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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?

The ACA MarketplaceS

In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year 

ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third between 2025 and 2027.

The Average Marketplace Deductible Grew by About $1,000 Per Person in 2026, With More Enrollees Shifting to Higher-Deductible Plans as Enhanced Tax Credits Expired

The average Affordable Care Act (ACA) Marketplace deductible experienced the steepest increase in history—growing by 37% or over $1,000, from $2,759 in 2025 to $3,786 in 2026 as enhanced premium tax credits expired, according to a new KFF analysis. After the enhanced tax credits ended, many Marketplace shoppers shifted toward lower-premium, higher-deductible plans.

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  • I heard that there have been changes to Marketplace premium tax credits and other Marketplace rules. How could these changes affect me?

    FAQs

    This FAQ was updated on January 14, 2026, to reflect the expiration of the enhanced premium tax credits. The premium tax credit enhancements that began in 2021 expired at the end of 2025 and have not been renewed by Congress. This means that many Marketplace enrollees eligible for premium tax credits will receive less financial assistance, and the amount they have to pay in monthly premiums has increased. Other Marketplace enrollees may no longer be…

  • What happens if I want to quit a Marketplace health plan during the year?

    FAQs

    It is important that you contact both the Marketplace and the health plan and let them know you no longer need coverage. Click here for details on how to terminate Marketplace coverage if you live in a HealthCare.gov state. State-based Marketplaces may have their own process for terminating coverage. Check with your state-based Marketplace for more information if you live in one of these states. Do not simply stop paying the premium for your Marketplace health plan…

  • Which states offer additional financial assistance for Marketplace plans?

    FAQs

    Ten states currently provide eligible residents subsidies in addition to what the federal government provides for their Marketplace plans: • California • Colorado • Connecticut • Maryland • Massachusetts • New Jersey • New Mexico • New York • Vermont • Washington Check these state Marketplaces for more information. Click here for links to each state's website.

  • Can I be charged higher premiums in the Marketplace if I smoke? Do e-cigarettes count?

    FAQs

    In most states, yes. Generally, an insurer can charge you up to 50% more if you have used tobacco products four or more times per week on average during the past 6 months. This is called a tobacco surcharge. For example, if the premium for somebody your age (before any tax credits are applied) would otherwise be $200 per month, if you are a tobacco user, your premium could be increased to $300 per month.…

  • I received a Form 1095-B in the mail. What’s that?

    FAQs

    Health insurance companies, certain employer-sponsored health plans, and public health programs such as Medicaid may provide you with documentation indicating the months during the prior year when you were covered under the plan. Coverage providers may send Form 1095-B directly to you, but in some cases, you may have to request a Form 1095-B from the coverage provider. If you were enrolled in family coverage, Form 1095-B will indicate the names of all family members who were…

  • I signed up for Marketplace coverage last year and I want to keep this plan for another year. Do I have to do anything during Open Enrollment?

    FAQs

    You may automatically be re-enrolled in your plan, but even if you like your current plan, it is strongly advised that you take steps to actively renew it during Open Enrollment. If you receive a premium tax credit, when you actively renew you can also update your income and family information and see how much tax credit you may be eligible for based on the new premiums for the coming year. Even if your circumstances…

  • What happens if I get care from a doctor who isn’t in my plan’s network?

    FAQs

    In general, plans are not required to cover care received from an out-of-network (OON) provider. For example, if you choose to visit a primary care doctor that is not in your plan’s provider network, your insurer might not pay any of the bill, or if they do, you might have much higher cost-sharing than if you had chosen to see an in-network provider. In these situations, the health care provider or facility might send you…

  • The insurance my employer offers is not affordable, so I enrolled in a Marketplace policy with premium tax credits. However, I later got a part-time job and now my annual income will be higher than I or...

    FAQs

    First, you should report your income change to the Marketplace as soon as possible. The Marketplace will determine your new eligibility for premium tax credits based on your higher income and adjust the amount of tax credits going forward. If you make this adjustment promptly, it’s likely you won’t receive any more advanced premium tax credit during the entire year than you’re eligible for based on your annual income. As for the new “affordability” of…

  • My child goes to college in another state, but we want him on our Marketplace family plan. Can we do that?

    FAQs

    Yes. Your child can join your Marketplace family plan, even if they live out of state. However, your child may need to return home to access care within your plan’s provider network. If they get health care services in another state, the provider may be outside your plan’s network, and you may have to pay higher cost sharing for non-emergency services. Your child may be eligible to buy coverage in the state where they attend…