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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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  • Can I buy a plan in the Marketplace if I don’t have a green card?

    FAQs

    Potentially, yes. You must be a lawfully present immigrant who is eligible for coverage, such as a lawful permanent resident (green card holder), certain types of visa holders, or a refugee or asylee. Deferred Action for Childhood Arrivals (DACA) is no longer considered an eligible immigration status for health coverage through the Marketplaces. You can find more information about qualifying statuses here.   You can also shop for health insurance outside of the Marketplace in…

  • I’m uninsured. Am I required to get health insurance?

    FAQs

    While there is no longer a federal tax penalty for being uninsured, some states (CA, MA, NJ, and RI) and DC have adopted individual mandates with state tax penalties for not having health insurance. One state (VT) also has an individual mandate but does not impose a tax penalty for not having coverage. Check with your tax advisor or state insurance department for more information. Regardless of the penalty, it is important to have health insurance if…

  • 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…

  • I am self-employed and my income varies from year to year. How do I apply for premium tax credits if I don’t know what my income will be next year?

    FAQs

    When you apply for the premium tax credit, you will be asked to estimate your expected income for the upcoming year. Often a good place to start is to consider what your income is this year, or what income you reported on your tax return last year. However, if your circumstances have changed since then, you should make your best estimate of what your income will be next year. For example, if you recently lost…

  • I had a Marketplace plan last year and received advanced premium tax credits. Since the Marketplace already determined that I was eligible for the tax credit, do I still have to file a federal income ta...

    FAQs

    Yes. You are required to file a federal income tax return for any year in which you received advanced premium tax credits. When you file, you will have to calculate how much tax credit you were actually eligible for in that year. The Marketplace determination you received last year was based on your good-faith estimate of what your annual income would be.  When you file your tax return, you will need two special tax forms: Form 1095-A and Form…

  • I got a premium tax credit this year, but I didn’t realize I was supposed to file taxes for last year. Will that affect my ability to renew my premium tax credits for next year?

    FAQs

    Yes. In general, you are required to file a federal income tax return for any tax year in which you received Advanced Premium Tax Credits (APTC) for a Marketplace plan. You are also required to file Form 8962 with your tax return to “reconcile” the amount of APTC you received with your actual income for the tax year. Click here for more information. Consumers who do not file their taxes and reconcile any of their advance…

  • Can I pay my health insurance premium with a credit card, debit card, money order, or cash?

    FAQs

    All insurers in the Marketplace are required to accept money orders, checks, pre-paid debit cards, and electronic funds transfers (EFT), which are digital direct deposits. Some states may also require insurers to accept credit card or debit card payments. Many insurers in other states accept debit and credit cards even though they are not federally required to.

  • 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…