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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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  • I’m divorced and I pay alimony to my ex-spouse. Does that affect my income for determining eligibility for premium tax credits?

    FAQs

    Federal tax rules set out what is included in your household income. Eligibility for and the amount of premium tax credits are largely based on your household income. Check with a tax advisor, but in general, for divorce or separation agreements after December 31, 2018, alimony payments are no longer deductible from the income of the paying ex-spouse, and alimony is not included as income for the recipient ex-spouse. For pre-2019 divorces, the paying ex-spouse…

  • How much can I earn and qualify for premium tax credits in the Marketplace?

    FAQs

    Premium tax credits are available to people who buy Marketplace coverage and whose income is at least as high as the federal poverty level. For an individual, that means an income of at least $15,650 in 2026. For a family of four, that means an income of at least $32,150 in 2026. This Marketplace subsidy calculator can show you your eligibility for different income amounts and family sizes.

  • My kids are eligible for the Children’s Health Insurance Program (CHIP). Can I enroll them in our Marketplace health plan and get premium tax credits for them instead?

    FAQs

    You can add your children to your Marketplace plan, but because they are eligible for your state’s Children’s Health Insurance Program (CHIP), they are not eligible for premium tax credits. The exception to that is if you live in a state that has a waiting period for enrolling in CHIP. During the waiting period, your children are eligible for a premium tax credit; when the waiting period has ended, they can enroll in CHIP and…

  • What are premium tax credits and how do they work?

    FAQs

    Premium tax credits reduce your premium for most Marketplace plans. The amount of the tax credit you may receive depends on your income and the cost of Marketplace health plans in your area. The Marketplace will determine the expected contribution you are required to pay toward the premium for a mid-range (Silver) benchmark plan. The expected contribution will increase on a sliding scale based on your 2026 income, with more financial assistance for enrollees with…

  • 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…

  • 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…