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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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  • What happens after the COBRA subsidies end in September?

    FAQs

    You can continue on COBRA unsubsidized until your 18 months of COBRA eligibility ends. In addition, you will have the option to enroll in marketplace coverage when the subsidy ends in September.  Loss of the COBRA subsidy will make you eligible for a special enrollment period (SEP) to sign up for marketplace coverage.  If you make your plan selection before the end of September, new marketplace coverage will take effect on October 1. 

  • I just got laid off. I am eligible for 6 months of COBRA subsidy, also eligible for Medicaid. Can I choose option that is best for me?

    FAQs

    Yes, eligibility for COBRA does not affect your eligibility for Medicaid or vice versa.  Medicaid also offers premium-free coverage (in some states Medicaid charges a nominal monthly premium for some adults) with no or nominal cost sharing.  As you consider options, you will want to compare provider networks, cost sharing, covered benefits, other plan features. If you elect COBRA, remember the subsidy ends no later than September 30, 2021.  If income remains at or below…

  • 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…

  • ¿Qué ingreso cuenta para determinar mi elegibilidad para recibir subsidios?

    FAQs

    La elegibilidad para los créditos fiscales para las primas (subsidios) se basa en su ingreso bruto ajustado modificado o MAGI. Cuando presenta una declaración federal de impuestos, debe informar su ingreso bruto ajustado (que incluye sueldos y salarios, intereses y dividendos, beneficios por desempleo y varias otras fuentes de ingresos). MAGI modifica su ingreso bruto ajustado añadiéndole cualquier beneficio de Seguro Social sujeto a impuestos que reciba, cualquier interés exento de impuestos que gane y…

  • ¿Qué pasa si no actualizo mi aplicación para asistencia financiera?

    FAQs

    Si no actualiza su solicitud, en la mayoría de los casos, el mercado ajustará automáticamente la cantidad de su crédito fiscal para la prima para el próximo año. Si resulta ser menor que la cantidad para la que realmente es elegible, tendrá que pagar más prima cada mes de lo que hubiera tenido que pagar, aunque puede recibir un reembolso por el resto cuando presente su declaración anual de impuestos. Por otro lado, si el…

  • Soy un adulto joven y necesito seguro de salud. ¿Cuáles son mis opciones de cobertura?

    FAQs

    Hay varias opciones que pueden estar disponibles: Si sus ingresos son de $21.597 o menos en 2026 (138% del nivel federal de pobreza para un adulto solo), puede calificar para cobertura de Medicaid. No todos los estados han optado por ampliar la elegibilidad para Medicaid para este nivel de ingresos. Consulte con un navegador u otro asistente usando la herramienta “Buscar Ayuda Local” en su mercado de seguros para obtener más información sobre la elegibilidad…

  • ¿Pueden los inmigrantes obtener ayuda para pagar las primas y/o los costos compartidos para el seguro de salud en los mercados de seguros?

    FAQs

    Usualmente, la mayoría de los inmigrantes legalmente presentes pueden obtener subsidios para ayudar a pagar las primas y los costos compartidos del seguro de salud obtenido en los mercados. Al igual que los ciudadanos, pueden calificar para créditos fiscales para primas que varían en una escala móvil basada en los ingresos. Por lo general, las personas deben tener ingresos por lo menos del 100% del nivel federal de pobreza ($15,650 para un individuo adulto o…

  • Los individuos a los que se les concedió Acción Diferida bajo el programa de Acción Diferida para los Llegados en la Infancia (DACA) ¿son elegibles para Medicaid, CHIP, y el mercado de seguros de salud?

    FAQs

    No. A algunos jóvenes que entraron al país de niños sin papeles se les otorgó un permiso temporal para permanecer en los Estados Unidos bajo el programa llamado de Acción Diferida para los Llegados en la Infancia (DACA). Estos individuos están legalmente en los Estados Unidos y pueden recibir permiso de trabajo y número de Seguro Social. Sin embargo, ya no son elegibles para Medicaid, CHIP, o el mercado de seguros de salud.

  • I was denied coverage for a health service/prescription drug that my doctor said I need. How do I appeal the decision?

    FAQs

    If you are enrolled in an ACA-compliant plan, you will have at least 180 days (six months) after being notified of your insurer’s decision to file an "internal appeal" with your insurer. Your insurer is required to inform you of their decision within 30 days for a service you have not yet received, and within 60 days for a service that was already provided. If both your request and appeal are denied by your insurance company,…

  • What is a student health plan?

    FAQs

    A student health plan is a special type of health coverage that colleges and universities make available to their enrolled students. Typically, a student health plan is different from the employer-sponsored coverage that colleges and universities offer their faculty and staff.