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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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  • Can I be charged more because of my age?

    FAQs

    Yes, in most states, you can be charged more based on your age, but within certain limits. For example, older adults in their sixties can be charged up to three times more than younger adults (e.g., in their early twenties). Some states have established lower limits or a complete prohibition on “age rating,” a federal policy that applies to all individual health insurance plans and those offered by fully-insured small employers, whether sold on or…

  • How can I find out if a health plan covers the prescription drugs that I take?

    FAQs

    If your state uses HealthCare.gov, a prescription look-up tool is available when shopping for a plan that will tell you whether your health plan covers a prescription drug on its “formulary” (a list of covered drugs) and other information, such as the cost sharing structure. A similar feature may be available if your state operates its own Marketplace website. Click here to look up the Marketplace in your state. If you don’t find your drug on the…

  • How can I find out if my doctor is in a health plan’s network?

    FAQs

    Every plan Marketplace plan must provide a link to its health provider directory on the Marketplace website to its health provider directory so consumers can find out if their health care providers are included. The provider network information from insurance companies must also tell you whether a provider is accepting new patients. Some insurers' provider directories may list the languages spoken by providers, but this is not federally required. If your state uses HealthCare.gov (federally-facilitated…

  • Will people in hurricane- or wildfire-affected areas have more time to sign up for coverage?

    FAQs

    Yes, although the extension is not automatic. In HealthCare.gov states, you must apply for the extra time using an Exceptional Circumstances special enrollment period (SEP). You can apply for this SEP by calling the federal Marketplace call center at 1-800-318-2596. You will have to attest to residing in -- or moving from -- areas affected by a disaster event during an enrollment period you were eligible for. Affected areas are those designated by the Federal…

  • What is the health insurance Marketplace?

    FAQs

    Health insurance Marketplaces (also known as Exchanges) are organized markets where individuals and families can shop for and enroll in health insurance online, over the phone, or in person. Marketplaces offer a choice of different health plans, certify plans that participate, and provide information to help consumers understand their options and apply for coverage. There is a health insurance Marketplace in every state. Some are operated by the state and have a special state name (such as…

  • I heard the Affordable Care Act’s individual mandate ended. Does it still make sense to sign up?

    FAQs

    While there is no longer a federal tax penalty for being uninsured, some states (CA, MA, NJ, and RI) and DC have enacted individual mandates and may apply a state tax penalty if you lack health coverage for the year. Regardless of any tax penalty, it is still important to have insurance coverage to help reduce the risk of large medical bills if you get sick, to pay for medications, and to pay for check-ups…

  • 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…

  • I am covered by Medicaid, but I’m wondering if I can drop my Medicaid and purchase one of the health plans offered through the Marketplace instead?

    FAQs

    While you are allowed to purchase Marketplace coverage, if you are currently covered by Medicaid or have been told you are eligible for Medicaid, you are not eligible for premium tax credits that make Marketplace coverage more affordable for people with lower incomes. Without the Marketplace tax credits, the cost of a Marketplace plan will likely be unaffordable. Medicaid offers comprehensive coverage with no or low premiums and limited out-of-pocket costs.

  • Is there any reason the Marketplace wouldn’t automatically adjust and continue my premium tax credit at renewal time?

    FAQs

    Yes. If you live in a state that uses HealthCare.gov, when you first applied for coverage, you had the opportunity to authorize the Marketplace to check online income data about you, including from your tax returns, for another 1 to 5 years. If you did not authorize this, your financial assistance will NOT be automatically continued for next year and you will have to re-apply for financial assistance in order to keep receiving it. If…

  • 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…