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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 if I’m late with a monthly health insurance premium payment?

    FAQs

    It depends on whether you are receiving advanced premium tax credits. If you receive a premium tax credit, your insurer must provide a 90-day grace period to pay all past-due premiums. If the amount owed for all outstanding premium payments is not paid in full by the end of the grace period, the insurer can terminate coverage. However, the grace period only applies if you have paid at least one month’s premium within the current…

  • I am a recent immigrant, and I don’t have a checking account. Can the insurance company require that I get one and pay my premiums through automatic monthly withdrawals?

    FAQs

    No. Insurers offering coverage in the Marketplace are required to provide a variety of payment methods and cannot require a consumer to pay by automatic bank withdrawals (sometimes called electronic funds transfers, or EFT) or debit card. Federal rules require the insurer to also accept paper checks, cashier’s checks, money orders, and general-purpose pre-paid debit cards. These methods must be available to consumers for both the initial premium payment (at enrollment) and ongoing payments.

  • 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…

  • Do Marketplace plans cover dental care?

    FAQs

    It depends on your age. Dental coverage for children ages 18 and under is an "essential health benefit," meaning it must be available to any children you have, either as part of a health plan or through a separate dental plan, though you are not required to buy it. Dental coverage for adults is not considered an essential health benefit, so Marketplace plans don’t have to offer it.

  • How can I compare covered benefits in different Marketplace plans?

    FAQs

    Although all Marketplace health plans are required to cover the ten categories of essential health benefits, insurers in many states have flexibility to modify coverage for some of the specific services within each category, subject to approval by their Marketplace. All health plans must provide consumers with a Summary of Benefits and Coverage (SBC) to make it easier to compare differences in health plan benefits and cost sharing. It is also available for each plan…

  • What health plans are offered through the Marketplace?

    FAQs

    All health plans offered through the Marketplace must meet the requirements of “qualified health plans.” This means they will cover essential health benefits, limit the amount of cost sharing (such as deductibles and co-pays) for covered benefits, cover certain preventive services at no cost to consumers, and satisfy all other consumer protections required under the Affordable Care Act. Health plans vary in the benefits they cover and the level of cost sharing required. Plans are…

  • I notice something called “Easy pricing” under the plan name on HealthCare.gov. What does that mean?

    FAQs

    "Easy pricing" refers to a "standardized" plan design on HealthCare.gov that aims to make it simpler to compare plans by applying the same to each category of essential health benefits across all easy pricing plans in the same metal level. For example, all Bronze-level easy pricing plans have the same deductible and copays. By contrast, non-standardized Bronze-level plans might have different deductible and copay amounts. Easy pricing plans are marked with a green circle with…

  • 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…

  • My 24-year-old daughter is eligible for premium tax credits and a cost-sharing reduction. We are not eligible for any financial assistance, but we would all like to enroll in the same Marketplace plan....

    FAQs

    You do not need to claim your daughter as a tax dependent to be covered on your Marketplace health plan; however, since you do not claim her as a tax dependent, she will likely have to submit a separate application, and she likely will not be able to apply her premium tax credits to your shared plan. Additionally, because you do not qualify for cost-sharing subsidies, she will not be able to apply hers to…