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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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  • Comparison of Medicare Provisions in Recent Bills and Proposals to Repeal and Replace the Affordable Care Act

    Issue Brief

    Repealing and replacing the Affordable Care Act is a top priority of the Trump Administration and the Republican leadership, which could have implications for the Medicare program. This brief provides a side-by-side comparison of the Medicare-related provisions in six bills and proposals that would repeal the ACA, excluding proposals that would not directly affect Medicare.

  • What is at Stake for Health and Health Care Disparities under ACA Repeal?

    Issue Brief

    This brief describes health and health care disparities today, highlights recent advancements in reducing disparities under the Affordable Care Act (ACA), and discusses how the American Health Care Act (AHCA) and proposed reductions in discretionary funding may affect ongoing efforts to address disparities.

  • Assessing the Performance of the U.S. Health System

    Issue Brief

    Health spending growth has consistently outpaced U.S. economic growth and is higher than medical spending in other wealthy countries. Despite spending more, the United States doesn't have better health outcome in terms of life expectancy, mortality rates and other measures. This brief provides an overview of trends in health costs and the performance of the U.S. health system, including comparisons to countries from the Organisation for Economic Co-operation and Development (OECD). The brief charts growth…

  • El seguro de salud, explicado: ¡los YouToons lo tienen cubierto!

    Video

    El seguro de salud, explicado: ¡los YouToons lo tienen cubierto! desglosa conceptos de seguros como primas, deducibles y redes de proveedores.  Explica cómo las personas pagan por su cobertura y cómo obtener cuidado médico y medicamentos recetados con distintos tipos de seguros de salud, incluyendo HMOs y PPOs.

  • The ACA Family Glitch and Affordability of Employer Coverage

    Issue Brief

    This analysis estimates that 5.1 million people fall into the Affordable Care Act's "family glitch," which occurs when a worker receives an offer of affordable employer coverage for themselves but not for their dependents, making them ineligible for financial assistance for marketplace coverage. It explores the demographic characteristics of this group, including state-level estimates.

  • Joe Biden’s New Health Care Agenda (and CMS’s Big Role In It)

    From Drew Altman

    With the Georgia runoff elections giving Democrats control of the U.S. Senate, Drew Altman discusses President-elect Biden’s potential health care agenda and suggests that the Centers for Medicare & Medicaid Services could have an expanded role and that it may be time to rename it and elevate it to a cabinet agency.

  • 2021 Premium Changes on ACA Exchanges and the Impact of COVID-19 on Rates

    Issue Brief

    This brief summarizes premium rate filings in all 50 states and the District of Columbia and finds the majority of rate changes for 2021 are moderate, with increases or decrease of a few percentage points. Insurers say the COVID-19 pandemic is putting both upward and downward pressure on health costs in 2021.

  • For 3rd Year in a Row, More Insurers are Entering the ACA Marketplaces, Creating More Options for Consumers

    News Release

    For the third straight year, more insurers are entering the Affordable Care Act’s marketplaces and expanding their service areas, creating more options for consumers seeking to buy their own insurance for 2021, a new KFF analysis finds.  The analysis finds 30 insurers joining the marketplace across 20 states, and another 61 insurers are expanding their services within states that they already served. More than a third of counties (1,207, or 38%) will have more insurers…

  • Compare the Candidates on Health Care Policy

    Feature

    The side-by-side comparison tool provides a quick overview of former President Trump's and Vice President Harris' records, positions, public statements, and proposed policies on a range of key health care topics.

  • Many Women Use Preventive Services, but Gaps in Awareness of Insurance Coverage Requirements Persist: Findings from the 2022 KFF Women’s Health Survey

    Issue Brief

    This brief presents findings from the 2022 KFF Women’s Health Survey on women’s receipt of cancer screenings and other preventive services and differences between subgroups of women. We also present data on women’s and men’s awareness of federal requirements for private insurance coverage of preventive services.