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Affordable Care Act

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

Promotional image for KFF video How Affordable is the Affordable Care Act

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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  • ACA Preventive Services at the Supreme Court

    Quick Insights

    If the Court rules in favor of Braidwood, private health insurers would no longer be required to cover, without cost sharing, certain preventive services recommended by USPTF after 2010 when the ACA was enacted.

  • A 90% Cut to the ACA Navigator Program

    Quick Insights

    Cutting funding for the trusted and impartial source of important information Navigators provide could have big impacts just as many consumers may need to re-evaluate their coverage options.

  • Most of the Public Oppose Major Federal Cuts to Health Agencies and Programs and Say They Have Been Made “Recklessly”

    News Release

    As the Trump administration and Congress pursue broad cuts to federal health agencies and budgets, most of the public, including some Republicans, oppose deep budget and staffing cuts to federal health programs and agencies, a new KFF Health Tracking Poll finds. Across a range of questions, large majorities of Democrats and independents oppose the Trump administration’s major cuts to federal health agencies and programs, while Republicans are more supportive. Those who identify with President Trump’s…

  • What is a self-funded/self-insured plan? How do I know if I have one?

    FAQs

    Many employers, especially large ones, offer workers health coverage that is known as a “self-funded” (also referred to as “self-insured”) arrangement, which is where the employer pays enrollees’ medical claims directly, as opposed to traditional health insurance (known as fully-insured), where the employer buys coverage from a state-regulated insurance company. Most companies with a self-funded plan contract with a health insurance company to pay the medical claims and provide enrollees access to the insurance company’s…

  • My employer doesn’t offer health insurance. Can I buy a plan on the Marketplace and qualify for financial assistance?

    FAQs

    Yes, if your employer does not offer you health insurance, you can shop for a plan on the Marketplace instead. The annual Open Enrollment period to sign up for coverage runs from November 1 to January 15 in most states. Depending on your income and household information, you may qualify for premium tax credits and cost-sharing reductions to help offset your costs. If your income is very low, the Marketplace will also help determine if…

  • ¿Qué es un plan de salud para estudiantes?

    FAQs

    Un plan de salud estudiantil es un tipo especial de cobertura médica que las universidades ofrecen a sus estudiantes matriculados. Normalmente, un plan de salud estudiantil es diferente de la cobertura patrocinada por el empleador que las universidades ofrecen a su plantel de profesores y a su personal.

  • No sé cuánto tiempo hace que terminó mi Medicaid. ¿Hay una fecha límite para solicitar la cobertura del mercado?

    FAQs

    Sí, el período especial de inscripción por pérdida de Medicaid o CHIP es de 90 días en la mayoría de los estados. Esto significa que los consumidores tendrán hasta 90 días después de la pérdida de Medicaid o CHIP para inscribirse en el mercado de seguros. Si no solicita la cobertura del mercado dentro de este plazo, podría tener que esperar hasta el próximo período de inscripción abierta para hacerlo. Los estados que administran sus…

  • ¿Qué sucede si recibo atención de un médico que no está en la red de mi plan?

    FAQs

    En general, los planes no están obligados a cubrir la atención recibida de un proveedor fuera de la red (OON). Por ejemplo, si decide consultar a un médico de cabecera que no pertenece a la red de su plan, es posible que su aseguradora no cubra la factura o, si lo hace, podría tener que pagar un costo compartido mucho mayor que si hubiera optado por consultar a un proveedor dentro de la red. En…