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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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  • 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…

  • I received a Form 1095-A from the Marketplace. What is that?

    FAQs

    Form 1095-A gives you information about the amount of advance premium tax credit (APTC) you received during the previous year. A copy of this form is also reported to the IRS. Keep this form with your other tax records. The APTC you received was based on the annual income you estimated you would earn when you signed up for Marketplace coverage. Now you must file a federal income tax return to compute your actual income for that coverage…

  • Can someone else, such as my family member, church, or another third party pay my portion of the monthly health insurance premium for me?

    FAQs

    Family members, your church, federal programs such as the Ryan White HIV/AIDS program, or any charity that doesn't condition financial help on health status can pay your premium on your behalf. However, Marketplace plans are discouraged from accepting third-party payments from hospitals and other commercial entities. Some dialysis facilities offer to pay premiums for Medicare-eligible patients with end-stage renal disease who elect Marketplace coverage instead of Medicare. Check with a Marketplace navigator or your State…

  • I want to enroll in a Marketplace family plan to cover myself, my spouse, and our children. How will my family premium be calculated?

    FAQs

    Family premiums will reflect the composition of family members; in most states, this includes their ages and any tobacco use. To calculate a “family premium,” insurers will add together a separate premium for each adult age 21 and older. Insurers can charge a separate premium for up to three children under age 21. For example, if you have four children under age 21, your family premium will reflect two adult premiums and only three child…

  • I have COBRA, but it’s too expensive. Can I drop it during Marketplace Open Enrollment and enroll in a Marketplace plan instead?

    FAQs

    During Marketplace Open Enrollment, you can sign up for a Marketplace plan even if you already have COBRA. You will have to drop your COBRA coverage effective on the date your new Marketplace plan coverage begins. After Marketplace Open Enrollment ends, however, if you voluntarily drop your COBRA coverage or stop paying premiums, you will not be eligible for a special enrollment opportunity to enroll in a Marketplace plan and will have to wait until…

  • Do I have to prove eligibility for a special enrollment period?

    FAQs

    Yes, in some cases. When you apply for Marketplace coverage and qualify for a Special Enrollment Period, the Exchange may request additional documents to confirm that you qualify for coverage in your Marketplace Eligibility notice. If you apply for Marketplace coverage following loss of other coverage, HealthCare.gov will let you select a health plan but will delay the effective date of coverage while it verifies your loss of other coverage. If the Marketplace cannot automatically…

  • When can small employers enroll in coverage through the SHOP Marketplace?

    FAQs

    Small employers can buy coverage for their employees through the SHOP Marketplace at any time during the year. HealthCare.gov no longer operates a SHOP Marketplace website for small employers. However, if you want to sponsor small group coverage through the Marketplace for your employees, you can contact insurance companies directly or work with a broker who is certified to sell SHOP policies. In HealthCare.gov states, you can find a SHOP-certified broker using the Find Local Help tool. Be…

  • How long after I enroll in a plan will coverage take effect?

    FAQs

    During Open Enrollment in HealthCare.gov and some other states, if you enroll in a private health insurance plan by December 15 and make your first premium payment by the due date specified by your plan, your new health coverage will start January 1. If you sign up after December 15, your coverage will begin on February 1. If you sign up for a Marketplace plan during a special enrollment period, your coverage will usually take…

  • When can I enroll in Marketplace health plan coverage?

    FAQs

    This FAQ was updated January 14, 2026, to reflect newly extended Open Enrollment deadlines in Connecticut, Illinois, and Pennsylvania. In general, you can only enroll in Marketplace health plan coverage during the annual Open Enrollment period. For 2026 coverage, the Open Enrollment period in most states begins November 1, 2025, and closes at the end of the day on January 15, 2026. The following states have different Open Enrollment end dates: Idaho: December 15 Massachusetts:…