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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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  • ¿Cómo aplico para recibir los subsidios para ayudarme a pagar las primas?

    FAQs

    Comience completando la solicitud de cobertura en línea en cuidadodesalud.gov. Esto podría ser más rápido, aunque también puede enviarla mediante una solicitud impresa por correo postal o llamando al centro de atención telefónica del mercado y solicitando por teléfono. Solicitar en línea es probablemente la opción más rápida. Para solicitar en línea, deberá crear una cuenta personal segura con un nombre de usuario y una contraseña. Haga clic aquí para obtener información sobre cómo configurar…

  • Soy un adulto joven, recién independizado de mis padres, y nunca antes había presentado mi propia declaración de impuestos federal. ¿Puedo solicitar subsidios para las primas este año? ¿Eso generará alg...

    FAQs

    Sí, puede solicitar créditos fiscales para las primas este año. Un desafío que puede enfrentar es verificar sus ingresos. El mercado de seguros verifica los ingresos estimados de un solicitante en tiempo real durante el proceso de solicitud, utilizando datos del IRS de declaraciones de impuestos federales recientes y, a veces, otras fuentes de datos. Sin embargo, dado que nunca antes ha presentado una declaración de impuestos, el mercado debe aceptar su autodeclaración sobre su…

  • Navigating the Family Glitch Fix: Hurdles for Consumers with Employer-sponsored Coverage

    Issue Brief

    About 5 million people could benefit from the fix to the Affordable Care Act’s “family glitch” that allows workers offered unaffordable family coverage to get subsidies in the marketplace – if they can show they qualify. This brief looks at some of the challenges consumers may face in deciding whether to take advantage of the fix.

  • Pulling it Together: On Health Reform, Will All Roads Meet in the Middle?

    Perspective

    A few weeks ago a small group of upset single-payer advocates followed Senator Baucus into the parking garage of our D.C. building as he was arriving to do one of our health reform newsmaker breakfasts, cosponsored by Families USA and the National Federation of Independent Business. They were angry because they feel that single payer is not receiving enough attention in the current debate, and it is true that it is not getting a lot…

  • Health Reform: Implications for Women’s Access to Coverage and Care

    Issue Brief

    This issue brief, Health Reform: Implications for Women's Access to Coverage and Care, reviews how the Affordable Care Act is expected to affect access to care and affordability of health coverage for women. It also explains the provisions in the health reform law related to preventive screening services, reproductive health, maternity care and women on Medicare. The brief includes national and state-level estimates of the percentage of uninsured women ages 18-64 who are likely to…

  • Pulling It Together: The Repeal Trap?

    Perspective

    Almost a year into an often acrimonious health reform debate, we stand poised for near certain passage of historic health reform legislation. Yet, somewhat perplexingly, there's now talk about whether a law that has not even been enacted might actually be repealed and reporters have been calling asking what the chances of repeal may be. I have a very hard time imagining any scenario for repeal unfolding. Calls for repeal have much to do with…

  • Chronic Disease and Co-Morbidity Among Dual Eligibles: Implications for Patterns of Medicaid and Medicare Service Use and Spending

    Report

    The health reform law contains provisions that aim to improve the delivery and coordination of services for persons enrolled in both Medicaid and Medicare, known as the dual eligibles. This population includes individuals with some of the most severely disabling chronic conditions. While the higher costs associated with services to dual eligibles is well-known, information on how spending is distributed across these programs is less understood. This study uses linked Medicare and Medicaid data to…

  • A Challenge for States: Assuring Timely Access to Optimal Long-Term Services and Supports in the Community

    Issue Brief

    The Medicaid program is a major payer for long-term services and supports (LTSS) in the United States, accounting for 40 percent of total spending for long-term services and supports. The federal government has played an active role in sponsoring initiatives to promote a shift to community-based care; and evidence from several states suggests that providing care in the community can be less expensive than providing institutional care. The Affordable Care Act (ACA) provides incentives for…

  • Resources Examine Recession-Driven Record Medicaid Enrollment and Assess Medicaid Spending Growth

    Fact Sheet

    Three papers from the Foundation's Commission on Medicaid and the Uninsured examine Medicaid enrollment and spending during the recent recession. The analyses show Medicaid enrollment rose above 50 million people nationally for the first time in 2010, reflecting the program’s counter-cyclical role of helping people who become uninsured when the economy falters, with many turning to Medicaid after losing jobs and employer-based health insurance. Without access to Medicaid coverage, millions more people who suffered economic…

  • Uniform Coverage Summaries for Consumers

    Issue Brief

    This brief explains the proposed federal rule that requires private health plans to provide a short, easy-to-read uniform summary of benefits and coverage to all health insurance applicants and enrollees. The rule, which implements a provision in the Affordable Care Act (ACA), is intended to make it simpler for consumers to compare health plans before they enroll and understand their coverage once they are enrolled. Currently, consumers in employer-sponsored plans receive summaries of their benefits,…