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Individual Market Enrollment Declined by 18% Since June 2025

Individual Market Enrollment Fell 18%, Suggesting Continued ACA Marketplace Losses

Enrollment in the individual health insurance market fell by 18%—over 4.6 million people—from 25.2 million in June 2025 to 20.5 million in June 2026. Falling individual market enrollment suggests further decline in ACA Marketplace enrollment this year, since Marketplace enrollees represent the vast majority of individual market coverage.

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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 who are not U.S. citizens buy health insurance through the health insurance Marketplaces?

    FAQs

    Most lawfully present immigrants, including people with work (H1) and student visas, can buy health insurance through the health insurance Marketplaces. This group also currently includes lawfully present immigrants with incomes under 100% of the federal poverty level who cannot enroll in Medicaid based on immigration status, for example, because they are in the five-year waiting period for Medicaid or CHIP coverage. Deferred Action for Childhood Arrivals (DACA) is no longer considered an eligible immigration…

  • 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…

  • 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.…

  • My partner and I are unmarried and we have two children. How do we count our household size and income when we apply for premium tax credits in the Marketplace? Can we buy one plan to cover the whole fa...

    FAQs

    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…

  • 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…

  • I’m pregnant and want to enroll in Marketplace coverage. How do I project my household size for next year and enroll my baby?

    FAQs

    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…

  • I have been trying to get pregnant. Do Marketplace plans cover infertility services?

    FAQs

    The ACA does not require health plans to cover infertility services; however, some states require certain plans to cover certain infertility services. If you need these services and are shopping for coverage, check the plan details or your state insurance department about coverage and out-of-pocket costs for infertility care.

  • 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…

  • I’m covered on my parents’ health plan, but I’m turning 26 soon and won’t be eligible to stay on their plan. What are my options?

    FAQs

    You should act now to review your coverage options and sign up for new coverage. If your parents get their insurance through an employer that has at least 20 workers, you may be able to continue that coverage (known as COBRA) for up to 3 years, but it will likely be much more expensive than other coverage options. If you are employed, find out if your employer offers health insurance and if you qualify. If…