The Centers for Medicare and Medicaid Services (CMS) reports that, as of January 3, 2026 for states using the Healthcare.gov platform and December 27, 2025 for state-based exchanges, around 22.8M people have signed up for a plan (or been automatically renewed) during the 2026 Open Enrollment Period, down by about 830k from 23.6M people around the same time last year and down by about 1.5M from the end of Open Enrollment last year. Compared to around the same time last year, plan signs up for state-based Marketplaces in 2026 are 2% lower while plan selections for states using the Healthcare.gov platform are 4% lower.
However, these counts may not fully show how much the expiration of the enhanced premium tax credits has affected enrollment in the ACA Marketplaces. The extent of enrollment changes likely won’t be known until this summer, when effectuated enrollment data are typically released.
Data currently being released represent Open Enrollment ACA Marketplace plan selections, or how many people have signed up for or been automatically renewed into 2026 coverage. These data do not necessarily translate to enrollments. That is because people who have selected a plan or been automatically renewed may not ultimately choose to pay for their coverage, thus “effectuating” their enrollment. More than four in ten signups in 2025 were from people who were automatically renewed into their coverage. This means that the Exchanges placed these enrollees into their prior year’s plan or a similar plan for 2026, without the enrollee having to take action. As these people receive their first bills from their insurance carriers and see how much they have to pay, they may not pay their premium and eventually lose their coverage or they may actively disenroll. Without the enhanced premium tax credits in place, effectuation rates may drop compared to the prior years.
In 2025, the ACA effectuated enrollment report was released in late July. So, it will likely be several more months before we have a more complete picture of the state of ACA Marketplace enrollment.