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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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  • What happens after the COBRA subsidies end in September?

    FAQs

    You can continue on COBRA unsubsidized until your 18 months of COBRA eligibility ends. In addition, you will have the option to enroll in marketplace coverage when the subsidy ends in September.  Loss of the COBRA subsidy will make you eligible for a special enrollment period (SEP) to sign up for marketplace coverage.  If you make your plan selection before the end of September, new marketplace coverage will take effect on October 1. 

  • 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 am covered in a Marketplace health plan now, but I am behind on my premium payments. If I don’t actively renew my plan but the Marketplace auto-renews me in the same plan, and if I at least pay my Jan...

    FAQs

    Yes, your insurer must accept your January payment to start your coverage for next year and your payment for January 1 cannot be applied to the back-due premiums you owe. Insurers are not allowed to require people who owe back-due premiums to repay the premium debt before they will renew coverage for another year. Whether you actively renew or auto-renew, the process will work the same way. Keep in mind that insurers are allowed to cancel your…

  • 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…

  • Are there special timelines for enrolling in the Marketplace for people who lose Medicaid or CHIP?

    FAQs

    The special enrollment period due to loss of Medicaid or CHIP is 90 days, which means consumers will have up to 90 days after loss of Medicaid or CHIP to enroll in Marketplace coverage. However, state-based Marketplaces have the option to extend the special enrollment period beyond 90 days. Check with your state Marketplace for more information if you live in one of these states.

  • My spouse and I have a teenage daughter who has a part-time job. Do we count her income as part of our household income when we apply for Marketplace premium tax credits?

    FAQs

    It depends on whether she earned enough income to be required to file a federal income tax return on her own. Generally, kids who qualify as tax dependents aren’t required to file a federal income tax return or pay taxes on their income if they earned less than a certain amount ($14,600 in 2025). If your daughter earned less than that, you would not count her income as part of your household income when you…

  • 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…