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The ACA Marketplace

2025 KFF Marketplace Enrollees Survey

In 2025, about one in three ACA enrollees said they would be “very likely” to look for a lower-premium Marketplace plan If their premium payments doubled.

Cost Concerns and Coverage Changes: A Follow-Up Survey of ACA Marketplace Enrollees

Following the expiration of the enhanced premium tax credits for people with Affordable Care Act (ACA) Marketplace plans, a new KFF follow-up survey of the same Marketplace enrollees KFF surveyed in 2025 finds half (51%) of returning enrollees say their health care costs are “a lot higher” this year compared to last year, including four in 10 who specifically say their premiums are “a lot higher.”

New AND NOTEWORTHY

Tracking the Public’s Views on the ACA

While overall opinion of the Affordable Care Act has been more favorable than unfavorable since 2017, there remain deep partisan divides. See how public opinion on the ACA has changed from the inception of the law to the present. This interactive tool highlights key moments when views shifted and trends based on party identification, income, age, gender, and race/ethnicity.

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  • I like my Marketplace plan just the way it is. Will it stay the same next year?

    FAQs

    It depends. Insurers are allowed to make changes to plans each year. Most likely, the premium for your current policy will change next year. There may be other changes as well such as the deductible or copays. In some cases, an insurer may stop offering a particular plan and offer you new choices, instead. Shortly before Open Enrollment begins, you should receive a notice from your insurance company describing any changes to your plan and…

  • Can I pay my health insurance premium with a credit card, debit card, money order, or cash?

    FAQs

    All insurers in the Marketplace are required to accept money orders, checks, pre-paid debit cards, and electronic funds transfers (EFT), which are digital direct deposits. Some states may also require insurers to accept credit card or debit card payments. Many insurers in other states accept debit and credit cards even though they are not federally required to.

  • I am a recent immigrant, and I don’t have a checking account. Can the insurance company require that I get one and pay my premiums through automatic monthly withdrawals?

    FAQs

    No. Insurers offering coverage in the Marketplace are required to provide a variety of payment methods and cannot require a consumer to pay by automatic bank withdrawals (sometimes called electronic funds transfers, or EFT) or debit card. Federal rules require the insurer to also accept paper checks, cashier’s checks, money orders, and general-purpose pre-paid debit cards. These methods must be available to consumers for both the initial premium payment (at enrollment) and ongoing payments.

  • I notice Marketplace plans are labeled “Bronze,” “Silver,” “Gold,” and “Platinum.” What does that mean?

    FAQs

    Plans in the Marketplace are separated into categories — Bronze, Silver, Gold, or Platinum — based on the amount of cost sharing they require. Cost sharing refers to health plan deductibles, copays, and coinsurance. For most covered services, you will have to pay some of the cost, at least until you reach the annual out-of-pocket limit on cost sharing. Preventive health services, however, are covered without cost-sharing. In the Marketplace, Bronze plans have the highest…

  • When can small employers enroll in coverage through the SHOP Marketplace?

    FAQs

    Small employers can buy coverage for their employees through the SHOP Marketplace at any time during the year. HealthCare.gov no longer operates a SHOP Marketplace website for small employers. However, if you want to sponsor small group coverage through the Marketplace for your employees, you can contact insurance companies directly or work with a broker who is certified to sell SHOP policies. In HealthCare.gov states, you can find a SHOP-certified broker using the Find Local Help tool. Be…

  • How long after I enroll in a plan will coverage take effect?

    FAQs

    During Open Enrollment in HealthCare.gov and some other states, if you enroll in a private health insurance plan by December 15 and make your first premium payment by the due date specified by your plan, your new health coverage will start January 1. If you sign up after December 15, your coverage will begin on February 1. If you sign up for a Marketplace plan during a special enrollment period, your coverage will usually take…

  • Can I buy a plan in the Marketplace if I don’t have a green card?

    FAQs

    Potentially, yes. You must be a lawfully present immigrant who is eligible for coverage, such as a lawful permanent resident (green card holder), certain types of visa holders, or a refugee or asylee. Deferred Action for Childhood Arrivals (DACA) is no longer considered an eligible immigration status for health coverage through the Marketplaces. You can find more information about qualifying statuses here.   You can also shop for health insurance outside of the Marketplace in…

  • I’m eligible for health benefits at work, but want to see if I can get a better deal on the Marketplace. Can I do that?

    FAQs

    You can always shop for coverage on the Marketplace, assuming you meet other eligibility requirements, but if you have access to job-based coverage that is determined to be affordable (no more than 9.96% of your household income in 2026), you won’t qualify for premium tax credits. Browse more questions in the Employer-Sponsored Health Coverage and the Marketplace section.

  • Who can buy coverage in the Marketplace?

    FAQs

    Most people can shop for coverage in the Marketplace. To be eligible you must live in the state where your Marketplace is, you must be a citizen of the U.S. or be lawfully present in the U.S., you must not currently be incarcerated, and you cannot currently be enrolled in Medicare. Deferred Action for Childhood Arrivals (DACA) is no longer considered an eligible immigration status for health coverage through the Marketplaces. Not everybody who is…

  • I am unemployed and receiving UI this year, but my income is low enough to qualify for Medicaid and I live in an expansion state. Can I choose between that and marketplace subsidies?

    FAQs

    No.  If you are eligible for Medicaid you cannot be eligible for marketplace subsidies.  Some people who receive UI benefits will be eligible for Medicaid, in part because Medicaid will NOT take into account the $300 per week federal supplemental UI benefits.  When you apply through the marketplace, you will receive a determination indicating whether you are eligible for Medicaid.  Medicaid coverage is also free or low cost (some states charge a nominal monthly premium…