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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?

The ACA MarketplaceS

In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year 

ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third between 2025 and 2027.

The Average Marketplace Deductible Grew by About $1,000 Per Person in 2026, With More Enrollees Shifting to Higher-Deductible Plans as Enhanced Tax Credits Expired

The average Affordable Care Act (ACA) Marketplace deductible experienced the steepest increase in history—growing by 37% or over $1,000, from $2,759 in 2025 to $3,786 in 2026 as enhanced premium tax credits expired, according to a new KFF analysis. After the enhanced tax credits ended, many Marketplace shoppers shifted toward lower-premium, higher-deductible plans.

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  • I don’t have a checking account. Can the insurance company require that I get one and pay my premiums through automatic monthly withdrawals?

    FAQs

    No. Insurers offering coverage in the Marketplace are required to provide a variety of payment methods and cannot require a consumer to pay by automatic bank withdrawals (sometimes called electronic funds transfers, or EFT) or debit card. Federal rules require the insurer to also accept paper checks, cashier’s checks, money orders, and general-purpose pre-paid debit cards. These methods must be available to consumers for both the initial premium payment (at enrollment) and ongoing payments.

  • ¿Cómo puedo proteger mi información personal al inscribirme en la cobertura del mercado a través de un sitio web que no pertenece al mercado?

    FAQs

    Aquí tiene algunos consejos para proteger su información personal si decide inscribirse en el mercado de seguros a través de un sitio web externo: Tenga cuidado con las técnicas de venta que lo presionan para tomar decisiones rápidas. Utilice esta herramienta cuidadodesalud.gov para encontrar sitios web de socios de inscripción certificados y aprobados por el mercado de seguros. Tenga cuidado al interactuar con anuncios que ofrecen dinero en efectivo, regalos u otros beneficios. La información…

  • Trabajo con una visa H-2A. ¿Tengo derecho a cobertura en el mercado de seguros?

    FAQs

    Sí. Los inmigrantes con residencia legal que, de otro modo, serían elegibles para cobertura médica, incluyendo a los "no inmigrantes", como los trabajadores con visa H-2A y aquellos con visas de estudiante, pueden adquirir cobertura en los mercados de seguros. Quienes tengan bajos ingresos y sean elegibles también podrían recibir asistencia con las primas y reducciones en los costos compartidos para reducir el costo de la cobertura. Sin embargo, DACA ya no se considera un…

  • ¿Qué sucede si recibo atención de un médico que no está en la red de mi plan?

    FAQs

    En general, los planes no están obligados a cubrir la atención recibida de un proveedor fuera de la red (OON). Por ejemplo, si decide consultar a un médico de cabecera que no pertenece a la red de su plan, es posible que su aseguradora no cubra la factura o, si lo hace, podría tener que pagar un costo compartido mucho mayor que si hubiera optado por consultar a un proveedor dentro de la red. En…

  • Mi pareja y yo vivimos juntos, pero no estamos casados. ¿Se utilizarán nuestros ingresos familiares combinados para determinar nuestra elegibilidad y el monto de los subsidios para las primas?

    FAQs

    Suponiendo que ninguno de los dos declara dependientes en su declaración de impuestos, se considerará que cada uno forma un hogar individual y sus ingresos se utilizarán para determinar la elegibilidad y el monto de los subsidios para las primas y las reducciones de costos compartidos. Si cumplen los requisitos para los subsidios para las primas, cada uno recibirá una determinación por separado sobre el monto de su crédito y si cumplen los requisitos para…

  • How an ACA Premium Spike Will Affect Family Budgets, and Voters

    From Drew Altman

    In his latest column, President and CEO Dr. Drew Altman shows how spiking premiums, which may come if the enhanced ACA tax credits are not extended, will hit people in the context of their family budgets, alongside rising costs for food, housing and utilities. For some families, their new health care costs could far exceed what they pay for food, affecting their economic security and potentially their vote.

  • Why Might Republicans Consider Extending Obamacare Tax Credits?

    Quick Insights

    KFF Vice President Cynthia Cox takes a broader look at the expiring enhanced tax credits, which Congressional Democrats have made central to their government funding demands, and how they lower health costs for many traditionally Republican constituencies, such as people in southern states, small business owners and employees, farmers and ranchers, older adults, and rural Americans.