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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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  • 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.…

  • Can I adjust the level of subsidy I collect in advance when my income goes up or down during the year? How often during the year can I make adjustments?

    FAQs

    You can make adjustments during the year whenever you need to. There is no limit to the number of times a person may report income, family, or insurance-eligibility changes to the Marketplace. Changes that you report will be verified by the Marketplace. Then the Marketplace will send you a notice (called a redetermination notice) showing your revised eligibility for premium tax credits and cost-sharing reductions. The adjustment should take effect by the first day of…

  • I had a Marketplace plan last year, but paid the full premium myself because I made too much to qualify for premium tax credits. When I did my taxes though, my income for the year ended up being less th...

    FAQs

    Yes. Premium tax credits can be claimed in advance (during the year) or when you file your taxes. To claim the credit, you will need to file a federal income tax return and Form 8962. Follow the instructions on Form 8962 to determine the amount of tax credit you should receive as a refund when you file your taxes.

  • What is Form 8962?

    FAQs

    If you received an advanced premium tax credit (APTC) through the Marketplace last year, you must file a Form 8962 with your federal income tax return in order to "reconcile" your estimated and actual income for the year, even if you estimated your income perfectly. You can get a blank Form 8962 from the IRS website, or, if you use tax preparation software, the form will be automatically generated for you. The instructions for Form…

  • 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’ve picked the plan I want. What do I do next, and where do I send my premium payments?

    FAQs

    Your enrollment in the health plan is not complete until the insurance company receives your first premium payment. Once you’ve selected your plan, the Marketplace will direct you to your insurance company’s website to make the first premium payment. In most states, you will make your premium payments directly to the health insurance company. Insurance companies must accept different forms of payment, including for those who do not have a credit card or bank account.…

  • 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…

  • What health benefits do Marketplace plans cover?

    FAQs

    All qualified health plans offered in the Marketplace cover the "essential health benefits" (EHB), including: Ambulatory patient services (outpatient care you get without being admitted to a hospital) Emergency services Hospitalization Maternity and newborn care (care before and after your baby is born) Mental health and substance use disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain…