Record ACA Marketplace Signups for 2024 Are Driven in Part by Medicaid Unwinding and More Affordable Coverage 

Enrollment in the Affordable Care Act (ACA) Marketplaces will hit another record high in 2024, with sign-ups to date topping 20 million—already 4 million above last year’s record high.

The Medicaid unwinding, enhanced Marketplace subsidies that make coverage more affordable, as well as increased marketing, outreach, and enrollment assistance have all played a role in this growth, according to a new analysis from KFF.

Marketplace sign-ups have nearly doubled since 2020. The Medicaid unwinding is likely contributing to 2024’s record-high enrollment. States provided continuous enrollment in Medicaid during most of the pandemic, but disenrollments resumed in April.

Unlike most previous years, the individual market grew mid-year in 2023, outside the open enrollment window and at a time when attrition normally occurs. From early April to the end of September 2023, enrollment in the individual market grew by 5.7%, or just over 1 million enrollees. The only other time the ACA individual market recently saw mid-year growth was in 2021, when the American Rescue Plan’s enhanced subsidies were first rolled out.

Enhanced subsidies make coverage more affordable generally and ease the transition from Medicaid to private coverage, with zero-premium plans available to more people with low incomes. In addition to these new enrollees, enhanced subsidies may also be helping current enrollees maintain their coverage. The enhanced subsidies will expire at the end of 2025, requiring Congress to decide whether to extend them using additional federal funding.