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Affordable Care Act

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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  • My employer offers health benefits to me and my family. The company pays the entire cost of my coverage but contributes nothing toward the cost of covering my family. We can’t afford to enroll my spouse...

    FAQs

    Yes, they can. People who are eligible for employer-sponsored coverage can still qualify for Marketplace premium tax credits if the employer-sponsored coverage is considered unaffordable. The affordability test will look at the cost of self-only coverage for you, and at the cost of family coverage for your spouse and kids. Because your employer pays 100% of the premium to cover you only, you will not be eligible for premium tax credits on the Marketplace. However,…

  • 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…

  • I entered the U.S. lawfully and I’m over 65, but I don’t qualify for Medicare. Can I apply for coverage and subsidies in the Marketplace? Will my premium be higher because I’m over age 65?

    FAQs

    You can currently purchase Marketplace coverage and qualify for subsidies depending on your income. Deferred Action for Childhood Arrivals (DACA) recipients are no longer eligible for health coverage through the Marketplaces, and starting in 2027, certain other lawfully present immigrants will no longer be eligible for subsidized Marketplace coverage. Premiums for Marketplace plans can vary by age unless states decide otherwise. In most states, your premium (before taking into account tax credits) could be up…

  • Are individuals granted deferred action under “Deferred Action for Childhood Arrivals” (DACA) eligible for Medicaid, CHIP, and the health insurance Marketplaces?

    FAQs

    No. Some individuals who entered the U.S. as children have been given temporary permission to stay in the United States under a program called Deferred Action for Childhood Arrivals (DACA). These individuals are lawfully present in the United States and can be granted work authorization and Social Security numbers. However, DACA recipients are no longer eligible for health coverage through Medicaid, CHIP, or the Marketplaces. Browse more questions in the Marketplace Basics section.

  • How will an individual’s citizenship and immigration status be checked?

    FAQs

    Only those individuals in a family who are applying for health insurance are required to provide citizenship and immigration status. Applicants also must provide a Social Security Number if they have one. Citizenship and immigration status for those applying for health insurance will be checked electronically with several systems, including the Social Security Administration, the Department of Homeland Security, and SAVE (Systematic Alien Verification for Entitlements). If an individual’s status cannot be checked through an…

  • Can immigrants enroll in Medicaid or Children’s Health Insurance Program (CHIP) coverage?

    FAQs

    Most lawfully present immigrants with a “qualified” immigration status who meet Medicaid and CHIP program requirements, such as income and state residency, can enroll in Medicaid or CHIP after they have been in the United States with qualified status for 5 years or more. A list of “qualified statuses” can be found here. Some groups of lawfully present immigrants do not have to wait five years before they may enroll in Medicaid and CHIP. These include…

  • 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…

  • 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…

  • 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 most 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…

  • What happens if I just make up an income level that I know will qualify me for financial assistance?

    FAQs

    That’s not advisable. The Marketplace will check the information you provide against a number of databases (including IRS data, Social Security data, wage databases, and others). If the information you provide is very different from what’s in these databases, you may be asked to provide additional documentation. In addition, at the end of the Application for Health Coverage and Help Paying Costs, you will have to sign that you have provided true answers to all…