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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

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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  • The insurance my employer offers is not affordable, so I enrolled in a Marketplace policy with premium tax credits. However, I later got a part-time job and now my annual income will be higher than I or...

    FAQs

    First, you should report your income change to the Marketplace as soon as possible. The Marketplace will determine your new eligibility for premium tax credits based on your higher income and adjust the amount of tax credits going forward. If you make this adjustment promptly, it’s likely you won’t receive any more advanced premium tax credit during the entire year than you’re eligible for based on your annual income. As for the new “affordability” of…

  • My child goes to college in another state, but we want him on our Marketplace family plan. Can we do that?

    FAQs

    Yes. Your child can join your Marketplace family plan, even if they live out of state. However, your child may need to return home to access care within your plan’s provider network. If they get health care services in another state, the provider may be outside your plan’s network, and you may have to pay higher cost sharing for non-emergency services. Your child may be eligible to buy coverage in the state where they attend…

  • Recibí un formulario 1095-A del mercado de seguros. ¿Qué es?

    FAQs

    El formulario 1095-A brinda información sobre el monto del crédito tributario anticipado para las primas (APTC) que recibió el año anterior. Una copia del formulario también fue reportada al IRS. Guarde una copia en sus récords. El APTC se basó en el ingreso anual que usted estimó que ganaría cuando se inscribió en la cobertura del mercado. Ahora debe presentar una declaración de impuestos federal para calcular su ingreso real para ese año de cobertura.…

  • Health Coverage and Care for Youth in the Juvenile Justice System: The Role of Medicaid and CHIP

    Issue Brief

    This brief provides an overview of the health and mental health needs of girls and boys in the juvenile justice system and the role of Medicaid and CHIP in addressing those needs. It focuses on the circumstances of youth who are placed in juvenile justice residential facilities, the discontinuity of Medicaid coverage for those youth, and the options for improving coverage, continuity of care and access to needed services post-discharge, including new opportunities provided by…

  • Visualizing Health Policy: Experiences and Attitudes of Primary Care Practitioners After the ACA

    News Release

    Based on a survey of primary care clinicians in early 2015, this Visualizing Health Policy infographic examines the experiences and attitudes of primary care practitioners (PCPs) after the Affordable Care Act’s (ACA’s) major coverage provisions took effect in January 2014. Although most report no change in their ability to provide quality care, their opinions about the health care law are sharply divided along political party lines. Generally, primary care physicians have a more negative view…

  • States with Section 1115 ACA Expansion Waivers, December 2015

    Feature

    This slide shows the current status of state decisions to use Section 1115 waivers to expand Medicaid. A total of 31 states including DC have adopted the ACA Medicaid expansion, including 6 states with ACA 1115 ACA expansion waivers. AZ has a pending waiver application that seeks changes to its expansion. MT and NH’s waivers will take effect on 1/1/16. PA originally expanded through a waiver but subsequently transitioned to a state plan amendment. TN…

  • Which Path for Health-Care Politics in 2015?

    News Release

    In his first 2015 column for The Wall Street Journal's Think Tank, Drew Altman explains why this year, status quo for the Affordable Care Act is not an option and how the Supreme Court rules in King v. Burwell will determine its path. All previous columns by Drew Altman are available online.

  • Visualizing Health Policy: Premium Changes in the Affordable Care Act’s Insurance Marketplaces 2014-2015

    News Release

    This Visualizing Health Policy infographic illustrates the change in monthly premiums by county, and select cities, from 2014 to 2015 for a 40-year-old person covered by the second-lowest-cost silver “benchmark” plan in the Affordable Care Act’s insurance marketplaces. Premium changes were greatest in Summit County, Colo. (45% decrease) and southeastern Alaska (34% increase), before tax credits. After accounting for tax credits, premiums for a 40-year-old person with an annual income of $30,000 would remain flat in…

  • Women’s Health Issues Journal: Medicaid and Women’s Health Coverage Two Years into the Affordable Care Act

    Issue Brief

    As Medicaid marks its 50th year, the program has unquestionably become the mainstay of health coverage for low-income women in the nation. Since its inception, its role for women has continued to evolve and expand, but the passage of the Affordable Care Act (ACA) swung open the doors for Medicaid to serve even more low-income women who lack access to private or employer-based insurance. This is because the ACA enabled states to finally eliminate Medicaid's…