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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Assuming you are eligible for premium tax credits, the amount of your credit will be calculated based on how you file your taxes. If, for example, you claim your partner and your children as tax dependents, you will be considered a household of four when you apply for subsidies. As another example, if you and your partner file taxes separately and you each claim one of your children, you each will be considered as a household…
During Open Enrollment, you will apply as a household of one (or two if you are enrolling with a spouse). When the baby is born, you can update your family information with the Marketplace to reflect that you have become a household of two (or three if you are enrolling with your spouse). After the baby is born, you will have a 60-day special enrollment period to add the baby to your plan. You will…
Yes. However, while you are still pregnant, you may only enroll during an Open Enrollment period, which is typically from November through mid-January. Once enrolled, your plan will be required to cover maternity services. You may also qualify for a premium tax credit and/or a cost-sharing reduction, depending on your family income and your eligibility for employer coverage. After the baby is born, you can sign up for health insurance and add the baby to your plan, no…
Most health plans, including Marketplace plans, are required to cover a wide range of preventive services and may not impose cost-sharing (such as deductibles, copayments, or co-insurance). The ACA requires private plans to cover services under four broad categories: Evidence-based screenings and counseling Routine immunizations Childhood preventive services Preventive services for women So long as the preventive service is performed by an in-network provider, is not billed separately from the office visit, and is the main…
A “Catastrophic plan” is a qualified health plan offered on or off the Marketplace that covers the “essential health benefits.” While Catastrophic plans have lower premiums than other qualified health plans, they also have the highest level of cost sharing allowable for an ACA-compliant plan. For 2026, the annual deductible for covered services in a Catastrophic plan is $10,600 for an individual or $21,200 for a family. The plan does not have to cover more…
Federal laws require most employer-sponsored plans and all ACA-compliant individual insurance plans, including those available through the Marketplaces, to cover maternity services, including pregnancy, childbirth, and newborn care. Cost sharing may apply to some maternity services. Most private plans also must cover prenatal visits and screenings, folic acid supplements, tobacco cessation counseling and interventions, and breastfeeding services without any cost-sharing because they are considered preventive services. Some health plans are not required to cover all…
No. You do not need to be a tax dependent of your parents to continue to be covered on their health plan.
Yes, you can stay on your parents’ plan up to age 26 if they have coverage through work, or until the end of the year you turn 26 if they have Marketplace coverage. Eligibility for health benefits through your own job does not make you ineligible to be covered as a dependent on your parents’ plan.
You can stay on your parents' plan up to age 26 if they have coverage through work, or until the end of the year you turn 26 if they have Marketplace coverage. Eligibility for student health coverage does not make you ineligible to be covered as a dependent on your parents' plan.
A data match issue means the Marketplace is not able to verify the information on your application based on the data it has available to them. Usually, when this happens, HealthCare.gov will temporarily determine that you are eligible for tax credits, based on the income that you attested you expect to earn next year, but it will require you to send additional documentation. People are typically given up to 90 days to submit documentation. If…
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