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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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  • Tengo cobertura a través del plan de mis padres, pero me estoy mudando a otro estado. ¿Puedo seguir teniendo seguro de salud como dependiente?

    FAQs

    Sí, usted es elegible para estar en el plan de sus padres hasta los 26 años si tienen cobertura a través del trabajo, o hasta el final del año en el que ha cumplido 26 si tienen un plan del mercado de seguros. Esto independientemente de dónde viva. Sin embargo, el plan de salud de sus padres probablemente tiene una red de proveedores de salud participantes y puede ser difícil encontrar atención dentro de la…

  • Estoy teniendo problemas al abrir una cuenta del mercado online. Soy un adulto joven sin historial de crédito. ¿Puede ser ese el problema? ¿Qué debería hacer?

    FAQs

    Algunos consumidores con poco o ningún historial de crédito, como adultos jóvenes o nuevos inmigrantes, pueden tener dificultades para abrir cuentas en CuidadoDeSalud.gov. Esto se debe a que el mercado federal utiliza técnicas de prueba de identidad en tiempo real para proteger a los consumidores del acceso no autorizado a su información personal y evitar fraudes.Primero, debe verificar que haya ingresado toda la información solicitada para crear una cuenta, incluida la información etiquetada como opcional.…

  • New Survey Finds 1 in 5 Potential Marketplace and Medicaid Enrollees Used Consumer Assistance, But Many Others Report Trying and Failing to Obtain Help

    News Release

    A new KFF survey finds that nearly one in five potential marketplace and Medicaid enrollees – an estimated 7 million people - say that they got assistance applying for Affordable Care Act (ACA) marketplace plans or Medicaid in the past year, while one in eight – an estimated 5 million – tried and failed to obtain help. The survey suggests a shortage of consumer assistance prior to the COVID-19 pandemic, which has disrupted job-based health…

  • 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.

  • Poll: Majorities Favor a Range of Options to Expand Public Coverage, Including Medicare-for-All

    News Release

    At a time when debate is beginning about a national Medicare-for-all plan and other approaches to expanding coverage through public programs, this month’s KFF Health Tracking poll examines Americans’ early opinion on a range of options under consideration. The poll finds majority support for four different approaches: 77 percent of the public, including most Republican (69%), favor allowing people between the ages of 50 to 64 to buy health insurance through Medicare; 75 percent, including…

  • Health Care and the Candidates in the 2018 Midterm Elections: Key Issues and Races

    Issue Brief

    Introduction With the 2018 midterm election season in full swing, health care has emerged as one of the top issues for voters. The issue is playing a prominent role in many House, Senate, and gubernatorial races, and health-related measures have made it onto the ballot in several states. Democratic candidates, in particular, have made health care a central part of their campaigns and a focus of their political ads, highlighting popular provisions in the Affordable…

  • Poll: Most Americans Want Congress to Prioritize Targeted Actions that Address Personal Health Care Costs; Fewer Cite Broader Reforms like Medicare-for-All and ACA Repeal as Top Priorities

    News Release

    Most Do Not Want the Supreme Court to Overturn the ACA or its Pre-Existing Conditions Protections When it comes to tackling pressing health care issues, incremental actions to address personal health care costs take precedence over broader, more partisan reforms for most Americans, according to the latest KFF Health Tracking Poll. As policymakers jockey over Medicare-for-all proposals and the legal and political fate of the Affordable Care Act, the public is more likely to choose…

  • “Partial” Medicaid Expansions Could Limit States’ Spending But Cover Fewer People at a Higher Federal Cost Compared to Traditional ACA Expansions

    News Release

    If states were able to receive enhanced Affordable Care Act matching funds for “partial” expansions of Medicaid, fewer people would get health coverage and the federal government would spend more, compared to a traditional expansion under the law, KFF explains in a new brief. The explainer describes how a partial expansion would differ from a traditional ACA Medicaid expansion and summarizes some of the expected effects. It also documents which states have sought federal approval…

  • 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.