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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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  • Nine Changes to Watch in ACA Open Enrollment 2023

    Policy Watch

    The 2023 Affordable Care Act (ACA) Open Enrollment period will run from November 1, 2022 to January 15, 2023 in most states, longer in some state-based marketplaces. This policy watch examines nine changes that may affect what enrollees pay for coverage, the size of tax credits for those eligible, and other changes that could affect enrollees' experiences.

  • Firearms are the Leading Cause of Death for Children in the United States But Rank No Higher Than Fifth in Other Industrialized Nations

    News Release

    Firearms are now the number one cause of death for children in the United States, but rank no higher than fifth in 11 other large and wealthy countries, a new KFF analysis finds. Guns - including accidental deaths, suicides, and homicides - killed 4,357 children (ages 1-19 years old) in the United States in 2020, or roughly 5.6 per 100,000 children. In each of the peer countries, guns kill fewer children than motor vehicles, cancer,…

  • Marketplace Insurers are Proposing a 6% Average Premium Hike for 2024 and Pointing to Inflation as a Key Driver of Costs

    News Release

    ACA Marketplace insurers are requesting a median premium increase of 6% for 2024, according to a new KFF analysis of the preliminary rate filings. Insurers’ proposed rate changes – most of which fall between 2% and 10% – may change during the review process. Although most Marketplace enrollees receive subsidies and are not expected to face these added costs, premium increases could result in higher federal spending on subsidies. Insurers cite price increases for medical…

  • As ACA Marketplace Enrollment Reaches Record High, Fewer Are Buying Individual Market Coverage Elsewhere

    Issue Brief

    This analysis looks at how many people are signed up for each type of individual ACA Marketplace coverage—both on- and off-Marketplace and with or without subsidies—as of early 2023 based on federal enrollment data and administrative data insurers report to state regulators, as compiled by Mark Farrah Associates. The number of people enrolled in compliant and non-compliant plans was also evaluated.

  • State Marketplace Profiles: Delaware

    Other Post

    Final update made on October 10, 2013 (no further updates will be made) Establishing the Marketplace In July 2012, Governor Jack Markell (D) indicated that Delaware would begin planning for a State Partnership Marketplace.1  Delaware will retain plan management and consumer assistance functions, and defer other Marketplace management functionality to the federal government.2  In July 2013, the state announced that the Marketplace would be called Choose Health Delaware. The Delaware Health Care Commission, housed within the Department…

  • State Exchange Profiles: Nebraska

    Other Post

    Final update made on December 19, 2013 (no further updates will be made) Establishing the Exchange On November 15, 2012, Governor Dave Heineman (R) announced that Nebraska would not establish a health insurance exchange.1Earlier in 2012, the Nebraska legislature introduced two bills (LB 835 and LB 838) to establish a health insurance exchange in Nebraska, however both failed when the legislative session concluded in April.2,3 In 2011, Governor Heineman signed LB 22 into law, which…

  • State Marketplace Profiles: New Hampshire

    Other Post

    Final update made on November 1, 2013 (no further updates will be made) Establishing the Marketplace On June 18, 2012, Governor John Lynch (D) signed HB 1297 into law, which prohibits the state from participating in or enabling a state-based health insurance Marketplace. However, HB 1297 allows for state agencies or departments to “operate specific functions of a federally-facilitated exchange."1  Given this authority, newly-elected Governor Maggie Hassan (D) informed federal officials on February 13, 2013 that…