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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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  • What happens if I get care from a doctor who isn’t in my plan’s network?

    FAQs

    In general, plans are not required to cover care received from an out-of-network (OON) provider. For example, if you choose to visit a primary care doctor that is not in your plan’s provider network, your insurer might not pay any of the bill, or if they do, you might have much higher cost-sharing than if you had chosen to see an in-network provider. In these situations, the health care provider or facility might send you…

  • Me inscribí en un plan de salud estudiantil, pero pienso que tengo mejores opciones en el mercado de seguros. ¿Puedo dejar la cobertura estudiantil e inscribirme en el mercado?

    FAQs

    Si actualmente está inscrito en un plan de salud para estudiantes, aún puede inscribirse para obtener cobertura en el mercado de seguros durante el período anual de inscripción abierta. Si sus ingresos familiares previstos son de al menos $15.650 en 2026, también puede aplicar para subsidios para pagar las primas. Sin embargo, deberá cancelar su cobertura de salud estudiantil antes del 31 de diciembre. Fuera del período de inscripción abierta, no puede cancelar voluntariamente su…

  • Acabo de conseguir un trabajo con seguro médico, pero el seguro de mis padres es mejor y más económico. ¿Puedo seguir con el seguro de mis padres?

    FAQs

    Sí, puede permanecer en el plan de sus padres hasta los 26 años si ellos tienen cobertura a través del trabajo, o hasta el final del año en el que cumpla 26 si tienen cobertura del mercado. Ser elegible para recibir beneficios de salud a través de tu trabajo no te invalida para estar cubierto como dependiente en el plan de tus padres.

  • Recent Trends in Commercial Health Insurance Market Concentration

    Issue Brief

    Commercial health insurance markets remain highly concentrated across coverage types. However, the individual market, which consists mostly of the ACA Marketplaces, has attracted more insurers and witnessed greater insurer competition across a variety of measures since the implementation of the enhanced premium tax credits in 2021, according to a new Healthy System Tracker analysis.

  • Enrollment Growth in the ACA Marketplaces

    Policy Watch

    This analysis of enrollment in Affordable Care Act (ACA) Marketplace health plans finds a record 24.3 million people enrolled in 2025, more than double the total in 2020, with most of the growth occurring in states won by President Trump in the 2024 election. In six states, enrollment more than tripled from 2020 to 2025: Texas, Mississippi, West Virginia, Louisiana, Georgia, and Tennessee.

  • 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.…