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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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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 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…

  • Will people in hurricane- or wildfire-affected areas have more time to sign up for coverage?

    FAQs

    Yes, although the extension is not automatic. In HealthCare.gov states, you must apply for the extra time using an Exceptional Circumstances special enrollment period (SEP). You can apply for this SEP by calling the federal Marketplace call center at 1-800-318-2596. You will have to attest to residing in -- or moving from -- areas affected by a disaster event during an enrollment period you were eligible for. Affected areas are those designated by the Federal…

  • 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 eligible for health benefits at work, but want to see if I can get a better deal on the Marketplace. Can I do that?

    FAQs

    You can always shop for coverage on the Marketplace, assuming you meet other eligibility requirements, but if you have access to job-based coverage that is determined to be affordable (no more than 9.96% of your household income in 2026), you won’t qualify for premium tax credits. Browse more questions in the Employer-Sponsored Health Coverage and the Marketplace section.

  • 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…

  • I am covered by Medicaid, but I’m wondering if I can drop my Medicaid and purchase one of the health plans offered through the Marketplace instead?

    FAQs

    While you are allowed to purchase Marketplace coverage, if you are currently covered by Medicaid or have been told you are eligible for Medicaid, you are not eligible for premium tax credits that make Marketplace coverage more affordable for people with lower incomes. Without the Marketplace tax credits, the cost of a Marketplace plan will likely be unaffordable. Medicaid offers comprehensive coverage with no or low premiums and limited out-of-pocket costs.

  • 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.

  • I learned that my Medicaid coverage has ended. What do I do now?

    FAQs

    If you lose Medicaid but think you still qualify, contact your Medicaid agency. If your coverage ended less than 90 days ago, you may be able to submit any required forms and documents and have your coverage reinstated. If your coverage ended more than 90 days ago, you will likely need to reapply for Medicaid. If the Medicaid agency says you are no longer eligible for Medicaid but you believe that decision was made in…

  • I am having trouble setting up a Marketplace account online. The Marketplace website says that it cannot verify my identity. What should I do now?

    FAQs

    Some consumers with little or no credit history, such as young adults or recent immigrants, may have difficulty setting up accounts on HealthCare.gov. That is because the federal Marketplace uses real-time identity proofing techniques to protect consumers from unauthorized access to their personal information and to prevent fraud.  First, you should check to make sure you have entered all information requested in order to create an account, including information labeled as optional. If this does not…