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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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  • 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.

  • The Implications of the Most Recent Challenge to the ACA’s Preventive Care Requirement Could Affect Millions

    News Release

    A new brief explains the implications of the most recent legal challenge contesting the Affordable Care Act’s (ACA) requirement that most private insurance plans cover specific preventive care items and services—such as contraceptive services and supplies, and cancer screenings—at no cost to patients. In Braidwood Management v. Becerra, two Christian-owned businesses and six individuals in Texas have challenged the legality of the preventive care mandates on constitutional grounds. The plaintiffs are also challenging the requirement…

  • Nine Changes to Watch in ACA Open Enrollment 2023

    Policy Watch

    The 2023 Affordable Care Act (ACA) Open Enrollment period will run from November 1, 2022 to January 15, 2023 in most states, longer in some state-based marketplaces. This policy watch examines nine changes that may affect what enrollees pay for coverage, the size of tax credits for those eligible, and other changes that could affect enrollees' experiences.

  • 2022 Health Insurance Marketplace Calculator

    Interactive

    The Health Insurance Marketplace Calculator, updated with 2022 premium data, provides estimates of health insurance premiums and subsidies for people purchasing insurance on their own in health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA).

  • 2022 Calculadora del Mercado de Seguros Médicos

    Interactive

    Nota: Esta calculadora ha sido actualizada con los cambios a los subsidios en el American Rescue Plan Act de 2021 (el acta de alivio por COVID-19). 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,…

  • Year in Review: 10 Health Policy Issues for 2023

    Fact Sheet

    This fact sheet offers a look back at 10 issues that KFF tracked closely during 2023 in its polling, policy analysis and journalism, including summaries of major findings and news stories.

  • Record ACA Marketplace Signups for 2024 Are Driven in Part by Medicaid Unwinding and More Affordable Coverage 

    News Release

    Enrollment in the Affordable Care Act (ACA) Marketplaces will hit another record high in 2024, with sign-ups to date topping 20 million—already 4 million above last year’s record high. The Medicaid unwinding, enhanced Marketplace subsidies that make coverage more affordable, as well as increased marketing, outreach, and enrollment assistance have all played a role in this growth, according to a new analysis from KFF. Marketplace sign-ups have nearly doubled since 2020. The Medicaid unwinding is…