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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.

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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  • ¿Los planes Medicare Advantage, los planes de medicamentos de la Parte D de Medicare o las pólizas Medigap se venden a través del mercado de seguros de salud?

    FAQs

    No. Los planes Medicare Advantage (como Medicare HMO y PPO), los planes de medicamentos recetados de la Parte D de Medicare y las pólizas Medigap no se venden a través de los mercados federales o estatales. Puede inscribirse en un plan Medicare Advantage o un plan Medicare Parte D en el sitio web de Medicare (www.Medicare.gov) o registrándose directamente con la compañía que ofrece el plan. Para obtener más información sobre sus opciones de cobertura…

  • How the COVID-19 Pandemic is Affecting People’s Mental Health and Substance Use

    News Release

    Throughout the COVID-19 pandemic and resulting economic crisis, about 4 in 10 adults nationwide have reported symptoms of anxiety or depressive disorder – a four-fold increase from pre-pandemic levels. Drawing on the latest national survey data, KFF polling and other research, an updated brief explores what’s known about the pandemic’s impact on people’s mental health and substance use and its implications for Americans’ well-being. Among the key conclusions:   • Young adults have been especially…

  • What to Expect During the COVID Marketplace Enrollment Period

    Policy Watch

    This post provides details about the ongoing Special Enrollment Period to sign up for health coverage on the ACA exchanges, including who is eligible to enroll, how costly Marketplace insurance is on average, and what other factors will affect enrollment during this period.

  • Briefing Examines High Medicare Spending for Beneficiaries in Long-Term Care

    Event Date:
    Event

    These three reports examine the relatively high use of hospital and other Medicare-covered services and the associated costs of medical care for Medicare beneficiaries who live in nursing homes and other long-term-care facilities. They also explore the potential for delivery system reforms to improve quality and reduce costs. Medicare Spending and Use of Medical Services for Beneficiaries in Nursing Homes and Other Long-Term Care Facilities: A Potential for Achieving Medicare Savings and Improving the Quality…

  • ACA Sign-Ups Are Down by Over a Million People, But It’s Still an Incomplete Picture

    Quick Insights

    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.

  • Keeping the Alexander-Murray Health Care Bill in Context

    From Drew Altman

    This Drew Altman Axios column describes the scale of the problems in the ACA marketplaces and the public’s confusion about whether they are impacted. He says that the news media, experts and policy makers can do more to put the marketplace problems and fixes in context as debate evolves.

  • ANALYSIS: ACA Silver Plan Premium Increases from 7% to 38% Attributed to End of Cost-Sharing Payments

    News Release

    Insurers factored in premium increases ranging from 7 percent to 38 percent exclusively in silver plans to absorb the financial impact of the loss of cost-sharing reduction payments from the federal government, a new Kaiser Family Foundation analysis finds. The approach, used by insurers in many states, shields consumers from steep rate hikes, because tax credits defraying the cost of premiums rise dollar-for-dollar along with benchmark silver rates. Eighty-four percent of marketplace enrollees received premium…

  • JAMA Forum: The Health Care Law that Continues to Escape Death

    Perspective

    In this November 2017 post for The JAMA Forum, Larry Levitt reviews the status of the Affordable Care Act following actions by the Trump administration widely perceived as designed to undermine the marketplaces. Despite assertions to the contrary, Levitt finds, "at least for now, the ACA seems very much alive."