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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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  • I’m working on an H-2A visa. Am I eligible for coverage in the Marketplace?

    FAQs

    Yes. Lawfully-present immigrants who are otherwise eligible for coverage – including “nonimmigrants” like H-2A workers and those on student visas – may purchase insurance in the Marketplace. Those who are low-income and otherwise eligible may also receive premium assistance and cost-sharing reductions to lower the cost of coverage in Marketplace plans. However, DACA is no longer considered an eligible immigration status for health coverage through the Marketplaces, and starting in 2027, certain other lawfully present…

  • Are individuals granted deferred action under “Deferred Action for Childhood Arrivals” (DACA) eligible for Medicaid, CHIP, and the health insurance Marketplaces?

    FAQs

    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.

  • How will an individual’s citizenship and immigration status be checked?

    FAQs

    Only those individuals in a family who are applying for health insurance are required to provide citizenship and immigration status. Applicants also must provide a Social Security Number if they have one. Citizenship and immigration status for those applying for health insurance will be checked electronically with several systems, including the Social Security Administration, the Department of Homeland Security, and SAVE (Systematic Alien Verification for Entitlements). If an individual’s status cannot be checked through an…

  • Does being lesbian, gay, bisexual, or transgender (LGBT) affect my health insurance coverage and options? What if I am married to my same-sex partner?

    FAQs

    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.…

  • I just found out that I’m pregnant, and I do not have health insurance. Can I enroll in a plan through the health insurance Marketplace?

    FAQs

    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…

  • I’m covered under my parents’ plan and I’m pregnant. Will my parents’ plan cover my prenatal care and delivery?

    FAQs

    Federal laws require many 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…

  • What services do plans have to cover for pregnancy?

    FAQs

    Federal laws require many 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 such as pumps and lactation consultations without any cost-sharing because they are considered preventive services. All state Medicaid…

  • Do I need a referral to go to my OBGYN?

    FAQs

    Most health plans must allow enrollees to see their OBGYN without a referral from their primary care doctor. Check with your plan or state insurance department.

  • Does my health plan have to cover all birth control methods with a prescription? Do I have to pay a copay?

    FAQs

    Most employer plans and all Marketplace plans must cover at least one form of all FDA-approved, granted, or cleared birth control (“contraceptive”) services and supplies for women, without cost sharing. This includes sterilization services, insertion and removal of long-acting reversible birth control methods, and follow-up services. While some birth control methods are available over the counter without a prescription, plans typically require a prescription to trigger coverage. Though it is up to an insurer’s discretion,…

  • I’m covered under my parents’ health insurance plan, but I’m moving to another state. Can I remain covered on my parents’ plan?

    FAQs

    Yes, you are eligible to stay on your parents’ plan up to age 26 if they have coverage through a job, or until the end of the year you turn 26 if they have Marketplace coverage, regardless of where you live. However, your parents’ health plan probably has a network of participating health care providers, and it may be difficult for you to find in-network providers when you are living in another state. If you…