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The ACA MarketplaceS

How Has Marketplace Enrollment Changed Across States in 2026?

Following several years of rapid enrollment growth in the ACA Marketplaces that corresponded with temporary enhanced premium tax credits, enrollment fell for the first time in seven years in 2026, when those tax credits expired. Every state except for New Mexico saw a drop in Marketplace enrollment from 2025 to 2026. State-based Marketplaces that run their own enrollment platforms, including those that partially offset the enhanced tax credits, generally saw lower drops in enrollment.

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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  • Can immigrants enroll in Medicaid or Children’s Health Insurance Program (CHIP) coverage?

    FAQs

    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…

  • Do Marketplace plans or Medicaid cover abortions?

    FAQs

    It depends on where you live and what type of coverage you have. For Marketplace plans, there is no federal requirement for plans to cover abortion. About half of states prohibit Marketplace plans from covering abortion. However, other states require plans to cover abortion services and do not permit cost sharing. For Medicaid enrollees, federal law only allows the use of federal funds for abortion in cases of rape, incest, or life endangerment of the pregnant…

  • 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…

  • 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 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…

  • What happens if I just make up an income level that I know will qualify me for financial assistance?

    FAQs

    That’s not advisable. The Marketplace will check the information you provide against a number of databases (including IRS data, Social Security data, wage databases, and others). If the information you provide is very different from what’s in these databases, you may be asked to provide additional documentation. In addition, at the end of the Application for Health Coverage and Help Paying Costs, you will have to sign that you have provided true answers to all…

  • I’m divorced and I pay alimony to my ex-spouse. Does that affect my income for determining eligibility for premium tax credits?

    FAQs

    Federal tax rules set out what is included in your household income. Eligibility for and the amount of premium tax credits are largely based on your household income. Check with a tax advisor, but in general, for divorce or separation agreements after December 31, 2018, alimony payments are no longer deductible from the income of the paying ex-spouse, and alimony is not included as income for the recipient ex-spouse. For pre-2019 divorces, the paying ex-spouse…

  • My kids are eligible for the Children’s Health Insurance Program (CHIP). Can I enroll them in our Marketplace health plan and get premium tax credits for them instead?

    FAQs

    You can add your children to your Marketplace plan, but because they are eligible for your state’s Children’s Health Insurance Program (CHIP), they are not eligible for premium tax credits. The exception to that is if you live in a state that has a waiting period for enrolling in CHIP. During the waiting period, your children are eligible for a premium tax credit; when the waiting period has ended, they can enroll in CHIP and…

  • I’m under 26 and eligible to be covered as a dependent under my mom’s job-based policy. Mom no longer claims me as a tax dependent – I file my own taxes, though my income isn’t very high. If subsidized...

    FAQs

    Yes. Although the general rule is that people are not eligible for Marketplace subsidies when they are also eligible for affordable job-based health coverage, a young adult is eligible for premium tax credits in the Marketplace as long as they are not claimed as a tax dependent by their parents. The availability of dependent coverage under your parents' health plan does not affect your eligibility for premium tax credits in the Marketplace.

  • When can I apply for Marketplace premium tax credits when other coverage is available?

    FAQs

    In general, if you have or are offered other comprehensive, affordable coverage, you may not be eligible for premium tax credits on the Marketplace. However, there are several circumstances where you may be eligible. This chart lays out examples of different coverage types and whether or not they will disqualify you for premium tax credits.