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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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  • Amid the Coronavirus Crisis, President Trump and Democratic Nominee Joe Biden Offer Widely Different Views on Health Care

    News Release

    President Trump and Democratic nominee Joe Biden hold widely divergent views on health issues, with the president’s record and response to the coronavirus pandemic likely to play a central role in November’s elections. A new KFF side-by-side comparison examines President Trump’s record and former Vice President Biden’s positions across a wide range of key health issues, including the response to the pandemic, the Affordable Care Act marketplace, Medicaid, Medicare, drug prices, reproductive health, HIV, mental…

  • Election 2020: Where Trump and Biden Stand on Mental Health and Substance Use Issues

    News Release

    Amid the coronavirus pandemic, half of Americans report that their mental health has been negatively impacted due to related stress and worry. Many are, or will be, struggling with mental health challenges due to anxiety, social isolation, loss of loved ones, and job losses – potentially leading to increased mental health care needs over the long term. A new issue brief examines where President Trump and Democratic presidential nominee Joe Biden stand on key aspects of the…

  • For ACA Enrollees, How Much Premiums Rise Next Year is Mostly up to Congress

    Policy Watch

    Most customers with coverage through Affordable Care Act's marketplaces will face big premium increases next year if Congress doesn’t extend the temporary enhanced tax credits included in the American Rescue Plan Act (ARPA) of 2021. If the outcome isn’t clear by summer, fall open enrollment could be a mess.

  • Marketplace Insurers are Proposing a 6% Average Premium Hike for 2024 and Pointing to Inflation as a Key Driver of Costs

    News Release

    ACA Marketplace insurers are requesting a median premium increase of 6% for 2024, according to a new KFF analysis of the preliminary rate filings. Insurers’ proposed rate changes – most of which fall between 2% and 10% – may change during the review process. Although most Marketplace enrollees receive subsidies and are not expected to face these added costs, premium increases could result in higher federal spending on subsidies. Insurers cite price increases for medical…

  • What would ACA Subsidies Have Been in 2022 if COVID-19 Relief Had not passed?

    Interactive

    This calculator is for illustration purposes and shows the tax credits and premiums that marketplace customers would have paid in 2022 if not for the enhanced subsidies included in the 2021 COVID relief legislation, the American Rescue Plan Act, (ARPA). The enhanced subsidies expire at the end of the year.

  • Analysis: A Proposal Like Biden’s Health Plan Would Lower the Cost of ACA Marketplace Coverage for Nearly All Potential Enrollees and Lower Premiums for Over 12 Million Workers With Employer Coverage

    News Release

    A new KFF analysis finds that expanding Affordable Care Act (ACA) premium subsidies like Democratic presidential nominee Joe Biden has proposed would lower the cost of Marketplace coverage for nearly all potential enrollees, including the uninsured and others currently priced out of the Marketplace. While the former Vice President’s plan to create a public option has received substantial public attention, his companion proposal to expand ACA marketplace subsidies has been less discussed, even as it…

  • Eliminating the ACA: What Could It Mean for Medicaid Expansion?

    Policy Watch

    The debate over filling the Supreme Court seat previously held by Ruth Bader Ginsburg has brought renewed attention to the possibility of the Affordable Care Act (ACA) being overturned under the court challenge in California v. Texas, currently scheduled to be heard shortly after the election this November. The expansion of Medicaid was a central component of the ACA, and 39 states have now adopted the ACA expansion into their Medicaid programs. Because Medicaid is…