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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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  • Coronavirus Response and the Affordable Care Act

    Policy Watch

    This post examines the Affordable Care Act's impact 10 years after its enactment and how its provisions, especially those that expand coverage opportunities, could address the health threat and economic upheaval caused by the coronavirus pandemic.

  • Why the U.S. Doesn’t Have More Hospital Beds

    From Drew Altman

    With much of the news focused on the surge capacity of the nation’s hospitals during the COVID-19 pandemic, Drew Altman’s Axios column examines why the nation has a shortage of hospital beds and what can be done about it.

  • ACA Open Enrollment: If You Shop on Private Websites Instead of HealthCare.gov

    Fact Sheet

    Marketplace plans can now be sold through private websites, sometimes described as "direct enrollment” sites or “certified enrollment partner” sites. This short fact sheet explains how these sites and the plans they offer may differ from what consumers will find on HealthCare.gov.

  • 300+ FAQs Help Consumers Understand the ACA Marketplaces as Open Enrollment Begins

    News Release

    Ahead of the annual Affordable Care Act (ACA) open enrollment period, the time during which consumers can shop for health plans or renew existing coverage, KFF has updated and expanded its searchable collection of more than 300 Frequently Asked Questions about open enrollment, the health insurance marketplaces and the ACA. Designed to help consumers and the navigators, brokers and others who assist them, the FAQs cover a wide range of topics including eligibility for subsidies,…

  • 2019 Calculadora del Mercado de Seguros Médicos

    Interactive

    Nota: esta calculadora refleja las primas para 2019. Esta calculadora ilustra las primas (el costo mensual de su seguro) y subsidios para las personas que compran seguro médico por su propia cuenta en el nuevo mercado de seguros de salud (o de intercambio) creado por la Ley de Cuidado de Salud a Bajo Precio (Affordable Care Act, ACA, en inglés). Con esta calculadora, usted puede introducir diferentes niveles de ingresos, edades, y el tamaño de…

  • HIV, Intimate Partner Violence (IPV), and Women: An Emerging Policy Landscape

    Issue Brief

    Intimate partner violence has been shown to be associated with increased risk for HIV among women, as well as poorer treatment outcomes for those already diagnosed. This brief reviews the link between IPV and HIV, key policy changes and initiatives that attempt to address these challenges.

  • Democrats Like Medicare-for-All, but Swing Voters Don’t

    From Drew Altman

    Medicare-for-all is popular with Democrats in battleground states, but not with swing voters. In this Axios column, Drew Altman discusses the implications of the KFF-Cook Political Report poll findings. 

  • Implications of the Expiration of Medicaid Long-Term Care Spousal Impoverishment Rules for Community Integration

    Issue Brief

    To financially qualify for Medicaid long-term services and supports (LTSS), an individual must have a low income and limited assets. In response to concerns that these rules could leave a spouse without adequate means of support when a married individual needs LTSS, Congress created the spousal impoverishment rules in 1988. Originally, these rules required states to protect a portion of a married couple’s income and assets to provide for the “community spouse’s” living expenses when…