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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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  • Recibí un formulario 1095-C por correo. ¿Qué es?

    FAQs

    El formulario 1095-C indicará su nombre y el de su empleador, los meses en que tuvo derecho a cobertura y el costo de la prima mensual más baja que podría haber contratado bajo el plan de salud de su empleador. Si trabajó para una empresa grande que no ofrecía cobertura médica a sus empleados de tiempo completo, el formulario 1095-C también lo indicará. Conserve este formulario con sus registros fiscales. Es posible que lo necesite…

  • Do Marketplace plans cover gender-affirming care? What changes have there been to coverage requirements?

    FAQs

    Not necessarily. Coverage varies by state and by plan. Some, but not all, states prohibit health insurance plans from excluding coverage for gender-affirming care. Even in states where coverage is required, it is possible that not all gender affirming services will be covered. For example, a plan might cover hormone therapy but not laser hair removal. In states where coverage for gender-affirming care is not required, some plans may exclude this coverage altogether. Beginning in…

  • How can I protect my personal information while enrolling in Marketplace coverage through a non-Marketplace website?

    FAQs

    Here are some tips on protecting your personal information if you choose to enroll in Marketplace coverage through a non-Marketplace website: Beware of sales techniques that pressure you to make quick decisions. Use this HealthCare.gov tool to find certified enrollment partner websites approved by the Marketplace. Be cautious in engaging with advertisements that offer cash, gifts, or other perks. The information you provide through these advertisements could be used for other purposes without your consent.…

  • Policy Changes Bring Renewed Focus on High-Deductible Health Plans 

    Issue Brief

    Policy changes, anticipated increases in premium costs for enrollees, and new standards for health savings accounts may encourage consumers to seek out plans with lower premiums but higher deductibles. This issue brief explores the features of bronze and catastrophic plans, coverage and costs, and the complicated choices consumers face.

  • Media Briefing to Release New Survey Tracking California’s Previously Uninsured Residents Under the Affordable Care Act

    Event Date:
    Event

    Media-only web briefing that released a new survey tracking the experiences of California's previously uninsured residents under the Affordable Care Act (ACA). New survey provides a detailed assessment of how well the ACA is working for previously uninsured residents in a state that embraced the ACA's coverage expansion opportunities by establishing the Covered California insurance marketplace and expanding its Medi-Cal program.

  • Out-of-pocket spending on insulin among people with private insurance

    Issue Brief

    This analysis of insurance claims data finds that Congressional proposals to set a $35 per month cap on what people pay out of pocket for insulin would provide financial relief to at least 1 out of 5 insulin users with different types of private health insurance.

  • Get Ready for a Lot of Biden Executive Orders on Health Care

    Perspective

    In this column for the JAMA Health Forum, Larry Levitt explores what President-elect Biden might do to advance his health care vision both through legislation and through executive orders and waivers and demonstrations.