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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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  • 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…

  • 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.

  • 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…

  • Can I be covered under my parent’s health plan if I’m married?

    FAQs

    Yes. You can stay on your parents’ plan until you turn 26 if they have coverage through work, or until the end of the year you turn 26 if they have Marketplace coverage. Being married does not affect your eligibility to be covered under your parents' plan.

  • I used to be covered on my parents’ health plan, but I dropped off last year when I found other coverage. Now I’ve lost that other coverage and want to get back on my parents’ plan. Can I do...

    FAQs

    Yes, you can get back on your parents’ plan until you turn 26 if they have coverage through work, or before the end of the year you turn 26 if they have Marketplace coverage. You do not have to wait until the next Open Enrollment to enroll. Your parents' plan must offer you a special opportunity to re-enroll because you lost your other coverage. If your parents get their insurance through their employer, you have…

  • Does my student health plan have to cover birth control, and if not, what are my options?

    FAQs

    It depends on the type of coverage your college or university provides. “Fully-insured” plans are required to provide, without cost sharing, access to all FDA-approved birth control (“contraceptive”) methods, sterilization procedures, and patient education and counseling prescribed by a health care provider. If your student health plan is “self-insured,” coverage of birth control services depends on which state you live in. Check with your college or university to find out what type of student health…

  • I’m a young adult and I need health insurance. What are my coverage options?

    FAQs

    A number of options may be available to you: If your annual income is $21,597 or less in 2026 (138% federal poverty level for a single adult), you may qualify for Medicaid coverage. Not all states have elected to expand Medicaid eligibility to this income level. Check with a navigator or another type of assister using Find Local Help, or check with your state Marketplace to learn more about Medicaid eligibility in your state.  If…

  • I’m under 26 and eligible to be covered as a dependent under my mom’s job-based policy. Mom no longer claims me as a tax dependent – I file my own taxes, though my income isn’t very high. If subsidized...

    FAQs

    Yes. Although the general rule is that people are not eligible for Marketplace subsidies when they are also eligible for affordable job-based health coverage, a young adult is eligible for premium tax credits in the Marketplace as long as they are not claimed as a tax dependent by their parents. The availability of dependent coverage under your parents' health plan does not affect your eligibility for premium tax credits in the Marketplace.