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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

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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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  • ACA Replacement Plans and the Individual Market

    Feature

    This slideshow compares premiums and tax credits under proposed replacement plans for the Affordable Care Act, including the Senate's Better Care Reconciliation Act and the House-passed American Health Care Act.

  • Medicaid’s Role in Tennessee

    Fact Sheet

    This fact sheet provides data on Medicaid's role in Tennessee and describes how implementing a per capita cap or block grant would affect Tennessee.

  • Medicaid’s Role in Kentucky

    Fact Sheet

    This fact sheet provides data on Medicaid's role in Kentucky. It describes how ending the enhanced match for Medicaid expansion and implementing a per capita cap or block grant would affect Kentucky.

  • KFF Health Tracking Poll – April 2019: Surprise Medical Bills and Public’s View of the Supreme Court and Continuing Protections for People With Pre-Existing Conditions

    Feature

    The April 2019 KFF Health Tracking Poll examines the public’s position on the future of ACA and its protections for people with pre-existing medical conditions, in light of the ongoing legal battle which may end up in the Supreme Court. With lawmakers proposing legislation to address surprise medical bills, this month’s survey also measures the public’s support for federal government action to protect patients from having to pay the cost incurred from an inadvertent out-of-network…

  • Individual Insurance Market Performance in 2018

    Issue Brief

    Individual market insurers are expecting to return to consumers a record total of about $800 million in medical loss ratio rebates for 2018, a year in which the insurance companies posted their best annual financial performance under the Affordable Care Act to date. Financial results for 2018 suggest that insurers in the individual market are generally returning to or exceeding profitability levels seen before 2014, when ACA insurance market rules took effect, including the requirement…

  • How Affordable are 2019 ACA Premiums for Middle-Income People?

    Issue Brief

    This analysis finds that Affordable Care Act marketplace premiums are least affordable for older adults who earn too much to qualify for federal subsidies, especially those living in rural areas where premiums are highest. The analysis also discusses a variety of state and federal proposals that seek to lower premiums for middle-class people buying their own insurance who are ineligible for ACA subsidies.