Affordable Care Act

The ACA Marketplace

2025 KFF Marketplace Enrollees Survey

In 2025, about one in three ACA enrollees said they would be “very likely” to look for a lower-premium Marketplace plan If their premium payments doubled.

Cost Concerns and Coverage Changes: A Follow-Up Survey of ACA Marketplace Enrollees

Following the expiration of the enhanced premium tax credits for people with Affordable Care Act (ACA) Marketplace plans, a new KFF follow-up survey of the same Marketplace enrollees KFF surveyed in 2025 finds half (51%) of returning enrollees say their health care costs are “a lot higher” this year compared to last year, including four in 10 who specifically say their premiums are “a lot higher.”

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  • I’m working on an H-2A visa. Am I eligible for coverage in the Marketplace?

    FAQs

    Yes. Lawfully-present immigrants who are otherwise eligible for coverage – including “nonimmigrants” like H-2A workers and those on student visas – may purchase insurance in the Marketplace. Those who are low-income and otherwise eligible may also receive premium assistance and cost-sharing reductions to lower the cost of coverage in Marketplace plans. However, DACA is no longer considered an eligible immigration status for health coverage through the Marketplaces, and starting in 2027, certain other lawfully present…

  • Will getting health insurance through Medicaid, CHIP, or the health insurance Marketplaces affect an individual’s ability to obtain lawful permanent resident status or citizenship?

    FAQs

    Some people who apply for a green card (lawful permanent residence) or a visa to enter the U.S. must pass a “public charge” test, which looks at whether the person is likely to become primarily dependent on the federal government as demonstrated by the use of cash assistance programs for income maintenance or government-funded institutionalized long-term care. In making this determination, immigration officials consider certain factors in their totality, including a person's age, family status, income…

  • Can immigrants get help paying premiums and/or cost-sharing for health insurance in the Marketplaces?

    FAQs

    Most lawfully present immigrants can usually get tax credits to help pay premiums and cost-sharing for health insurance through the Marketplaces. Like citizens, they can get premium tax credits that vary on a sliding scale, based on income. Generally, people must have income at least as high as 100% of the federal poverty level ($15,650 for a single adult or $32,150 for a family of four) in 2026 to qualify for premium tax credits. People…

  • Can immigrants who are not U.S. citizens buy health insurance through the health insurance Marketplaces?

    FAQs

    Most lawfully present immigrants, including people with work (H1) and student visas, can buy health insurance through the health insurance Marketplaces. This group also currently includes lawfully present immigrants with incomes under 100% of the federal poverty level who cannot enroll in Medicaid based on immigration status, for example, because they are in the five-year waiting period for Medicaid or CHIP coverage. Deferred Action for Childhood Arrivals (DACA) is no longer considered an eligible immigration…

  • Do Marketplace plans or Medicaid cover abortions?

    FAQs

    It depends on where you live and what type of coverage you have. For Marketplace plans, there is no federal requirement for plans to cover abortion. About half of states prohibit Marketplace plans from covering abortion. However, other states require plans to cover abortion services and do not permit cost sharing. For Medicaid enrollees, federal law only allows the use of federal funds for abortion in cases of rape, incest, or life endangerment of the pregnant…

  • I’m pregnant and want to enroll in Marketplace coverage. How do I project my household size for next year and enroll my baby?

    FAQs

    During Open Enrollment, you will apply as a household of one (or two if you are enrolling with a spouse). When the baby is born, you can update your family information with the Marketplace to reflect that you have become a household of two (or three if you are enrolling with your spouse). After the baby is born, you will have a 60-day special enrollment period to add the baby to your plan. You will…

  • I have been trying to get pregnant. Do Marketplace plans cover infertility services?

    FAQs

    The ACA does not require health plans to cover infertility services; however, some states require certain plans to cover certain infertility services. If you need these services and are shopping for coverage, check the plan details or your state insurance department about coverage and out-of-pocket costs for infertility care.

  • I just found out that I’m pregnant, and I do not have health insurance. Can I enroll in a plan through the health insurance Marketplace?

    FAQs

    Yes. However, while you are still pregnant, you may only enroll during an Open Enrollment period, which is typically from November through mid-January. Once enrolled, your plan will be required to cover maternity services. You may also qualify for a premium tax credit and/or a cost-sharing reduction, depending on your family income and your eligibility for employer coverage. After the baby is born, you can sign up for health insurance and add the baby to your plan, no…

  • What services do plans have to cover for pregnancy?

    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 such as pumps and lactation consultations without any cost-sharing because they are considered preventive services. All state Medicaid…

  • Does my health plan have to cover all birth control methods with a prescription? Do I have to pay a copay?

    FAQs

    Most employer plans and all Marketplace plans must cover at least one form of all FDA-approved, granted, or cleared birth control (“contraceptive”) services and supplies for women, without cost sharing. This includes sterilization services, insertion and removal of long-acting reversible birth control methods, and follow-up services. While some birth control methods are available over the counter without a prescription, plans typically require a prescription to trigger coverage. Though it is up to an insurer’s discretion,…