Affordable Care Act

The ACA MarketplaceS

What We Know about Trump’s $500 ACA Checks and the User Fees Funding Them

This analysis examines the $500 checks that the Trump administration is sending to some Affordable Care Act Marketplace enrollees and the user fees that are paying for them. The checks are going to about 1 million enrollees in the 30 states that rely on the federal HealthCare.gov Marketplace who are not receiving any tax credits this year.

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. The enrollment decline coincides with the expiration of the enhanced premium tax credits and other policy changes that are expected to reduce enrollment.

About the ACA

Promotional image for KFF video How Affordable is the Affordable Care Act

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 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…

  • 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…

  • Can I be covered under my parent’s health plan if I’m married?

    FAQs

    Yes. You can stay on your parents’ plan until you turn 26 if they have coverage through work, or until the end of the year you turn 26 if they have Marketplace coverage. Being married does not affect your eligibility to be covered under your parents' plan.

  • 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…

  • Perdí mi empleo y mi seguro de salud. ¿Puedo comprar un plan en el mercado ahora, o debo esperar a la próxima inscripción abierta?

    FAQs

    Puede aplicar ahora. CuidadoDeSalud.gov y todos los mercados estatales permiten una oportunidad de inscripción especial cuando las personas pierden otra cobertura. Esto incluye la pérdida de la cobertura basada en el trabajo y la pérdida de Medicaid. En general, tiene 60 días después de la pérdida de otra cobertura para solicitar una oportunidad de inscripción especial a través del mercado. En CuidadoDeSalud.gov y en algunos otros estados, si recibe un aviso por adelantado de la…