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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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  • The Spotlight Is on Medicaid Cuts, But the ACA Marketplaces Could See a One-Third Cut in Enrollment

    From Drew Altman

    In his latest column, President and CEO Drew Altman shows how proposals contained in the House reconciliation bill could result in a one-third reduction in ACA Marketplace enrollment. “While all eyes are on the big Medicaid cuts being proposed in the House,” he writes, “significant changes are also being proposed that together would dramatically reduce enrollment in the ACA Marketplaces.”

  • Health Care Issues in the Early Stages of the 2024 Election

    Perspective

    In this JAMA Health Forum column, Larry Levitt examines differences in the Republican presidential candidates’ records and positions on health issues, including Medicaid and abortion, that could play a role in the primaries and would set up a sharp contrast in the general election against President Biden.

  • KFF News Release

    Medicaid Expansion Has Had Beneficial Effects on Some Sexual and Reproductive Health Outcomes 

    News Release

    A new KFF review of more than three dozen studies published between April 2021 and June 2023 finds that Medicaid expansion under the Affordable Care Act is associated with beneficial effects on a range of sexual and reproductive health outcomes. The studies, which echo findings of previous research, find that Medicaid expansion is associated with increased health insurance coverage prior to and after pregnancy, as well as increased access to, and utilization of, both prenatal…

  • KFF Examines Challenges in Navigating Coverage for Opill, the First Over-the-Counter Daily Oral Contraceptive Pill, Coming to Market Next Year 

    News Release

    As Opill—the first over-the-counter daily oral contraceptive pill in the United States—is expected to be available for purchase in early 2024, new research conducted by KFF examines barriers to its accessibility for consumers and challenges in providing insurance coverage for it. Based on interviews with nearly 80 representatives from private insurance plans, state Medicaid programs, chain pharmacies, and other key groups, the report provides a deeper view into the operational challenges in expanding access to…

  • Do I have to renew Medicaid coverage every year?

    FAQs

    Yes. States must redetermine Medicaid eligibility for most enrollees every 12 months. When your coverage period is ending, you will receive a notice from the state. If your coverage has been automatically renewed, the notice will indicate the new coverage period. If your coverage has not been automatically renewed, the notice will include instructions for completing the renewal process. Note that the renewal process might look different depending on where you live. Click here for a…

  • I heard that health plans sold on the Marketplace no longer have to cover certain preventive services. Is that true?

    FAQs

    No, this is not true. Health plans sold on the Marketplace are still required to cover certain preventive services without any patient cost sharing. The categories of preventive services Marketplace plans must cover are: Evidence-based screenings and counseling Routine immunizations Childhood preventive services Preventive services for women Click here for more information on covered preventive services.