can purchase subsidized exchange coverage while the employee stays on employer coverage.

The employer’s coverage must also meet a minimum value standard that requires the plan to provide substantial coverage for physician services and for inpatient hospital care with an actuarial value of at least 60% (meaning the plan pays for an average of at least 60% of all enrollees’ combined health spending, similar to a bronze plan). To be ACA-compliant, the plan must also have an annual OOP limit on cost sharing of no more than $12,000 for self-only coverage and $24,000 for family coverage in 2027.

People who are offered employer-sponsored coverage that fails to meet either the affordability threshold or minimum value requirements can qualify for Marketplace subsidies if they meet the other criteria listed above.

Eligibility for Medicaid: In states that have expanded Medicaid under the ACA, adults earning up to 138% FPL are generally eligible for Medicaid and not for Marketplace subsidies. In states that have not adopted Medicaid expansion, adults with income as low as 100% FPL can qualify for Marketplace subsidies. However, those with incomes lower than 100% FPL are generally not eligible for tax credits or Medicaid unless they meet other state eligibility criteria. KFF estimates that 1.2 million Americans living in non-expansion states fall into this coverage gap, where they are eligible for neither Medicaid nor Marketplace subsidies.

Immigration status: As a result of the 2025 budget reconciliation law, lawfully present low-income immigrants who are ineligible for Medicaid, often because they have resided in the U.S. for less than five years, will not qualify for tax credits starting in the 2026 plan year. Beginning in 2027, only people with certain immigration statuses can qualify for Marketplace financial assistance. They include Lawful Permanent Residents (including Green Card holders), Cuban or Haitian entrants, and Compact of Free Association (COFA) migrants. Other immigration statuses may be eligible for Marketplace coverage but not premium tax credits.

Immigrants who do not hold an eligible immigration status, including DACA recipients, cannot enroll in health insurance through the Marketplace, receive tax credits through the Marketplaces, or enroll in non-emergency Medicaid and CHIP.

What amount of premium tax credit is available?

Required Individual Contribution to Benchmark Plan Premium for 2027 Coverage Year (Table)

The premium tax credit limits an individual’s contribution toward the premium of the “benchmark” plan, the second-lowest cost silver plan in their Marketplace. This “required individual contribution” is set on a sliding income scale. In 2027, for individuals with income below 133% FPL, the required contribution is 2.15%, while at an income between 300% to 400% FPL, the required contribution is 10.22% of household income (Table 2). People with incomes above 400% FPL are not eligible for premium tax credits.

In 2021, enhanced premium tax credits were introduced temporarily by the American Rescue Plan Act, expanding eligibility for premium assistance to people with higher incomes and increasing the amount of financial assistance for lower-income people who were already eligible. These enhanced tax credits were extended by the Inflation Reduction Act but expired at the end of 2025. While in effect, Marketplace enrollees with incomes up to 150% FPL were eligible for a benchmark silver plan with no monthly premium payment. The required premium contribution level was also capped at no more than 8.5% of income for enrollees with household incomes above 400% FPL, gradually phasing out at higher incomes. With the expiration of the enhanced premium tax credits, there is no longer a cap on what enrollees with incomes above 400% FPL pay, so they face the full cost of an unsubsidized premium. Between 2025 and 2026, average premium payments increased by 58% and average deductible increased by 37% (about $1,000) as many enrollees moved to higher-deductible plans to offset steep premium payments.

The amount of tax credit is calculated by subtracting the individual’s required contribution from the actual cost of the “benchmark” plan. So, for example, if the benchmark plan costs $6,000 annually, the required contribution for someone with an income of 133% of FPL ($21,227 in 2027), is 3.23% of $21,227 or $686, resulting in an annual premium tax credit of $5,314. If that same person’s income equals 250% FPL (or $39,900 in 2027), the individual contribution is 8.66% of $39,900 or $3,455 per year, resulting in an annual premium tax credit of $2,545.

The premium tax credit can then be applied toward any other plan sold through the Marketplace (except Catastrophic coverage). The amount of the tax credit remains the same, so a person who chooses to purchase a plan that is more expensive than the benchmark plan will have to pay the difference in cost. Conversely, if a person chooses a less expensive plan, such as the lowest-cost silver plan or a bronze plan, the tax credit will cover a greater share of that plan’s premium, and possibly even cover the entire cost, leaving the consumer with a zero-premium plan. When the tax credit exceeds the cost of a plan, it lowers the premium to zero, and any remaining tax credit amount is unused.

For certain components of a Marketplace plan premium, the premium tax credit will not apply. First, the tax credit cannot be applied to the portion of a person’s premium attributable to covered benefits that are not essential health benefits (EHB). For example, a plan may offer adult dental benefits, which are not currently included in the definition of EHB. In that case, the person would have to pay the portion of the premium attributable to adult dental benefits without financial assistance. In addition, the ACA prohibits applying premium tax credits to the portion of premiums covering “non-Hyde” abortion benefits. Marketplace plans that cover abortion are required to charge a separate $1 monthly premium to cover the cost of this benefit; this means a consumer who is otherwise eligible for a fully subsidized, zero-premium policy would still need to pay $1 per month for a policy that covers abortion benefits. Finally, if the person smokes cigarettes and is charged a higher premium for smoking, the premium tax credit is not applied to the portion of the premium that is the tobacco surcharge.

How do people receive the premium tax credit?

To receive the premium tax credit, people must apply for coverage through the Marketplace and provide information about their age, address, household size, citizenship status, and estimated income for the coming year. After submitting the application, people will receive a determination letting them know the amount of premium tax credit for which they qualify. The consumer then has the option to have the tax credit paid in advance, claim it later when they file their tax return, or some combination of the two options.

The advance premium tax credit (APTC) option allows consumers to have 1/12 of their tax credit paid directly to their Marketplace plan insurer each month, reducing the monthly amount the consumer owes. However, because the APTC eligibility determination is based on estimated income, the enrollee is required to reconcile their APTC at tax time the following year, once they know what their actual income was. For people receiving an advance payment of the premium tax credit in 2027, the reconciliation would occur when they file their 2027 tax return in 2028. If the consumer overestimated their income when they applied, they can receive the unclaimed premium tax credit as a refundable tax credit when they file.

Previously, lower-income consumers who underestimated their income at the time of application and excess APTC was paid on their behalf during the year would repay some of the excess tax credit when they file, while consumers over 400% FPL were required to repay the entire amount of excess tax credit. Beginning in tax year 2026, all consumers who underestimate their income are required to repay all excess APTC that was paid on their behalf, as repayment caps were eliminated by the 2025 federal budget reconciliation law (“The One Big Beautiful Bill Act”).

Alternatively, people can opt to pay their entire premium costs each month and wait to receive their tax credit until they file their annual income tax return the following year, although most Marketplace participants cannot afford this option. The premium tax credit is refundable, meaning it is available to qualifying enrollees regardless of whether they otherwise owe any federal income tax. Everyone who receives an APTC in a tax year is required to file a tax return for that year in order to continue receiving financial assistance in the future.

The second form of financial assistance available to Marketplace enrollees is a cost-sharing reduction. Cost-sharing reductions lower enrollees’ out-of-pocket cost due to deductibles, copayments, and coinsurance when they use covered health care services.

People eligible for premium tax credits and have household incomes between 100 to 250% of poverty are eligible for cost-sharing reductions.

Unlike the premium tax credit (which can be applied toward any metal level of coverage), cost-sharing reductions (CSR) are only offered through silver plans. For eligible individuals, cost-sharing reductions are applied to a silver plan, which, for people receiving the more generous CSRs, essentially makes deductibles and other cost sharing under that plan more like that under a gold or platinum plan. Individuals with income between 100 and 250% FPL can continue to apply their premium tax credit to any metal level plan, but they can only receive plans with reduced cost sharing if they pick a silver-level plan.

Cost-sharing reductions are determined on a sliding scale based on income. The most generous cost-sharing reductions are available for people with income between 100 and 150% FPL. For these enrollees, silver plans that otherwise typically have higher cost sharing are modified to be more similar to a platinum plan by substantially reducing the silver plan deductibles, copays, and other cost sharing. For example, in 2026, the average annual deductible under a silver plan was just over $5,300, while the average annual deductible under a platinum plan was $92. Silver plans with the most generous level of cost-sharing reductions are sometimes called CSR 94 silver plans (with 94% actuarial value, which represents the average share of health spending paid by the health plan, compared to 70% actuarial value for a silver plan with no cost-sharing reductions).

Somewhat less generous cost-sharing reductions are available for people with incomes above 150 and up to 200% FPL. These reduce cost sharing under silver plans to 87% actuarial value (CSR 87 plans). In 2026, the average annual deductible under a CSR 87 silver plan was about $800.

For people with incomes above 200 and up to 250% FPL, cost-sharing reductions are available to modestly reduce deductibles and copays to 73% actuarial value (sometimes called CSR 73 plans). In 2026, the average annual deductible under a CSR 73 silver plan was about $3,700.

Insurers have flexibility in how they set deductibles and copays to achieve actuarial value benchmarks set by the ACA for Marketplace plans, including CSR plans, so actual deductibles may vary from these averages.

The ACA also requires maximum annual out-of-pocket spending limits on cost sharing under Marketplace plans, with reduced limits for CSR plans. In 2027, the maximum OOP limit will be $12,000 ($24,000 family) for all QHPs with lower maximum OOP limits permitted under cost-sharing reduction plans (Table 3). Insurers can set lower out-of-pocket maximums.

Maximum Annual Limitation on Cost Sharing, 2027 (Table)

National Academy of Medicine’s 2026 Annual Meeting (Scientific Symposium on Chronic Disease)

2026 Victor J. Dzau Keynote Address by Drew Altman, PhD: The Big Challenges Ahead in Health Policy, and Where Chronic Illness Fits

Author: Drew Altman

Published: Oct 28, 2026

Note from Drew Altman: On October 19, 2026, I had the honor of delivering the keynote address at the annual meeting of the National Academy of Medicine (NAM), where I am a member and former member of the Institute of Medicine (IOM) Governing Council. As the event drew closer, I asked to convert the formal remarks to a fireside chat, feeling that format is more accessible to audiences. The discussion was moderated by the program head for the day, Brendan Lee, MD, PhD, the distinguished – in title and in fact – professor and chairman of the Department of Molecular and Human Genetics at Baylor. Subsequently, many requested that I write down what I had said that day, which I have done with as much fidelity to what I actually said as possible. The program focused on chronic disease, and I had been asked to paint the policy and political environment and discuss how chronic illness fits.

The Health Policy Agenda and Where Chronic Illness Fits

A long time ago in government, I was described in a major newspaper as “a nice guy trapped in a deadly serious face.” So, I hope it shines through the mask what a special privilege it is to be the first Victor Dzau Keynote speaker this year. Victor has always led with science, values, transparency and tremendous honor.

He led through a transition from IOM to NAM that I was on the other side of, feeling it was a mistake for IOM to lose control of so many of its substantive programs, even co-authoring a dissenting report when I was on the Governing Council, but I have nothing but admiration for how Victor has guided us through the changes, and now we have superb new leadership at the Academy, which we just witnessed in action.

I have transitions on my mind, making my own after 37 years since founding KFF.

A million years ago, when I received a PhD in political science at MIT, I received a note from my 96-year-old grandmother which simply said: “Congratulations, so what are you going to do, open a political science store?” Those of you who know KFF know I sort of did. I started what is now KFF back in the early 1990s based on a simple idea: Health was becoming a bigger issue and the country would need a trusted independent source for health policy information. We do that by doing lots of policy analysis, polling and survey research, and through our newsroom, now the largest health newsroom in the country, with bureaus across the U.S. We are not a policy research shop, although we do tons of policy research. We are not a polling organization, although we are well known for that. Nor are we a news organization. We are a “unicornish” combination of all three, and it’s the combination of all three, coordinated and focused on the same issues, that gives us the power and presence to play our national role and reach the different audiences we want to reach. For those of you who may remain confused about this: We do not have and never have had any connection to Kaiser Permanente, and we are not a foundation. We are a public charity – or endowed nonprofit – based in San Francisco.

One important thing about us is that we never take positions or make recommendations, but I certainly understand that data and analysis are not neutral in national health policy. In fact, we are built to annoy all sides at one time or another, and we do.

Big health policy debates come in cycles and health policy is heating up again, driven by voter concern about cost of living and health care costs, the midterms, wins by progressive Democrats pushing more expansive reform ideas again (whether they go anywhere or not), controversial administration policies, and much more. They will continue to grow through 2028 and a potentially big legislative agenda beyond. Today, I want to talk about a few of the biggest challenges we face in health policy, and how your topic today – chronic illness – is central to them, obviously viewed through the lens of a hard-core health policy organization. I recognize that there are lots of different folks here with different perspectives and NAM has its own priorities, and I have no quarrel with that. There will be overlap, but we are a different animal in health policy.

There are three problems I want to talk about:

Rebuilding Medicaid and Affordable Care Act (ACA) coverage after almost a trillion dollars in cuts in federal spending in the two programs over the next 10 years, the largest cuts in coverage and federal health spending in our history.
Reconstructing federal agencies – a task which is receiving inadequate attention and will mean daunting decisions about funding, staffing, and most challenging of all – redesigning what agency missions should be. Lest we forget, nobody was happy with the primary Health and Human Services (HHS) agencies before, but we are so unhappy with the state of affairs now we forget that.
And third, there is a new zeal to take on health care costs. But what do we even mean by that? Have we discovered the courage we never had before to do it, and, in particular, to take on underlying costs driven mostly by hospital spending and high prices?
Finally, a bonus theme: we can’t deal effectively with any of this unless we make some progress restoring trust in evidence and facts, and the people and institutions that convey them, especially government scientific agencies. I am more optimistic than many people about this big challenge based on our survey data, and I will touch on that.

Two points weave in and out: 1) these challenges will compete for space on the agenda and funding. No president, secretary, or new Congress will take them all on simultaneously in a meaningful way and 2) I have written often, there is an invisible crisis of costs and affordability affecting the chronically ill and people with major diseases. And I don’t use the over-used word “crisis” lightly. It’s why I am so pleased with your focus today.

To start…

The One Big Beautiful Bill (OBBB) included almost a trillion dollars in cuts in federal health spending over ten years. Then, following on the heels of that, was the failure to extend the ACA enhanced premium tax credits, which our widely cited analysis showed, on average, doubled premiums for almost 24 million enrollees, leading millions to drop coverage and driving many more into plans with big deductibles averaging 7k a year. Effectively that’s not insurance if you drive an Uber or work in hair salon or work on a farm and make, say, 35k a year. (Fun KFF fact: 1/3 of farmers and ranchers get their coverage through the Marketplaces.)

All told, estimates are that these cuts will result in about 14 million more uninsured people over the decade, reversing progress made in recent years and bringing the number of uninsured back up to close to 40 million. But that’s not the only effect.

As a former state Human Services Secretary, I can tell you that states will try to replace some but far from all of these cuts, especially blue states. When they do, something else in the state budget will have to give. It may be education or higher education or environmental protection or corrections. Few to none will raise taxes.

The single biggest cut—330 billion over 10 years—comes from the Medicaid work requirements, a popular but highly questionable policy.

It’s popular because Americans love the idea of work and personal responsibility. Medicaid work also draws on a conservative view of Medicaid dominating current policy as a “welfare program,” a dividing line between Rs and Ds. Seventy-four percent of Democrats see Medicaid as a “government insurance program for low-income people.” By contrast, more than half or Republicans see it as “a welfare program.” If you view it as welfare, like cash assistance, you are likely to want to impose requirements to get it and cut it if you can. If you view it as “insurance,” you want to protect it and expand it if you can. The difference in underlying views is fundamental.
I was a leader in the welfare reform movement many years ago as state human services secretary, actually for a Republican governor. I can’t stress enough how different this is from what I thought I was doing then. Welfare reform then was built on what Bill Clinton called a “reciprocal obligation.” Beneficiaries were asked to take steps towards self-sufficiency and government committed new resources to help them do that, for job training and childcare, job search and more. In my state, that meant historic new commitments to childcare and other employment-related supports. In “Medicaid work,” only the beneficiary has an obligation. That’s one reason why CBO says it produces no new work. Let me repeat that, NO new employment gains – only red tape that forces people off the rolls (5 million more uninsured says CBO). It’s a popular policy that’s a huge administrative lift for any governor, which doesn’t produce work but is popular because it sounds like it promotes work and personal responsibility.

A Second Big Challenge Is Rebuilding the Federal Agencies

I was a young academic at MIT when I got a job working for the head of what is now CMS, an agency I was later asked to run. It changed my career and my life, which became all about public service, whether in the public or nonprofit sectors. Can that happen anymore? How do we revitalize rather than demonize public service? What does it mean that 60% of the graduates of the Kennedy School go to big consulting firms (the last time I looked)?

I don’t need to tell this audience about the staffing cuts in the federal agencies, the dismantling of agencies of special relevance to this audience such as AHRQ, the warping of missions and science, including jarring recent reports from research arms of HHS asserting that enrollees dropping coverage all did so because they were there fraudulently. I have had hundreds of calls from expats from HHS looking for help and so have many of you.

Interestingly, by far the largest of the agencies in terms of budget, CMS, protected by Dr. Oz, has been largely immune from the storms that have swept through other agencies caught up in the science and culture wars.

I don’t want to present a lot of data about staffing cuts, and a lot of it is fluid and unreliable or from advocacy groups. To me, these are the critical points:

It will take a Marshall Plan to rebuild the HHS agencies
No secretary will be able to do it and do everything else he or she needs to do. (I know how daunting it will be. I have been offered that job too and looked it in the eye.)
If plans are not made ahead of time, it will be two years into an administration before much is done, and that could be too late; likewise if it is done agency head and agency by agency over time
For those reasons, it would be timely for some distinguished nonpartisan group (KFF, NAM, a new commission funded by foundations) to take this on now. If I were a Secretary, I would appoint, in effect, a reconstruction czar, who would focus solely on plans and proposals for the reconstruction of CDC, FDA, the PHS agencies and NIH, including mission, staffing and funding.
How to formulate an updated commitment to equity across HHS will by itself be a daunting challenge, but it must be done.

This is a tough one because no candidate will run on restoring federal agencies, but this audience understands how essential it is.

Third, there is a new zeal to take on health care costs. But what do we even mean by that? At all the conferences I speak at, I find that we are often talking past each other as if we operate in a Venn Diagram with sets that only somewhat overlap and often conflict. Often in my world, we are talking about federal health spending. Cutting that often puts pressure on a different problem we sometimes talk about, state health spending. Employers are entirely concerned about their annual premium increases, and they should be. Our annual survey shows the average cost of a family policy is now almost $28,000 a year, the equivalent of buying a Toyota Corolla each year. Then there is “value” – a concept which encompasses at one and the same time the most forward-looking reforms in payment and delivery and the most backward rear-guard actions to forestall either real market competition or government regulation that might address underlying costs. In general, beware of any idea that is popular with everyone.

Then there are the two really big cost problems.

There is the one experts have always cared about most, national health care spending, measured as the share of GDP we spend on health care or per capita health spending. For reasons we debate endlessly in my world, health care as a share of GDP, long predicted to blow through 20% of GDP, has been pretty stable for a long time at about 18%. That’s much higher than other wealthy nations but reasonably stable. It’s predicted to rise more sharply again, and the main culprit as always is our high prices, which we don’t deal with much, focusing more on volume and utilization in bits and pieces.

And then there is the cost problem, which is driving the rising concern about health care nationally and has made health care a political issue. It’s none of the above; its “affordability” – the cost of health care to people. That—and only that—is what has made health care a voting issue.

If you look at the polls, the economy always emerges as the voters’ top concern. So, in our monthly tracking poll, we asked voters and I paraphrase: You said the economy was your top worry, what about the economy worries you the most? Health care costs were at the top of the list, ahead of the cost of food, housing, and even gas prices.
Assuming gas prices would eventually eclipse health care, we continue to ask every month and health care costs have remained number one, just ahead of gas prices, until tying with them recently.
But they are all closely clumped together, and it makes sense that health care costs are a top “worry” since they are less predictable than some other costs. The uncertainty makes people worry about it more.
The best way to understand this: voters see health care costs as one dimension of a set of inter-related cost-of-living concerns they are concerned about. It’s not number one, two or three…it’s all one concern.
While I am talking about the midterms, it’s also useful to always remember that issues are only one factor that drive votes. Think about your own vote. Partisan affiliation matters. The candidates and voters’ feeling about them matter a lot. Their feelings about the mood and direction of the nation and about President Trump matter (especially for turnout). All these things matter more than issues and a lot more than candidates’ policy plans to address issues. Polling assesses these factors as well, but issue rankings tend to get featured the most.

So, there are six different cost problems – national spending, people’s health costs, federal spending, state spending, employer premiums and value – and often we talk past each other as if they are the same. Often, they conflict: cut federal spending, for example, and you drive up state spending. The real challenge is to take on underlying costs but there is little evidence that the country has the stomach for that, nor do Democrats and Republicans have anything resembling agreement on how to do it except for some incremental measures that will have impact only at the margin. It means aggressively taking on hospital spending either through market forces (tough in a very consolidated industry) or government regulation, which is off the table with Republicans in charge and industry strongly opposed. For at least the next two years we are destined for “small ball” on costs, typically dressed up to sound more impactful than it is. A bright spot now is the action in several states to take on hospital costs.

It Turns Out that Chronic Illness Is at the Heart of the Affordability and the Complexity Problems

When we do surveys, we generally find that about 25% of the American people have trouble paying their health care bills and skipped or delayed care as a result.
Partly for this talk, we did a survey of 20,000 people looking at people with chronic conditions and serious illnesses such as asthma, cancer, heart disease, diabetes, and mental health conditions.
I am not going to give you a lot of numbers without slides, but for people with those conditions, the shares having problems paying their medical bills approach 40%; as many as 59% say they skipped or delayed needed care in the past year; around a quarter said their health got worse as a result; and, around a quarter said they had to cut back on other basic household needs as a result.
They also get caught in the health care maze more often: between 40 and 50% say their insurance company denied or delayed their care.

You could simply say, sure, of course they have the most problems; they use the most care. You could also say that the most basic obligation of any health system is to take care of people who are sick and we are not doing that. If I leave you with any big message today it is this: the chronically ill are the heart of the health care affordability crisis in the country.

But wait there’s more…

Again, not surprisingly, but tellingly, the worst thing you can be in our health system is chronically ill AND UNINSURED.
Among uninsured adults with multiple chronic conditions, 72% had problems paying or were unable to pay their medical bills. Seventy-one percent skipped or delayed needed care.
Forty-three percent said they got sicker as a result, and half said they had to cut back on other household needs.

To use a technical term, the chronically ill and uninsured are probably the most screwed group of all in our health system, and now with all the cuts, their ranks will grow.

Finally, I don’t believe we can make real progress without dealing with declining trust; in government agencies, the news media, medicine and science.

We have to have shared trust in information and science. A shared belief that government can make a difference, even if we disagree over how. And a shared understanding that access to affordable health care, and health coverage, make a difference in people’s lives.

We have polled extensively on this and it has made me somewhat more optimistic. The polling doesn’t show a country drowning in health misinformation and mistrust on social media.

It shows a small group of hard-core disbelievers, but smallish; just 1% believe all of the vaccine myths, for example.
It shows another group who trust the science. Let’s call them the NAM Americans.
But most Americans are stuck in the middle, uncertain about what is true and who to believe on almost every key question. They have heard the lies, but they don’t necessarily believe them. They say they don’t believe what they see on social media.

They are “up for grabs.” The situation is far from hopeless. A few hundred thousand or even a million posts on social media are NOT the whole country. Usually, its folks reinforcing views they already hold. And the most trusted messengers are still physicians and nurses and pharmacists – MANY OF YOU. It’s up to us to reach the vast majority in the middle and turn this around. Many of us seek discovery or to fill knowledge gaps in our work. We also need to keep people and relevance centered in everything we do.

Thank you very much for having me and for honoring Victor.

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Frequently Asked Questions about the ACA’s Health Insurance Marketplace

Published: Oct 27, 2026

The comprehensive set of ACA FAQs has been discontinued and will no longer be updated. We have instead included some of the most popular ACA FAQs, updated as of September 25, 2026, for the ACA 2027 Marketplace plan year. These FAQs are also available in Spanish here.

What are premium tax credits and how do they work?
How much can I earn and qualify for premium tax credits in the Marketplace?
What income is counted in determining my eligibility for premium tax credits?
Who is eligible for Marketplace premium tax credits?
Can I buy health insurance outside of the Marketplace that meets all ACA consumer protection standards?
My employer pays 100% of the premium for workers, but nothing for spouses and kids. Could we get a better deal on the Marketplace?
What happens if I want to quit a Marketplace health plan during the year?
I’m covered under my parents’ health insurance plan, but I’m moving to another state. Can I remain covered on my parents’ plan?

While we have made every effort to provide accurate and up-to-date information in these FAQs, people should contact HealthCare.gov or the health insurance Marketplace in their state for guidance on individual circumstances.

What are premium tax credits and how do they work?

Premium tax credits reduce your premium for most Marketplace plans. The amount of the tax credit you may receive depends on your income and the cost of Marketplace health plans in your area. The Marketplace will determine the expected contribution you are required to pay toward the premium for a mid-range (Silver) benchmark plan. The expected contribution will increase on a sliding scale based on your 2027 income, with more financial assistance for enrollees with lower incomes and less for those with higher incomes.

The difference between the premium for the benchmark plan and your expected contribution equals the amount of your tax credit. (You do not have to pay more than the actual premium for the plan.) You can use that amount to help pay the premium for any Bronze, Silver, Gold, or Platinum plan offered in the Marketplace. The credit cannot be used to pay for a Catastrophic plan. You can use this Marketplace subsidy calculator to estimate the premium tax credit amounts that apply to you.

Premium tax credits may be claimed at the end of the year, or you can apply for an advance premium tax credit based on your estimated income for the upcoming year. If you elect to receive an advance credit, the government will pay the credit directly to your insurance company each month and the insurer will bill you for the rest of the premium (if you owe an additional amount).

If you do not know for sure what your income for the coverage year will be when you apply, provide your best estimate. Later, when you file your tax return, the IRS will compare your actual income to the amount of premium tax credit you claimed in advance. If you underestimated your income and claimed too much premium tax credit, you will have to repay all of the difference paid on your behalf to the IRS when you file your federal income tax return next year. If you didn’t receive all of the premium tax credit you were entitled to during the year, you can claim the difference when you file your tax return. Report any changes in your income during the year to the Marketplace, so your credit can be adjusted and you can avoid any significant repayments at the end of the year.

For more information about premium tax credits, click here for an explainer.

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How much can I earn and qualify for premium tax credits in the Marketplace?

Premium tax credits are available to people who buy Marketplace coverage and whose income is at least as high as the federal poverty level.

For an individual, that means an income of at least $15,960 in 2027.
For a family of four, that means an income of at least $33,000 in 2027.

This Marketplace subsidy calculator can show you estimates of your eligibility for premium tax credits at different income amounts and family sizes.

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What income is counted in determining my eligibility for premium tax credits?

Eligibility for premium tax credits is based on your Modified Adjusted Gross Income, or MAGI. Click here for a list of the types of income that qualify as MAGI.

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Who is eligible for Marketplace premium tax credits?

Premium tax credits are available to U.S. citizens and certain lawfully present immigrants who purchase coverage in the Marketplace and who have income at least as high as 100% of the federal poverty level ($15,960 for a single adult or $33,000 for a family of four in 2027).

Starting in 2027, eligibility for premium tax credits will be eliminated for many groups of lawfully present immigrants; only those with the following immigration statuses will qualify for subsidized coverage:

Lawful permanent residents (LPRs or “green card” holders)
Cuban and Haitian entrants
People living in the U.S. under a Compact of Free Association (COFA)

In addition, to be eligible for premium tax credits, all individuals must not be eligible for public coverage—including Medicaid, the Children’s Health Insurance Program, Medicare, or military coverage—and must not have access to health insurance through an employer. (There is an exception in cases when the employer plan is unaffordable because the employee share of the premium exceeds 10.22% of the employee’s income in 2027. There is also an exception in cases where the employer plan doesn’t meet the minimum value standard.)

If your income is below 100% of the FPL, you typically will not qualify for premium tax credits under Marketplace plans. Check with your state Marketplace to find out what other options may be available to you.

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Can I buy health insurance outside of the Marketplace that meets all ACA consumer protection standards?

Yes. Many insurers that offer plans through the ACA Marketplace also offer identical plans outside of the Marketplace that meet all ACA standards; however, premium tax credits and cost-sharing subsidies are not available for plans sold outside of the Marketplace. Some people prefer to buy health insurance outside of the Marketplace when they are sure they won’t qualify for financial assistance.

Like health insurance plans sold on the Marketplace, “ACA-compliant” plans sold outside the Marketplace cover essential health benefits, and they can’t turn you down, charge you more, or limit coverage if you have a pre-existing health condition.

ACA-compliant plans are sold only during the annual Open Enrollment period, or at other times during the year for people who are eligible for a special enrollment period (such as losing other coverage or having a baby).

Many types of health plans that are not ACA-compliant, such as short-term limited-duration plans and hospital indemnity plans, are also sold outside of the Marketplace, though comparison-shopping may be more difficult. Plans that are not ACA-compliant may have lower premiums because they can exclude people with pre-existing conditions and offer more limited benefits.

Some signs that a health plan is not ACA-compliant include:

The plan brochure states that it is “NOT comprehensive health coverage.”
The application asks questions about your health status or medical history
The plan doesn’t cover essential health benefits, such as maternity care or prescription drugs
The plan has annual or lifetime dollar limits on how much the plan will pay for covered benefits
The plan is for sale outside of Open Enrollment, regardless of whether the person is eligible for a special enrollment period

If you are shopping outside of the Marketplace and you want an ACA-compliant plan, be sure to specify that to the insurer or broker you’re working with.

Finally, even if you think you won’t qualify for financial assistance for a Marketplace plan, it still might be worthwhile to shop for coverage on the Marketplace. All plans offered through the Marketplace will meet ACA standards; no non-ACA-compliant plans are sold there.

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My employer pays 100% of the premium for workers, but contributes nothing toward the cost of adding my spouse and kids. Could we get a better deal on the Marketplace?

You can evaluate whether obtaining Marketplace coverage for you or your spouse and children may be more affordable compared to your employer’s coverage. Since your employer pays 100% of the premium to cover you, you will not be eligible for premium tax credits on the Marketplace. However, your spouse and children may be if the premium contribution you would have to pay for family coverage under your employer plan is more than 10.22% of your household income in 2027.

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What happens if I want to quit a Marketplace health plan during the year?

It is important that you contact both the Marketplace and the health plan and let them know you no longer need coverage. Click here for details on how to terminate Marketplace coverage if you live in a HealthCare.gov state that uses the federally facilitated Marketplace. State-based Marketplaces may have their own process for terminating coverage. Check with your state Marketplace for more information if you live in one of these states.

Do not simply stop paying the premium for your Marketplace health plan as a way to terminate coverage. Nonpayment will eventually cause your coverage to end, but your insurer might still try to collect from you if they think you just got behind on your premium payments. In addition, if the government continues to pay premium tax credits on your behalf to your insurer for another month after you intended for your Marketplace plan coverage to end, you might end up having to repay some or all of that amount to the IRS.

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I’m covered under my parents’ health insurance plan, but I’m moving to another state. Can I remain covered on my parents’ plan?

Yes, you are eligible to stay on your parents’ plan up to age 26 if they have coverage through a job, or until the end of the year you turn 26 if they have Marketplace coverage, regardless of where you live.

However, your parents’ health plan probably has a network of participating health care providers, and it may be difficult for you to find in-network providers when you are living in another state. If you find that your parents’ plan doesn’t cover health providers in the state where you’re moving, you can consider signing up for coverage on your own. If it’s outside of the regular Open Enrollment period, moving will qualify you for a 60-day special enrollment opportunity to enroll in other coverage.

Check your state Marketplace website or contact a health insurance navigator or other assister for more information about your options.

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Health Insurance Marketplace Calculator webpage on a laptop screen, prompting users to enter household information. The page includes a submit button and a results section indicating likely eligibility for financial help.

The Health Insurance Marketplace Calculator provides estimates of health insurance premiums and subsidies for people purchasing insurance on their own in health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA).

Medicaid/CHIP Monthly Enrollment Tracker

Enrollment Data

Medicaid/CHIP Historical Enrollment Trends

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Unwinding Data - Archived

State Data on Renewal Outcomes

Medicaid Disenrollments

Medicaid Renewals

Federal Data on Renewal Outcomes

State Unwinding Data - Archived

Related Resources - Archived

Resources on unwinding data

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KFF’s unwinding explainer

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5. Recent federal actions to address fraud may affect enrollment counts and make it more difficult for enrollees needing brokers’ services in 2027.

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7. Enrollees will face the elimination of repayment limits.

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Premiums

The Average Monthly Premium for Medicare Part D Stand-Alone PDPs Is Projected to Be $51 in 2027, a 50% Increase From $34 in 2026, Based on Current Enrollment

PDP Enrollees Will Pay Higher Monthly Premiums Than MA-PD Enrollees in 2027 – an Estimated $51 versus $9, on Average

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I’m covered under my parents’ health insurance plan, but I’m moving to another state. Can I remain covered on my parents’ plan?

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