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Affordable Care Act Signups Are Down, But Still an Incomplete Picture

Data from CMS may not fully show how much the expiration of the enhanced premium tax credits has affected enrollment in the ACA Marketplaces. The extent of enrollment changes likely won’t be known until this summer, when effectuated enrollment data are typically released.
DATA

Marketplace Enrollment Snapshot for Open Enrollment 2026

ANALYSIS

Higher Premium Payments or Higher Deductibles: The ACA's Tradeoffs

QUIZ

Test Your Knowledge of the Affordable Care Act

ANALYSIS

Competition Increased in Individual Market But Fell in Fully Insured Group Markets

Enhanced Premium tax credits

2025 KFF Marketplace Enrollees Survey

If their premium payments double, about one in three ACA enrollees say they would be “very likely” to look for a lower-premium Marketplace plan.

Updated Larry QT on ePTCs

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

A discharge petition in the House paves the way for a vote on a three-year extension of the tax credits, which would provide ACA enrollees premium relief whenever it comes. While there is still time to extend the enhanced tax credits, with each passing day, more and more ACA Marketplace enrollees are going to drop their health insurance when faced with eye-popping increases in their premium payments, writes KFF’s Larry Levitt.

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  • As ACA Marketplace Enrollment Reaches Record High, Fewer Are Buying Individual Market Coverage Elsewhere

    Issue Brief

    This analysis looks at how many people are signed up for each type of individual ACA Marketplace coverage—both on- and off-Marketplace and with or without subsidies—as of early 2023 based on federal enrollment data and administrative data insurers report to state regulators, as compiled by Mark Farrah Associates. The number of people enrolled in compliant and non-compliant plans was also evaluated.

  • Insurance Coverage of OTC Oral Contraceptives: Lessons from the Field

    Report

    This report is based on 35 structured interviews conducted from January to August 2023, with nearly 80 experts and key players such as pharmacists, health plans, and state Medicaid officials involved in the coverage and provision of OTC contraception in seven states with one or more of these coverage approaches (IL, NJ, NM, NY, OR, UT, and WA). It discusses the challenges and successes in coverage under private health insurance and Medicaid and reviews policy options for operationalizing insurance coverage of non-prescribed OTC contraception such as Opill.

  • The 4 Arguments You Will Hear Against Drug Price Negotiation

    Perspective

    As the Biden administration begins the process of negotiation drug prices for Medicare as authorized in the Inflation Reduction Act, KFF's Larry Levitt probes some of the arguments against it and the policy and political implications of the debate in this New York Times op-ed column.

  • Over-the-Counter Oral Contraceptive Pills

    Issue Brief

    Oral contraceptives are the most commonly used method of reversible contraception in the U.S. In July 2023, the FDA approved Opill, the first daily oral contraceptive pill to become available over the counter (OTC) without a doctor’s prescription. This issue brief provides an overview of OTC oral contraceptives and laws and policies related to insurance coverage.

  • How Much and Why ACA Marketplace Premiums Are Going Up in 2025

    Issue Brief

    This analysis of insurers' preliminary rate filings shows that ACA Marketplace insurers are requesting a median premium increase of 7% for 2025, similar to the 6% premium increase filed for 2024. Insurers cite growing health care prices – particularly for hospital care – as a key driver of premium growth in 2025.

  • Responding to Federal Medicaid Reductions: Which States Are Most at Risk?

    Issue Brief

    A new KFF analysis examines a range of measures that may make it harder for states to respond to possible federal Medicaid cuts and finds that six states (Kentucky, Mississippi, Missouri, New Mexico, South Carolina, and West Virginia) rank in the top five for multiple risk categories. Across four broad categories of measures that could affect demand for Medicaid and states’ abilities to raise revenue or reduce spending—population demographic characteristics, health status of Medicaid enrollees, available revenue and state budget choices, and health care costs and access to care—KFF finds that 15 states rank in the top five for at least one category of risk factors.

  • 5 Key Facts About Medicaid Expansion

    Issue Brief

    This issue brief examines Medicaid expansion enrollment and Medicaid spending in expansion and non-expansion states and describes the characteristics of adults covered by the Medicaid expansion.