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Affordable Care Act

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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  • How can I find out if my doctor is in a health plan’s network?

    FAQs

    Every plan Marketplace plan must provide a link to its health provider directory on the Marketplace website to its health provider directory so consumers can find out if their health care providers are included. The provider network information from insurance companies must also tell you whether a provider is accepting new patients. Some insurers' provider directories may list the languages spoken by providers, but this is not federally required. If your state uses HealthCare.gov (federally-facilitated…

  • What health benefits do Marketplace plans cover?

    FAQs

    All qualified health plans offered in the Marketplace cover the "essential health benefits" (EHB), including: Ambulatory patient services (outpatient care you get without being admitted to a hospital) Emergency services Hospitalization Maternity and newborn care (care before and after your baby is born) Mental health and substance use disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain…

  • 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…

  • Can I buy or change private health plan coverage outside of Open Enrollment?

    FAQs

    In general, you can have a special enrollment period (SEP) to sign up for Marketplace coverage during the year, other than during Open Enrollment period, if you have a qualifying event. Some examples of qualifying events include marriage, gaining a dependent, or loss of employment. Only one person in a household applying for coverage or financial assistance through the Marketplace must qualify for an SEP in order for the entire household to qualify for the…

  • 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…

  • 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. 

  • Are there special timelines for enrolling in the Marketplace for people who lose Medicaid or CHIP?

    FAQs

    The special enrollment period due to loss of Medicaid or CHIP is 90 days, which means consumers will have up to 90 days after loss of Medicaid or CHIP to enroll in Marketplace coverage. However, state-based Marketplaces have the option to extend the special enrollment period beyond 90 days. Check with your state Marketplace for more information if you live in one of these states.

  • 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…