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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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  • Do I have to renew Medicaid coverage every year?

    FAQs

    Yes. States must redetermine Medicaid eligibility for most enrollees every 12 months. When your coverage period is ending, you will receive a notice from the state. If your coverage has been automatically renewed, the notice will indicate the new coverage period. If your coverage has not been automatically renewed, the notice will include instructions for completing the renewal process. Note that the renewal process might look different depending on where you live. Click here for a…

  • I hear there is a special enrollment opportunity for people with very low income. How does that work?

    FAQs

    Starting August 25, 2025, the special enrollment opportunity that allowed individuals with incomes at or below 150% of the federal poverty level to sign up for Marketplace coverage year-round --simply due to their low income --was eliminated. Individuals at this income level might still qualify for special enrollment under other special enrollment events, such as when they lose coverage due to job loss or lose Medicaid coverage.

  • How long after I enroll in a plan will coverage take effect?

    FAQs

    During Open Enrollment in HealthCare.gov and some other states, if you enroll in a private health insurance plan by December 15 and make your first premium payment by the due date specified by your plan, your new health coverage will start January 1. If you sign up after December 15, your coverage will begin on February 1. If you sign up for a Marketplace plan during a special enrollment period, your coverage will usually take…

  • I received a Form 1095-B in the mail. What’s that?

    FAQs

    Health insurance companies, certain employer-sponsored health plans, and public health programs such as Medicaid may provide you with documentation indicating the months during the prior year when you were covered under the plan. Coverage providers may send Form 1095-B directly to you, but in some cases, you may have to request a Form 1095-B from the coverage provider. If you were enrolled in family coverage, Form 1095-B will indicate the names of all family members who were…

  • I notice “short-term limited-duration” insurance plans for sale outside of the Marketplace, and they are cheaper than many other health plans. What is a short-term limited-duration health plan?

    FAQs

    “Short-term limited-duration” insurance plans are intended to fill a temporary gap in health coverage, such as when someone is between jobs. The maximum duration of short-term plans varies by state. Short-term plans must disclose to consumers that these plans are “NOT comprehensive health coverage.” Short-term plans often do not have the consumer protections found in Marketplace plans. For example, short-term plans can exclude coverage of pre-existing health conditions. Also, many short-term plans do not cover essential health…

  • I received premium tax credits last year. At the end of the year though, my total income ended up being lower than the minimum income eligibility level for premium tax credits. Will I have to repay the...

    FAQs

    No, you will not be required to repay the premium tax credits paid on your behalf when you file your tax return as long as the tax credits were authorized and paid for at least one month during the year. In this situation, if the Marketplace found that your estimated income made you eligible for premium tax credits at the time you enrolled, even though your income later fell below the minimum income eligibility level…

  • Can I be charged more if I have a pre-existing health condition?

    FAQs

    Not if you're buying a Marketplace plan. Marketplace plans are not allowed to charge you more based on your health status or pre-existing health condition. Some plans that are sold off the Marketplace, such as short-term plans and health sharing ministries, can turn you down or charge you more based on your health status or pre-existing condition. Click here for information on what to look for if you’re considering shopping for a plan off the…

  • I notice “Catastrophic plans” that look even cheaper than other Marketplace plans. What are those, and can I buy one?

    FAQs

    Catastrophic plans have the highest cost sharing and lowest premiums. In 2026, Catastrophic plans will have an annual deductible of $10,600 for an individual or $21,200 for a family. The plan does not have to cover more than three primary care visits before the deductible has been met. Catastrophic plans may only be sold to certain individuals. See this FAQ for details. Note that if you are eligible for financial assistance on the Marketplace, it…