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Affordable Care Act

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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  • Women’s Health Quiz: Health Coverage and the Affordable Care Act

    Feature

    Health insurance coverage is a critical factor in making health care accessible to women—women with health coverage are more likely to obtain needed preventive, primary, and specialty care services. Test your knowledge of women’s health coverage and the effect of the Affordable Care Act on women with our ten-question quiz.

  • Obamacare y Usted: Si no tiene seguro médico

    Fact Sheet

    Obamacare ha creado nuevas maneras de tener cobertura de salud. Si usted no tiene seguro médico a través de su empleador, seguramente pueda obtenerlo a través del nuevo Mercado de los Seguros Médicos (o "intercambio") en su estado. Nuevas opciones de cobertura Llenando una única aplicación, usted aprenderá sobre sus opciones de planes médicos y los costos, y si califica para tener cobertura a través de Medicaid o para recibir un subsidio para comprar un…

  • Obamacare y Usted: Si tiene seguro médico a través de un empleador

    Fact Sheet

    Si usted tiene cobertura de beneficios de salud a través de su empleador o del empleador de un miembro de su familia, usted probablemente pueda mantener esa cobertura y no tener que hacer ningún cambio. En la mayoría de los casos, la cobertura de su empleador satisface los requerimientos de la ley sobre la obtención de seguro. Cambios en la cobertura del empleador Algunas características de la cobertura de su empleador pueden ya haber cambiado…

  • Obamacare y Usted: Si tiene Medicare

    Fact Sheet

    Si usted tiene Medicare, su cobertura de salud no tiene cambios como consecuencia del Obamacare. Usted puede seguir confiando en el Medicare para ayudar a pagar su hospital, doctores y otros gastos médicos. Usted todavía tiene la opción de elegir entre el Medicare tradicional o el Medicare Advantage Plan (como un Medicare HMO) ofrecido en su área, y entre otros planes de Medicare para medicamentos recetados. Si usted está en Medicare y tiene bajos ingresos,…

  • Obamacare y usted

    Fact Sheet

    "Obamacare y usted" es una serie de materiales que explican cómo la Ley de Cuidado de Salud a (Affordable Care Act o ACA en inglés), también llamada “Obamacare,” afecta a diferentes grupos de personas. Haga clic en los links de abajo para aprender más: Si no tienes seguro médico Haga clic para leer en inglés / Click here to read this fact sheet in English Si tienes bajos ingresos y puede calificar para Medicaid Haga clic…

  • States’ Participation in Six Key Medicaid Long-Term Services and Supports Options Provided or Enhanced by the Affordable Care Act

    Feature

    States’ Participation in Six Key Medicaid Long-Term Services and Supports Options Provided or Enhanced by the Affordable Care Act Download Source M. O’Malley Watts, M. Musumeci, and E. Reaves, How is the Affordable Care Act Leading to Changes in Medicaid Long-Term Services and Supports (LTSS) Today? State Adoption of Six LTSS Options, The Henry J. Kaiser Family Foundation, April 2013, available at: http://www.kff.org/medicaid/issue-brief/how-is-the-affordable-care-act-leading-to-changes-in-medicaid-long-term-services-and-supports-ltss-today-state-adoption-of-six-ltss-options/;  updates available at: http://www.kff.org/state-category/health-reform/.

  • Obamacare y Usted: Si usted es una mujer

    Fact Sheet

    Como mujer, es especialmente importante para usted entender cómo la Ley de Cuidado de Salud a Bajo Precio (Affordable Care Act o ACA, en inglés) cambiará el cuidado de salud en el 2014. Su atención médica necesita diferenciarse de la de los hombres y a menudo usted es la que toma las decisiones sobre el cuidado de salud de su familia. Obamacare amplía la variedad de muchos servicios que son importantes para las mujeres, y…

  • Helping Hands: A Look at State Consumer Assistance Programs under the Affordable Care Act

    Issue Brief

    Navigator and In-Person Assister programs created by the Affordable Care Act (ACA) will provide outreach and enrollment assistance during the open enrollment period for the new health insurance Marketplaces. This brief describes these programs, highlighting differences in how they are funded and structured and discusses some of the challenges they face.

  • A Discussion with Leading Medicaid Directors: As FY 2013 Ends, Looking toward Health Care Reform Implementation in 2014

    Issue Brief

    The Kaiser Commission on Medicaid and the Uninsured convened a focus group discussion with Medicaid directors who serve on the Board of the National Association of Medicaid Directors (NAMD). The discussion focused on state progress and concerns about implementing the ACA including eligibility system changes and state action on the Medicaid expansion decision as well as activity around payment and delivery system reform, and other budget and enrollment trends. The discussion took place in May…