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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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  • There is No Drop-Dead Date for an ACA Tax Credit Extension, But Coverage Losses Will Mount as the Clock Ticks

    Quick Insights

    While the Affordable Care Act’s enhanced premium tax credits expired at the end of 2025, there is no absolute drop-dead date for extending them. An extension could happen even after the deadline to sign up for coverage and be made retroactive to January 1. Open enrollment could also be extended to allow people time to change their plans or allow new people to sign up. ACA enrollees would welcome premium relief whenever it comes.

  • ACA Preventive Services at the Supreme Court

    Quick Insights

    If the Court rules in favor of Braidwood, private health insurers would no longer be required to cover, without cost sharing, certain preventive services recommended by USPTF after 2010 when the ACA was enacted.

  • ¿Cubren los planes del mercado la atención médica de reasignación de género? ¿Qué cambios han habido en los requisitos de cobertura?

    FAQs

    No necesariamente. La cobertura varía según el estado y el plan. Algunos estados, pero no todos, prohíben que los planes médicos excluyan la cobertura de la atención de afirmación de género. Pero incluso en los estados donde la cobertura es obligatoria, es posible que no todos los servicios de afirmación de género estén cubiertos. Por ejemplo, un plan podría cubrir la terapia hormonal, pero no la depilación láser. En los estados donde no se exige…

  • What an Income Cap Could Mean for ACA Enrollees and the Federal Budget

    Quick Insights

    Some members of Congress are considering an income cap on the ACA enhanced premium tax credits to lower federal costs. Depending on the income cutoff chosen, a cap may have little effect on the federal budget and a big effect on some households’ budgets, particularly for older enrollees.

  • Veo “planes catastróficos” que parecen incluso más económicos que otros planes del mercado. ¿Qué son? ¿Puedo comprar uno?

    FAQs

    Los planes catastróficos tienen los costos compartidos más altos y las primas más bajas. En 2026, los planes catastróficos tendrán un deducible anual de $10.600 para una persona o $21.200 para una familia. El plan no tiene que cubrir más de tres consultas de atención primaria antes de alcanzar el deducible. Los planes catastróficos solo se pueden vender a ciertas personas. Consulte estas preguntas frecuentes para obtener más información. Tenga en cuenta que si es…

  • ¿Mi plan de salud estudiantil tiene que cubrir la anticoncepción? Y, si no, ¿cuáles son mis opciones?

    FAQs

    Depende del tipo de cobertura que ofrezca su universidad. Generalmente, sí, si se trata de un plan "Totalmente asegurado". Estos planes deben proporcionar, sin costo compartido, acceso a todos los métodos anticonceptivos aprobados por la Administración de Drogas y Alimentos (FDA), procedimientos de esterilización, educación y asesoramiento para pacientes ordenados por un profesional de la salud. Si su plan de salud estudiantil es "autoasegurado", la cobertura de anticonceptivos depende de qué servicios estén cubiertos, lo…

  • How Pending Health-Related Lawsuits Could be Impacted by the Incoming Trump Administration

    Issue Brief

    This brief provides an overview of current lawsuits in health policy including preventive services, abortion care, gender affirming care, Medicare drug price negotiations, nursing home staffing rules, private coverage consumer protections, and protections and health coverage for Deferred Action for Childhood Arrivals (DACA) recipients; how they may be affected by the incoming Trump administration; and the implications of their potential outcomes.

  • Prior Authorization Metrics Provide New Insights into Insurer Practices, but Gaps Remain

    Issue Brief

    This analysis of available 2025 prior authorization data finds insurers denied at least 1 in 8 standard requests for prior authorization across three insurance markets: Medicare Advantage, Medicaid managed care, and the federally facilitated ACA Marketplaces. Denial rates varied wide segments by insurer. The analysis highlights limitations of the data and challenges for consumers interpreting it.

  • ¿Cuánto tiempo pasa desde que me inscribo hasta que la cobertura entra en vigencia?

    FAQs

    En la mayoría de los estados, si se inscribe en un plan privado de salud en cualquier momento entre el 1 de noviembre y el 15 de diciembre, y realiza el primer pago de la prima antes de la fecha límite para su plan, su nueva cobertura de salud comenzará el 1 de enero. Si se inscribe después del 15 de diciembre, su cobertura de 2026 comenzará el 1 de febrero. Averigüe con el mercado…