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Individual Market Enrollment Declined by 18% Since June 2025

Individual Market Enrollment Fell 18%, Suggesting Continued ACA Marketplace Losses

Enrollment in the individual health insurance market fell by 18%—over 4.6 million people—from 25.2 million in June 2025 to 20.5 million in June 2026. Falling individual market enrollment suggests further decline in ACA Marketplace enrollment this year, since Marketplace enrollees represent the vast majority of individual market coverage.

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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 received a Form 1095-B in the mail. What’s that?

    FAQs

    Health insurance companies, certain employer-sponsored health plans, and public health programs such as Medicaid may provide you with documentation indicating the months during the prior year when you were covered under the plan. Coverage providers may send Form 1095-B directly to you, but in some cases, you may have to request a Form 1095-B from the coverage provider. If you were enrolled in family coverage, Form 1095-B will indicate the names of all family members who were…

  • I am covered in a Marketplace health plan now, but I am behind on my premium payments. If I don’t actively renew my plan but the Marketplace auto-renews me in the same plan, and if I at least pay my Jan...

    FAQs

    Yes, your insurer must accept your January payment to start your coverage for next year and your payment for January 1 cannot be applied to the back-due premiums you owe. Insurers are not allowed to require people who owe back-due premiums to repay the premium debt before they will renew coverage for another year. Whether you actively renew or auto-renew, the process will work the same way. Keep in mind that insurers are allowed to cancel your…

  • 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…

  • What happens if I don’t update my application for financial assistance?

    FAQs

    If you don't update your information with the Marketplace, in most cases, the Marketplace will automatically adjust the amount of your premium tax credit for next year. If that turns out to be less than the amount you’re actually eligible for, you will have to pay more premium each month than you otherwise would have had to, although you can receive a refund for the rest when you file your federal tax return. On the…

  • 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…

  • 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…

  • Can I pay my health insurance premium with a credit card, debit card, money order, or cash?

    FAQs

    All insurers in the Marketplace are required to accept money orders, checks, pre-paid debit cards, and electronic funds transfers (EFT), which are digital direct deposits. Some states may also require insurers to accept credit card or debit card payments. Many insurers in other states accept debit and credit cards even though they are not federally required to.

  • 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.

  • 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…

  • Can I be charged more because of my age?

    FAQs

    Yes, in most states, you can be charged more based on your age, but within certain limits. For example, older adults in their sixties can be charged up to three times more than younger adults (e.g., in their early twenties). Some states have established lower limits or a complete prohibition on “age rating,” a federal policy that applies to all individual health insurance plans and those offered by fully-insured small employers, whether sold on or…