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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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  • Visualizing Health Policy: Preventive Services for Women and the Affordable Care Act

    News Release

    This month’s Visualizing Health Policy infographic takes a look at preventive health services for women, including missed opportunities for preventive counseling on risk factors (such as smoking or alcohol) and sexual health issues (such as contraception, sexually transmitted infections, and domestic violence), the effects of lack of insurance on rates of mammograms and other screening tests for women, and how costs are a barrier that cause some women to postpone preventive services or skip a…

  • Health Care Access and Coverage for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community in the United States: Opportunities and Challenges in a New Era

    Perspective

    This Policy Insight looks at the challenges and questions surrounding recent policy changes that are expected to increase health insurance coverage and access to care for lesbian, gay, bisexual and transgender (LGBT) individuals and their families, including the impact of the Affordable Care Act (ACA) and the Supreme Court's DOMA decision.

  • Wisconsin’s BadgerCare Program and the ACA

    Fact Sheet

    This fact sheet provides an overview of changes to BadgerCare, Wisconsin's 1115 waiver demonstration project, and how it relates to the Affordable Care Act's Medicaid expansion.

  • For ACA Enrollees, How Much Premiums Rise Next Year is Mostly up to Congress

    Policy Watch

    Most customers with coverage through Affordable Care Act's marketplaces will face big premium increases next year if Congress doesn’t extend the temporary enhanced tax credits included in the American Rescue Plan Act (ARPA) of 2021. If the outcome isn’t clear by summer, fall open enrollment could be a mess.

  • Marketplace Insurers are Proposing a 6% Average Premium Hike for 2024 and Pointing to Inflation as a Key Driver of Costs

    News Release

    ACA Marketplace insurers are requesting a median premium increase of 6% for 2024, according to a new KFF analysis of the preliminary rate filings. Insurers’ proposed rate changes – most of which fall between 2% and 10% – may change during the review process. Although most Marketplace enrollees receive subsidies and are not expected to face these added costs, premium increases could result in higher federal spending on subsidies. Insurers cite price increases for medical…

  • 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.

  • ACA Marketplace Enrollment Has More Than Doubled Since 2020, with the Fastest Growth Occurring in States Won by President Trump in 2024

    News Release

    Enrollment in Affordable Care Act (ACA) Marketplace health plans reached a record 24.3 million people, more than double the total in 2020, with most of the growth occurring in states won by President Trump in the 2024 election, a new KFF analysis finds.  Almost all states have seen increases in enrollment since 2020, including six states where enrollment has more than tripled: Texas (up 255%), Mississippi (up 242%), West Virginia (up 234%), Louisiana (up 234%),…

  • The Rubber is About to Hit the Road on Medicaid Cuts

    Quick Insights

    Once Republicans in Congress get specific about Medicaid cuts, it will become more tangible and clearer who will be affected. Changes to the status quo in health care rarely get more popular when the details get filled in.

  • The Debate About Enhanced Premium Tax Credits Begins to Emerge (Finally)

    From Drew Altman

    In his latest column, president and CEO Drew Altman discusses why debate about extending the ACA enhanced tax credits set to expire this year has been slow to develop, and why it could matter to Republicans politically if the tax credits are not extended.