Affordable Care Act

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.

How Much and Why ACA Marketplace Premiums Are Going Up in 2027

ACA Marketplaces insurers are proposing a median premium increase of 15% in 2027, according to KFF’s updated analysis of 276 insurers with publicly available filings across all 50 states and the District of Columbia. This is the second consecutive year of double-digit premium hikes. Last year’s median nationwide proposed rate change was 18%, and the median finalized rate change was 20%. While this proposed rate change is lower than last year, it represents the second-highest requested rate change since 2018, as premium growth had been relatively flat in this market for several years.

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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  • Medicaid Expansion Waivers: What Will We Learn?

    Issue Brief

    Section 1115 waivers authorize research and demonstration projects that, in the view of the Health and Human Services (HHS) Secretary, further the purposes of the Medicaid program. The ACA implemented new requirements for these waivers, including that states must have a publicly available, approved evaluation strategy. This brief examines some of the major research questions and hypotheses relevant to the federal and state evaluations of Medicaid expansion Section 1115 waivers and explores key challenges that…

  • A New Way of Measuring Health Costs Sheds Light on Recent Health Spending Trends

    Issue Brief

    National health spending started to grow more rapidly recently after several years of unusually slow growth. This analysis from the Kaiser Family Foundation and the federal Bureau of Economic Analysis helps to dissect why that may be happening. Using recently-released disease-based health spending data compiled by the federal government, the analysis finds that the drivers of health spending growth shifted in the years following the Great Recession. The number of people treated for various diseases picked up,…

  • How Primary-Care Physicians Are Handling the Influx of Newly Insured

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Kaiser’s President Drew Altman is joined by The Commonwealth Fund's President David Blumenthal to discuss the impact of the Affordable Care Act’s coverage expansion on the primary care delivery system.

  • Can I be charged more because of my age?

    FAQs

    Yes, in most states, you can be charged more based on your age, but within certain limits. For example, older adults in their sixties can be charged up to three times more than younger adults (e.g., in their early twenties). Some states have established lower limits or a complete prohibition on “age rating,” a federal policy that applies to all individual health insurance plans and those offered by fully-insured small employers, whether sold on or…

  • How can I compare covered benefits in different Marketplace plans?

    FAQs

    Although all Marketplace health plans are required to cover the ten categories of essential health benefits, insurers in many states have flexibility to modify coverage for some of the specific services within each category, subject to approval by their Marketplace. All health plans must provide consumers with a Summary of Benefits and Coverage (SBC) to make it easier to compare differences in health plan benefits and cost sharing. It is also available for each plan…

  • When can small employers enroll in coverage through the SHOP Marketplace?

    FAQs

    Small employers can buy coverage for their employees through the SHOP Marketplace at any time during the year. HealthCare.gov no longer operates a SHOP Marketplace website for small employers. However, if you want to sponsor small group coverage through the Marketplace for your employees, you can contact insurance companies directly or work with a broker who is certified to sell SHOP policies. In HealthCare.gov states, you can find a SHOP-certified broker using the Find Local Help tool. Be…

  • ¿Pueden miembros de una familia con estatus migratorio mixto, donde algunos son ciudadanos o están legalmente presentes y otros son indocumentados, inscribirse en Medicaid o CHIP, o recibir ayuda para c...

    FAQs

    Los ciudadanos y los miembros de la familia que están legalmente presentes pueden obtener cobertura de salud a través de Medicaid, CHIP y los mercados de seguros, incluso si otros miembros de la familia son indocumentados. Los miembros de la familia que no están legalmente presentes pueden solicitar un seguro de salud para los ciudadanos y los miembros de la familia presentes legalmente. Por ejemplo, un padre indocumentado puede solicitar un seguro de salud para…

  • ¿Qué es un plan de salud catastrófico?

    FAQs

    Un "plan catastrófico" es un plan de salud calificado que se ofrece dentro y fuera del mercado de seguros que cubre beneficios esenciales de salud. Si bien los planes catastróficos tienen primas más bajas que otros planes de salud calificados, también requieren el nivel más alto de costo compartido permitido para un plan que cumple con ACA. En 2026, el deducible anual por servicios cubiertos en un plan catastrófico es $10.900 para un individuo o…