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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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  • Health Policy Resources for Covering the 2020 Elections

    News Release

    As the 2020 Election Day approaches, many candidates continue to focus on health care issues, including on the public health and economic response to COVID-19, the future of the Affordable Care Act, health care costs and abortion. To help reporters understand and cover these issues, KFF offers independent, non-partisan policy analysis, polling and other research and has experts who can provide context, explain trade-offs and provide key data points on health care issues that may arise…

  • Affordability in the ACA Marketplace Under a Proposal Like Joe Biden’s Health Plan

    Issue Brief

    This KFF analysis finds that expanding Affordable Care Act (ACA) premium subsidies like Democratic presidential nominee Joe Biden has proposed would lower the cost of Marketplace coverage for nearly all potential enrollees, including the uninsured and others currently priced out of the Marketplace. Biden's plan would, however, increase federal spending, which we do not attempt to estimate here.

  • Loss of the Affordable Care Act Would Widen Racial Disparities in Health Coverage

    Policy Watch

    In November, the Supreme Court is scheduled to hear arguments on a legal challenge that seeks to overturn the Affordable Care Act (ACA). This analysis shows that new coverage options under the ACA have contributed to large gains in coverage, particularly among people of color, helping to narrow longstanding racial disparities in health coverage.

  • I bought emergency contraception over-the-counter (OTC) at my pharmacy and thought it would be covered by my insurance, but I ended up having to pay the full cost out-of-pocket. Why wasn’t it cove...

    FAQs

    Emergency contraception is one of the FDA-approved methods for women that must be covered by most health plans, including those sold on the Marketplace, but it has to be prescribed by a health care provider in order for most insurance plans to cover it. If you don’t have a prescription, you will likely have to pay the full cost out-of-pocket. However, you can ask your provider (or pharmacist if your state allows it) for a prescription…

  • Insurer Participation on the ACA Marketplaces, 2014-2021

    Issue Brief

    For the third straight year, more insurers are entering the ACA Marketplaces or expanding their service area in 2021, creating more choices for consumers shopping for coverage during the 2021 open enrollment period.

  • The Stakes Beyond the Halbig Lawsuit

    From Drew Altman

    In a column for The Wall Street Journal’s Think Tank, Drew Altman discusses if the legal court cases about whether the government can provide tax credits to people in the Affordable Care Act’s federal health exchanges will be perceived by the American people as a legitimate legal question or as more inside-Washington politics.

  • Where are California’s Uninsured Now? Wave 2 of the Kaiser Family Foundation California Longitudinal Panel Survey

    Report

    This second wave of the Kaiser Family Foundation's California uninsured survey assesses the impact of the Affordable Care Act to date on state residents who were uninsured prior to open enrollment. The results capture the share of previously uninsured Californians who gained coverage or remained uninsured, how they feel about and interact with their new coverage options and what barriers to getting insurance remain. The report examines breakouts by race, coverage type, and other demographic…

  • A Closer Look at the Courts’ Impact on Health Policy

    From Drew Altman

    In his latest column for The Wall Street Journal’s Think Tank, Drew Altman maps what the combined impact of the Supreme Court decision on the Affordable Care Act’s Medicaid expansion and a plaintiff’s win in Halbig would look like and discusses the impact of court decisions on health policy.

  • One Year into Duals Demo Enrollment: Early Expectations Meet Reality

    Perspective

    One year into initial enrollment in the Medicare-Medicaid financial alignment demonstrations for dual eligible beneficiaries, some initial insights are beginning to emerge. This policy insight highlights key challenges and trends emerging in states’ demonstrations.