Editorial Note: This piece was originally published on January 12, 2026 and was updated on January 28, 2026 to reflect updated data from CMS on ACA sign-ups.
The Centers for Medicare and Medicaid Services (CMS) reports that around 23 million people have signed up for an Affordable Care Act (ACA) Marketplace plan (or been automatically reenrolled) during the 2026 Open Enrollment Period as of January 15, 2026 for states using the Healthcare.gov platform and January 10, 2025 for state-based exchanges. This represents a drop of about 1.2 million consumers compared to the 24.2 million who signed up around this point in time last year, and 1.3 million fewer sign-ups than the final enrollment numbers reported at the end of Open Enrollment in 2025.
Compared to around the same time last year, plan sign-ups for state-based Marketplaces in 2026 are 4% lower, while plan selections for states using the Healthcare.gov platform are 5% lower. This Open Enrollment snapshot captures the end of Open Enrollment for states using the federal platform, but it does not capture the end dates for many state-based Marketplaces, some of which still have active Open Enrollment periods.
The expiration of the enhanced premium tax credits (which is estimated to increase premium payments by 114%, on average, for subsidized enrollees if they choose to stay in the same plan) is expected to cause people to drop their ACA Marketplace coverage. Though ACA sign-ups are down, these data may not fully show how much the expiration of the enhanced premium tax credits has affected enrollment in the Marketplaces. A better picture of the enrollment changes likely won’t be known until this summer, when effectuated enrollment data are typically released.
Data currently being released represent Open Enrollment 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 effectuated enrollments. That is because people who have selected a plan or been automatically renewed may not ultimately choose to pay for their plan, thus “effectuating” their coverage. More than four in ten sign-ups 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 enrollees having to take action. As returning consumers 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 (or premium payment) rates may drop compared to prior years.
Also, while plan selections are an important metric to track, plan selection data in CMS’s Open Enrollment snapshot do not capture the affordability of ACA Marketplace coverage. For example, it does not contain data on how many people are switching into higher deductible, lower premium bronze plans from other tiers of coverage nor the demographics of people who signed up for 2026 coverage.
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.