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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’ve picked the plan I want. What do I do next, and where do I send my premium payments?

    FAQs

    Your enrollment in the health plan is not complete until the insurance company receives your first premium payment. Once you’ve selected your plan, the Marketplace will direct you to your insurance company’s website to make the first premium payment. In most states, you will make your premium payments directly to the health insurance company. Insurance companies must accept different forms of payment, including for those who do not have a credit card or bank account.…

  • Will people in hurricane- or wildfire-affected areas have more time to sign up for coverage?

    FAQs

    Yes, although the extension is not automatic. In HealthCare.gov states, you must apply for the extra time using an Exceptional Circumstances special enrollment period (SEP). You can apply for this SEP by calling the federal Marketplace call center at 1-800-318-2596. You will have to attest to residing in -- or moving from -- areas affected by a disaster event during an enrollment period you were eligible for. Affected areas are those designated by the Federal…

  • 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…

  • Can I buy a plan in the Marketplace if I don’t have a green card?

    FAQs

    Potentially, yes. You must be a lawfully present immigrant who is eligible for coverage, such as a lawful permanent resident (green card holder), certain types of visa holders, or a refugee or asylee. Deferred Action for Childhood Arrivals (DACA) is no longer considered an eligible immigration status for health coverage through the Marketplaces. You can find more information about qualifying statuses here.   You can also shop for health insurance outside of the Marketplace in…

  • I’m uninsured. Am I required to get health insurance?

    FAQs

    While there is no longer a federal tax penalty for being uninsured, some states (CA, MA, NJ, and RI) and DC have adopted individual mandates with state tax penalties for not having health insurance. One state (VT) also has an individual mandate but does not impose a tax penalty for not having coverage. Check with your tax advisor or state insurance department for more information. Regardless of the penalty, it is important to have health insurance if…

  • I got a premium tax credit this year, but I didn’t realize I was supposed to file taxes for last year. Will that affect my ability to renew my premium tax credits for next year?

    FAQs

    Yes. In general, you are required to file a federal income tax return for any tax year in which you received Advanced Premium Tax Credits (APTC) for a Marketplace plan. You are also required to file Form 8962 with your tax return to “reconcile” the amount of APTC you received with your actual income for the tax year. Click here for more information. Consumers who do not file their taxes and reconcile any of their advance…

  • I like my Marketplace plan just the way it is. Will it stay the same next year?

    FAQs

    It depends. Insurers are allowed to make changes to plans each year. Most likely, the premium for your current policy will change next year. There may be other changes as well such as the deductible or copays. In some cases, an insurer may stop offering a particular plan and offer you new choices, instead. Shortly before Open Enrollment begins, you should receive a notice from your insurance company describing any changes to your plan and…

  • 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…