2025 KFF Marketplace Enrollees Survey
In 2025, about one in three ACA enrollees said they would be “very likely” to look for a lower-premium Marketplace plan If their premium payments doubled.
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In 2025, about one in three ACA enrollees said they would be “very likely” to look for a lower-premium Marketplace plan If their premium payments doubled.
Adults ages 50 to 64 are disproportionately affected by the expiration of ACA enhanced premium tax credits because they make up a large number of Marketplace enrollees and premiums rise with age.
Following the expiration of the enhanced premium tax credits for people with Affordable Care Act (ACA) Marketplace plans, a new KFF follow-up survey of the same Marketplace enrollees KFF surveyed in 2025 finds half (51%) of returning enrollees say their health care costs are “a lot higher” this year compared to last year, including four in 10 who specifically say their premiums are “a lot higher.”
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Yes, leaving your job and losing eligibility for job-based health coverage will trigger a special enrollment opportunity for Marketplace coverage that lasts for 60 days. During that period, you can apply for a Marketplace health plan and depending on your income, you may qualify for premium tax credits and cost-sharing reductions. If your state uses the federally facilitated Marketplace (HealthCare.gov), you will need to provide proof of the coverage loss to be eligible for the…
The limited benefit plan you described probably does not meet the standard for “minimum value.” If that were the only plan your employer offered, you could qualify for premium tax credits to help pay for a more comprehensive plan on the Marketplace coverage. The premium tax credits could help you afford coverage that would be more comprehensive. However, if your employer also offers a major medical plan option that meets the test of minimum value,…
The term “minimum value” means that your job-based health insurance plan would cover at least 60% of an average group of people’s covered health costs. In addition, employer plans must provide substantial coverage for hospitalization and for physician care to meet the “minimum value” test. Most employer plans will meet this test, but some may not. The Marketplace application includes a form with questions about job-based coverage. You should take this form to your employer…
You should count your spouse’s income as well to determine whether your own employer-based plan is affordable to you. The test of whether your employer plan is affordable is whether the amount you must contribute to premiums is equal to or less than 9.96% of your household income for 2026. Household income includes your spouse’s income.
Yes, they can. People who are eligible for employer-sponsored coverage can still qualify for Marketplace premium tax credits if the employer-sponsored coverage is considered unaffordable. The affordability test will look at the cost of self-only coverage for you, and at the cost of family coverage for your spouse and kids. Because your employer pays 100% of the premium to cover you only, you will not be eligible for premium tax credits on the Marketplace. However,…
You can always shop for health coverage in the Marketplace. However, if you’re offered employer health benefits, you can’t qualify for premium tax credits in the Marketplace unless your employer coverage is considered unaffordable. If your share of the premium for self-only coverage in your employer plan is 9.96% or more of your 2026 household income, it is considered unaffordable, and you can apply for premium tax credits in the Marketplace.
No. Some individuals who entered the U.S. as children have been given temporary permission to stay in the United States under a program called Deferred Action for Childhood Arrivals (DACA). These individuals are lawfully present in the United States and can be granted work authorization and Social Security numbers. However, DACA recipients are no longer eligible for health coverage through Medicaid, CHIP, or the Marketplaces. Browse more questions in the Marketplace Basics section.
Citizens and lawfully present family members can get health insurance coverage through Medicaid, CHIP, and Marketplaces even if other family members are not lawfully present. Family members who are not lawfully present, including undocumented immigrants, may apply for health insurance for citizens and lawfully present family members. For example, an undocumented immigrant parent may apply for health insurance for a citizen child. When a family with mixed immigration status applies for health insurance through the…
Most lawfully present immigrants with a “qualified” immigration status who meet Medicaid and CHIP program requirements, such as income and state residency, can enroll in Medicaid or CHIP after they have been in the United States with qualified status for 5 years or more. A list of “qualified statuses” can be found here. Some groups of lawfully present immigrants do not have to wait five years before they may enroll in Medicaid and CHIP. These include…
You cannot be turned away or charged more for being lesbian, gay, bisexual, or transgender. You also can’t be denied coverage or charged more because of any pre-existing health condition, such as HIV status. Insurers can’t have any annual or lifetime limits on how much they’ll spend on your medical care. Additionally, health programs that receive federal funding, such as Marketplace plans, Medicaid, and Medicare, cannot discriminate based on sex. Notably, though, the legal landscape is evolving.…
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