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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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  • Access to Adult Dental Care Gets Renewed Focus in ACA Marketplace Proposal

    Policy Watch

    Adult dental care can lead to high out of pocket costs for consumers, especially for those with private insurance coverage. This post analyzes a proposed provision in the HHS Notice of Benefit and Payment Parameters for 2025, and possible implications for consumers who have Marketplace coverage.

  • What to Know About the FDA’s Recent Decision to Allow Florida to Import Prescription Drugs from Canada

    Policy Watch

    Florida’s plan to import certain prescription drugs from Canada represents the first time the Food and Drug Administration (FDA) has granted authority for a state to safely import prescription drugs from another country. This policy watch analysis unpacks some frequently asked questions related to state of Florida’s importation plan, including potential obstacles to implementation, who will benefit from any savings, and what types of drugs will (and will not) qualify for importation.

  • Kaiser Health Tracking Poll – June 2017: ACA, Replacement Plan, and Medicaid

    Feature

    As the Senate prepares to vote on the Republican plan to repeal and replace the Affordable Care Act and limit federal Medicaid funding, a new Kaiser Family Foundation Tracking Poll finds the Affordable Care Act itself remains far more popular than the bill that would replace it. A majority of Republicans, however, continue to support the Republican plan, though by a significantly narrower margin than last month. Furthermore, the Tracking Poll finds that the most…

  • Estimates: Average Monthly Premium after Tax Credit Would Be 74% Higher Under Senate Health Bill in 2020

    News Release

    A new analysis from the Kaiser Family Foundation estimates that the average monthly premium for a benchmark silver plan after tax credits in 2020 would be 74 percent higher under the Senate’s Better Care Reconciliation Act (BCRA) compared to the Affordable Care Act (ACA). Overall, most marketplace enrollees would pay higher premiums under the Senate bill than current law, the analysis finds. Older and lower-income enrollees would see the biggest increases, with people age 55-64…

  • How Individual Market Enrollment Changed with the Enhanced Premium Tax Credits

    Feature

    This chart examines individual market enrollment data from 2011 through 2025, when enrollment reached a record high of 25.2 million people. Affordable Care Act (ACA) Marketplace enrollment increased following the enactment of enhanced premium tax credits in 2021, as more individuals became eligible for subsidies.

  • Pending Changes to Marketplace Plans Could Increase Cost Sharing for Consumers

    Policy Watch

    This brief looks at changes to Marketplace plans recently finalized by the Centers for Medicare and Medicaid Services (CMS) that may incentivize insurers to make their plans less generous. With less generous plans, consumers could face higher out-of-pocket costs, though those who don't qualify for premium tax credits could see lower premiums.

  • Individual Market Insurers Requesting Largest Premium Increases in More Than 5 Years

    Issue Brief

    This analysis of preliminary rate filings submitted by 105 ACA Marketplace insurers in 19 states and DC shows that ACA Marketplace insurers are requesting a median premium increase of 15% for 2026, which would represent the largest hike in premiums since 2018, the last time policy uncertainty contributed to sharp premium growth. The scheduled expiration of enhanced tax credits and impact of tariffs on some drugs, medical equipment, and supplies are among the factors pushing…

  • Poll: New Tax and Budget Law Remains Largely Unpopular; Nearly Half Say It Will Hurt Their Families, though Republicans and MAGA Supporters Are More Optimistic

    News Release

    Nearly half (46%) of the public says that they expect the new tax and budget law signed by President Trump earlier this month to generally hurt them and their families, nearly twice the share (26%) who say it will generally help, a new KFF Health Tracking Poll finds. Among people who rely on Medicaid for their health coverage, two-thirds (65%) say it will hurt their families compared to one in five (18%) who say it…