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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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  • Web Briefing for Journalists: Key Issues Ahead of Marketplace Open Enrollment

    Event Date:
    Event

    Marketplace open enrollment, the period during which consumers can shop for health plans or renew existing coverage through the Affordable Care Act’s health insurance marketplaces, begins on Nov. 1. Recent policy changes at the state and federal levels have the potential to impact individuals and families purchasing health insurance for 2019. It’s the first open enrollment period following Congress’ repeal of the ACA’s individual mandate penalty, the requirement that individuals have minimum essential health coverage…

  • Evolving Picture of Nine Safety-Net Hospitals: Implications of the ACA and Other Strategies

    Issue Brief

    Safety-net hospitals are an integral part of the U.S. health care landscape, providing care to some of the nation’s most medically vulnerable populations, including Medicaid enrollees and the uninsured. With the implementation of the Affordable Care Act (ACA), the U.S. health care system is rapidly changing, and safety-net hospitals need to make major adjustments to survive in the post-reform environment. This brief draws on interviews with executives at nine safety-net hospital systems and examines how…

  • New Analysis Finds US Individual Insurance Market Grew 46 Percent in First Full Year of Affordable Care Act

    News Release

    A new analysis from the Kaiser Family Foundation finds that the nation's individual insurance market grew 46 percent to 15.5 million people in the first year plans could be purchased through the Affordable Care Act's marketplaces, which offer premium assistance to low- and moderate-income people. Four states -- California, Florida, Texas and Georgia -- accounted for almost half of the enrollment growth. In six states, the number of people covered in the individual market increased…

  • Round 2 on the Legal Challenges to Contraceptive Coverage: Are Nonprofits “Substantially Burdened” by the “Accommodation”?

    Issue Brief

    The Affordable Care Act (ACA) requires most private health insurance plans to provide coverage for a broad range of preventive services including Food and Drug Administration (FDA) approved prescription contraceptives and services for women. Since the implementation of the ACA contraceptive coverage requirement in 2012, over 200 corporations have filed lawsuits claiming that including coverage for contraceptives or opting for an “accommodation” from the federal government violates their religious beliefs. This brief explains the legal…

  • Survey of Non-Group Health Insurance Enrollees, Wave 2

    Poll Finding

    The survey is the second in a series exploring the experiences and perceptions of people who purchase their own health insurance, the group perhaps most affected by the Affordable Care Act's reforms to the individual insurance market and tax subsidies to make such coverage more affordable. It includes people in ACA-compliant plans sold both inside and outside the federal and state marketplaces, as well as those still in non-compliant plans, which took effect prior to…

  • ¿Mi plan de salud estudiantil tiene que cubrir la anticoncepción? Y, si no, ¿cuáles son mis opciones?

    FAQs

    Depende del tipo de cobertura que ofrezca su universidad. Generalmente, sí, si se trata de un plan "Totalmente asegurado". Estos planes deben proporcionar, sin costo compartido, acceso a todos los métodos anticonceptivos aprobados por la Administración de Drogas y Alimentos (FDA), procedimientos de esterilización, educación y asesoramiento para pacientes ordenados por un profesional de la salud. Si su plan de salud estudiantil es "autoasegurado", la cobertura de anticonceptivos depende de qué servicios estén cubiertos, lo…

  • Calculo que mis ingresos el próximo año serán muy bajos, así que necesito pagar por adelantado todo el subsidio para las primas. Si, para fin de año, resulta que mis ingresos anuales fueron incluso meno...

    FAQs

    No, el monto final de su subsidio para las primas se determinará en base a sus ingresos del año, según lo declarado en su declaración de impuestos. El hecho de que haya sido menor de lo esperado no significa que tenga que devolver el subsidio que recibió por adelantado, incluso si hubiera podido calificar para Medicaid. De hecho, el monto final de su crédito probablemente sea mayor que la cantidad que recibió por adelantado. (Esto…

  • Traté de renovar mi mismo plan para el próximo año, pero la aseguradora dice que olvidé un pago y que no me permitirán continuar con la cobertura hasta que pague la prima que debo. ¿Pueden hacer eso?

    FAQs

    No. Las aseguradoras no pueden exigir a quienes adeudan primas atrasadas que paguen la deuda antes de renovar la cobertura por un año más. Debe tener autorización para renovar, y el pago del 1 de enero no se podrá aplicar a la prima atrasada que adeude. De ahora en adelante, tenga en cuenta que las aseguradoras pueden cancelar su cobertura si no paga las primas. Si recibe subsidios para las primas por anticipado (APTC), las…

  • What kinds of health insurance plans do private enrollment websites sell?

    FAQs

    Private enrollment websites that are run by insurance companies typically only show plans offered by that insurer. Websites run by insurance brokers are required to show all plans offered by multiple insurers. If you have questions or concerns about information on these sites, contact the Marketplace call center, HealthCare.gov, or your state Marketplace. Many private enrollment websites also sell short-term health plans, cancer-only policies, and other less comprehensive products. These products may appear cheaper than…

  • The Spotlight Is on Medicaid Cuts, But the ACA Marketplaces Could See a One-Third Cut in Enrollment

    From Drew Altman

    In his latest column, President and CEO Drew Altman shows how proposals contained in the House reconciliation bill could result in a one-third reduction in ACA Marketplace enrollment. “While all eyes are on the big Medicaid cuts being proposed in the House,” he writes, “significant changes are also being proposed that together would dramatically reduce enrollment in the ACA Marketplaces.”