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Individual Market Enrollment Declined by 18% Since June 2025

Individual Market Enrollment Fell 18%, Suggesting Continued ACA Marketplace Losses

Enrollment in the individual health insurance market fell by 18%—over 4.6 million people—from 25.2 million in June 2025 to 20.5 million in June 2026. Falling individual market enrollment suggests further decline in ACA Marketplace enrollment this year, since Marketplace enrollees represent the vast majority of individual market coverage.

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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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  • Can someone else, such as my family member, church, or another third party pay my portion of the monthly health insurance premium for me?

    FAQs

    Family members, your church, federal programs such as the Ryan White HIV/AIDS program, or any charity that doesn't condition financial help on health status can pay your premium on your behalf. However, Marketplace plans are discouraged from accepting third-party payments from hospitals and other commercial entities. Some dialysis facilities offer to pay premiums for Medicare-eligible patients with end-stage renal disease who elect Marketplace coverage instead of Medicare. Check with a Marketplace navigator or your State…

  • 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…

  • I’m not sure how long ago my Medicaid ended. Is there a deadline for applying for Marketplace coverage?

    FAQs

    Yes, the special enrollment period due to loss of Medicaid or CHIP is 90 days in most states, which means consumers will have up to 90 days after loss of Medicaid or CHIP to enroll in Marketplace coverage. If you do not apply for Marketplace coverage within this timeframe, you may have to wait until the next Open Enrollment Period to enroll in Marketplace coverage. States that run their own Marketplaces can choose to extend…

  • When can small employers enroll in coverage through the SHOP Marketplace?

    FAQs

    Small employers can buy coverage for their employees through the SHOP Marketplace at any time during the year. HealthCare.gov no longer operates a SHOP Marketplace website for small employers. However, if you want to sponsor small group coverage through the Marketplace for your employees, you can contact insurance companies directly or work with a broker who is certified to sell SHOP policies. In HealthCare.gov states, you can find a SHOP-certified broker using the Find Local Help tool. Be…

  • 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…

  • Can I buy or change private health plan coverage outside of Open Enrollment?

    FAQs

    In general, you can have a special enrollment period (SEP) to sign up for Marketplace coverage during the year, other than during Open Enrollment period, if you have a qualifying event. Some examples of qualifying events include marriage, gaining a dependent, or loss of employment. Only one person in a household applying for coverage or financial assistance through the Marketplace must qualify for an SEP in order for the entire household to qualify for the…

  • 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…

  • Do I have to prove eligibility for a special enrollment period?

    FAQs

    Yes, in some cases. When you apply for Marketplace coverage and qualify for a Special Enrollment Period, the Exchange may request additional documents to confirm that you qualify for coverage in your Marketplace Eligibility notice. If you apply for Marketplace coverage following loss of other coverage, HealthCare.gov will let you select a health plan but will delay the effective date of coverage while it verifies your loss of other coverage. If the Marketplace cannot automatically…