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The ACA MarketplaceS

Change in February effectuated enrollment, by state, 2025-2026

How Has ACA Marketplace Enrollment Changed Across States in 2026?

ACA Marketplace enrollment fell this year in every state except New Mexico, which was the only state to fully replace the enhanced premium tax credits that expired last year with a state-funded subsidy, according to a new KFF analysis of effectuated enrollment data. The Marketplace enrollment decline—the first in seven years—follows several years of rapid enrollment growth and coincides with the end of the enhanced federal subsidies.

In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year 

ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third between 2025 and 2027.

About the ACA

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Did the Affordable Care Act Make Health Care More Affordable?

The expiration of the ACA’s enhanced premium tax credits at the start of 2026, combined with rising insurer premiums, put a spotlight on health care affordability that extends beyond Marketplace enrollees. KFF’s Cynthia Cox examines the ACA’s record and the broader underlying question it raises: what’s a fair price for Americans people to pay for health care?

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  • Examining Short-Term Limited-Duration Health Plans on the Eve of ACA Marketplace Open Enrollment

    Issue Brief

    As Marketplace Open Enrollment nears, policy changes could leave millions of people facing substantially higher premiums and coverage loss, which could lead more consumers to purchase less expensive and less comprehensive coverage through short-term health plans. KFF analyzes short-term health policies sold by nine large insurers in 36 states, examining premiums, cost sharing, covered benefits, and coverage limitations and comparing them to ACA Marketplace plans.

  • What an Income Cap Could Mean for ACA Enrollees and the Federal Budget

    Quick Insights

    Some members of Congress are considering an income cap on the ACA enhanced premium tax credits to lower federal costs. Depending on the income cutoff chosen, a cap may have little effect on the federal budget and a big effect on some households’ budgets, particularly for older enrollees.

  • A Steep Subsidy Cliff Looms for Older Middle-Income Enrollees if ACA Enhanced Tax Credits Expire

    Quick Insights

    The expiration of the ACA enhanced premium tax credits at the end of this year would reintroduce the “subsidy cliff,” which abruptly ends the credit for Marketplace enrollees earning over 400% of poverty. That means some middle-income enrollees, especially older ones, would spend a much larger share of their income on premium payments than those earning just slightly less with the credit.

  • Is it Too Late for ACA Insurers to Change Their Premiums?

    Quick Insights

    Affordable Care Act Marketplace insurers are raising premiums by an average of 18% next year, due in part to the expiring enhanced premium tax credits. Even if the credits are extended in shutdown negotiations, it is unlikely that insurers will have time to revise premiums, though the credits would still offer enrollees relief from them.

  • How Might Expiring Premium Tax Credits Impact People with HIV?

    Issue Brief

    This issue brief provides an overview of the potential impact not extending enhanced ACA premium tax credits could have on people with HIV and the Ryan White HIV/AIDS Program. Enhanced credits have improved insurance coverage affordability for millions of people, including those with HIV. People with HIV may be particularly vulnerable, given that they are more likely to have Marketplace plans and many also rely on the federally-funded Ryan White HIV/AIDS Program to help cover…