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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

Promotional image for KFF video How Affordable is the Affordable Care Act

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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  • Health and Access to Care and Coverage for Lesbian, Gay, Bisexual, and Transgender (LGBT) Individuals in the U.S.

    Issue Brief

    Lesbian, gay, bisexual, and transgender (LGBT) individuals often face challenges and barriers to accessing needed health services and, as a result, can experience worse health outcomes. These challenges can include stigma, discrimination, violence, and rejection by families and communities, as well as other barriers, such as inequality in the workplace and health insurance sectors, the provision of substandard care, and outright denial of care because of an individual’s sexual orientation or gender identity. This issue…

  • Most Say They Can Afford Their Prescription Drugs, But One in Four Say Paying is Difficult, Including More Than Four in Ten People Who are Sick

    News Release

    Large Bipartisan Majorities Support Range of Policy Changes They Believe Would Curb Drug Costs Opinion on the Affordable Care Act Remains Largely Unchanged In August About half of Americans (54%) report currently taking a prescription drug, and a large majority of them (72%) say their prescriptions are very or somewhat easy to afford. However, about a quarter (24%) say paying for their drugs is difficult, and the share facing difficulties rises among those with low…

  • The California Health Care Landscape

    Fact Sheet

    This fact sheet provides an overview of population health, health coverage, and the health care delivery system in California in the era of health reform.

  • Will GOP Candidates’ Positions on Obamacare Matter in Crowded Field?

    From Drew Altman

    In this column for The Wall Street Journal's Think Tank, Drew Altman analyzes the politics of Republican Affordable Care Act replacement plans and the challenges all Republican candidates will face distinguishing themselves from others on the ACA in a crowded primary field.

  • New Tracker Monitors Affordable Care Act Preventive Services Coverage

    News Release

    The Affordable Care Act requires private insurance plans to cover recommended preventive services with no out-of-pocket charges for patients. This slate of covered services can change when the U.S. Preventive Services Task Force and other authorized groups add or modify recommendations; the federal government also periodically issues clarifications to guide health plans in their coverage. A new tracker from the Kaiser Family Foundation monitors the preventive services that must be covered for adults without cost sharing,…

  • I hear there is a special enrollment opportunity for people with very low income. How does that work?

    FAQs

    Starting August 25, 2025, the special enrollment opportunity that allowed individuals with incomes at or below 150% of the federal poverty level to sign up for Marketplace coverage year-round --simply due to their low income --was eliminated. Individuals at this income level might still qualify for special enrollment under other special enrollment events, such as when they lose coverage due to job loss or lose Medicaid coverage.

  • ¿Puede mi iglesia (o un familiar o tercera parte) pagar mi parte de la prima mensual de mi seguro por mí?

    FAQs

    Familiares pueden realizar pagos de primas y costos compartidos en nombre de los afiliados por el Programa Ryan White de VIH/SIDA, otros programas gubernamentales federales y estatales que brindan apoyo para primas y costos compartidos para personas específicas, naciones u organizaciones nativas. Las reglas federales disuaden a los planes del mercado de aceptar pagos de terceros de hospitales, otros proveedores de atención médica y otras entidades comerciales. Consulte con su plan de salud para obtener…

  • Ten Changes to Watch in Open Enrollment 2022

    Issue Brief

    Even as the ninth annual Open Enrollment period gets underway, the Affordable Care Act (ACA) Marketplaces continue to evolve and important changes are expected. This issue brief discusses what changes to watch out for in the coming enrollment period.

  • What Are Some Policy Options for Reaching the 2.2 Million Uninsured People in the ACA’s “Coverage Gap”?

    News Release

    A new KFF issue brief explores several potential policy options that would help close the Affordable Care Act’s "coverage gap," including providing further new incentives for states to expand Medicaid, creating a new "public option" or extending ACA Marketplace premium subsidies to low-income people who don’t currently qualify for federal help. At stake is affordable health coverage for 2.2 million uninsured people with incomes below the federal poverty level ($12,880 annually for an individual in…