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The ACA MarketplaceS

What We Know about Trump’s $500 ACA Checks and the User Fees Funding Them

This analysis examines the $500 checks that the Trump administration is sending to some Affordable Care Act Marketplace enrollees and the user fees that are paying for them. The checks are going to about 1 million enrollees in the 30 states that rely on the federal HealthCare.gov Marketplace who are not receiving any tax credits this year.

Individual Market Enrollment Declined by 18% Since June 2025

Individual Market Enrollment Fell 18%, Suggesting Continued ACA Marketplace Losses

Enrollment in the individual health insurance market fell by 18%—over 4.6 million people—from 25.2 million in June 2025 to 20.5 million in June 2026. Falling individual market enrollment suggests further decline in ACA Marketplace enrollment this year, since Marketplace enrollees represent the vast majority of individual market coverage. The enrollment decline coincides with the expiration of the enhanced premium tax credits and other policy changes that are expected to reduce enrollment.

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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  • 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 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…

  • I estimate my income next year will be very low, so I need my premium tax credit all paid in advance. If, by the end of the year, it turns out my annual income was even lower than I expected and I could...

    FAQs

    No, your final premium tax credit amount will be determined based on your income for the year as reported on your tax return. The fact that it ended up being less than you expected does not mean you have to repay the advance premium tax credit paid on your behalf, even if you could have qualified for Medicaid. In fact, your final credit amount will likely be larger than the amount you received in advance.…

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

    FAQs

    Form 1095-C will indicate your name and the name of your employer, the months when you were eligible for coverage, and the cost to you of the cheapest monthly premium you could have enrolled in under your employer’s health plan. If you worked for a large employer that did not offer its full-time employees health coverage, Form 1095-C will also indicate that. Keep this form with your tax records. You may need this form if…

  • I’m covered under my parents’ plan and just had a baby. Will my parents’ plan cover my baby after he’s born?

    FAQs

    Your parents' plan, regardless of the source, is generally not required to cover your child as a dependent. Depending on your income, your child may be eligible for coverage under the Medicaid/CHIP program in your state. Or you can buy a family plan through the Marketplace and, depending on your income and whether health insurance is available from your own employer, you may be eligible for a premium tax credit and cost-sharing subsidy to reduce…