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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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  • Who is eligible for Marketplace premium tax credits?

    FAQs

    Premium tax credits are available to U.S. citizens and certain lawfully present immigrants who purchase coverage in the Marketplace and who have income at least as high as 100% of the federal poverty level (FPL) ($15,650 for a single adult or $32,150 for a family of four in 2026). In the past, lawfully present immigrants who made less than 100% of the federal poverty level could also receive help paying premiums and cost-sharing for coverage…

  • I’m covered under my parents’ plan and I’m pregnant. Will my parents’ plan cover my prenatal care and delivery?

    FAQs

    Federal laws require many employer-sponsored plans and all ACA-compliant individual insurance plans, including those available through the Marketplaces, to cover maternity services, including pregnancy, childbirth, and newborn care. Cost sharing may apply to some maternity services. Most private plans also must cover prenatal visits and screenings, folic acid supplements, tobacco cessation counseling and interventions, and breastfeeding services without any cost-sharing because they are considered preventive services. Some health plans are not required to cover all…

  • Tuve cobertura con un plan del mercado de seguros este año y estoy seguro que nunca olvidé un pago. Pero la aseguradora dice que no pagué la prima de octubre y no me dejarán renovar la cobertura para el...

    FAQs

    Esto no está claro. Por ahora, el gobierno federal no ha establecido un proceso claro para apelar por problemas que surjan bajo la nueva regla. Es importante que usted se registre para tener cobertura antes del final del Período de Inscripción Abierta. A este punto, las opciones para considerar incluyen: Pídale a su aseguradora que reconsidere. Asegúrese de presentar una copia de cheque u otra prueba de que la prima se pagó Reporte este problema…

  • ¿Qué pasa si quiero dejar mi plan de salud del mercado durante el año?

    FAQs

    Es importante que se comunique con su mercado y con el plan de salud y les informe que ya no necesita cobertura. El enlace que se proporciona aquí ofrece detalles sobre cómo cancelar la cobertura del mercado en los estados que utilizan CuidadoDeSalud.gov. Los mercados de seguros estatales pueden tener su propio proceso para cancelar la cobertura. Si reside en uno de estos mercados, haga clic aquí para acceder al enlace que lo llevará al…

  • My husband would like to get a vasectomy, but when I checked with our insurer, they told me that the plan would cover my sterilization without cost-sharing, but we would have to pay part of the costs fo...

    FAQs

    The ACA requires most private health plans to cover birth control, including sterilization, for women, but they are not required to cover sterilization (vasectomies) for men. However, nine states (CA, IL, MD, NJ, NM, NY, OR, VT, and WA) require certain health plans in those states to cover vasectomies, at no cost to the patient. Check with your insurance plan or state insurance department for more information.

  • ¿Me pueden cobrar primas más altas en el mercado si fumo? ¿Cuentan los cigarrillos electrónicos?

    FAQs

    En la mayoría de los estados, sí. Generalmente, una aseguradora puede cobrarle hasta un 50% más si ha consumido productos de tabaco cuatro o más veces por semana en promedio durante los últimos 6 meses. Esto se denomina recargo por tabaco. Por ejemplo, si la prima para alguien de su edad (antes de aplicar los subsidios) fuera de $200 al mes, si usted consume tabaco, su prima podría aumentar a $300 al mes. Las normas…

  • I am in my early 60s and have signed up for a Marketplace plan so that I have health insurance coverage until I qualify for Medicare at age 65. What happens when I go on Medicare?

    FAQs

    When you turn 65, you should sign up for Medicare and notify your Marketplace plan that you now qualify for Medicare coverage. Your Marketplace coverage will not be cancelled automatically by your plan when you turn 65 and sign up for Medicare, but if you receive premium tax credits to help you pay for your Marketplace plan premium, your eligibility for these tax credits will end when your Medicare Part A coverage starts (people with…

  • I’m enrolled in a student health plan, but now I think I can get a better deal in the Marketplace. Can I drop student health plan coverage and go to the Marketplace instead?

    FAQs

    If you are currently enrolled in a student health plan, you can still apply for Marketplace coverage during the annual Open Enrollment period. If your expected household income is at least $15,650 in 2026, you may qualify for premium tax credits; however, you will have to drop your student health coverage by December 31 to remain eligible for them. Outside of Open Enrollment, you cannot voluntarily drop your student health plan and qualify for Marketplace…

  • What is a self-funded/self-insured plan? How do I know if I have one?

    FAQs

    Many employers, especially large ones, offer workers health coverage that is known as a “self-funded” (also referred to as “self-insured”) arrangement, which is where the employer pays enrollees’ medical claims directly, as opposed to traditional health insurance (known as fully-insured), where the employer buys coverage from a state-regulated insurance company. Most companies with a self-funded plan contract with a health insurance company to pay the medical claims and provide enrollees access to the insurance company’s…

  • How do I appeal a Marketplace decision?

    FAQs

    You can request an appeal of any Marketplace decision, including: Your eligibility to buy coverage in the Marketplace Your eligibility for, or the amount of, premium tax credits or cost sharing reductions (for example, a reduction in your premium tax credit amount) Untimely (late) notice from the Marketplace about a decision To start your appeal, review the Marketplace’s decision (called an eligibility notice), which describes the process you should follow. If you have questions about…