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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?

The ACA MarketplaceS

In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year 

ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third between 2025 and 2027.

The Average Marketplace Deductible Grew by About $1,000 Per Person in 2026, With More Enrollees Shifting to Higher-Deductible Plans as Enhanced Tax Credits Expired

The average Affordable Care Act (ACA) Marketplace deductible experienced the steepest increase in history—growing by 37% or over $1,000, from $2,759 in 2025 to $3,786 in 2026 as enhanced premium tax credits expired, according to a new KFF analysis. After the enhanced tax credits ended, many Marketplace shoppers shifted toward lower-premium, higher-deductible plans.

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  • 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…

  • 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…

  • I lost my job and my health coverage. Can I buy a Marketplace plan now, or do I have to wait for the next Open Enrollment?

    FAQs

    You can apply now. HealthCare.gov and all state Marketplaces allow a special enrollment opportunity when people lose other coverage, including job-based coverage. In general, you have 60 days following the loss of other job-based coverage to apply for a special enrollment opportunity through the Marketplace. If you have advance notice of your coverage loss, you can apply for the special enrollment opportunity up to 60 days in advance. If your state uses the federally facilitated Marketplace…

  • I’m a few years away from turning 65 and becoming eligible for Medicare, and I would like to sign up for a Marketplace plan in the meantime. I am a lawfully-present immigrant, and I hear there&#82...

    FAQs

    In general, lawfully-present immigrants (except for DACA recipients) are eligible to buy a plan on the ACA Marketplace. The new law does not affect eligibility for Marketplace coverage for lawfully-present immigrants. Currently, depending on your income and household size, you may be eligible for premium tax credits to offset the cost of your premiums. However, beginning in 2027, the types of lawfully-present immigrants eligible for tax credits will become much more limited than it is…