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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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  • Calculator: ACA Enhanced Premium Tax Credit

    Feature

    The ACA's enhanced premium tax credits expired at the end of 2025. This calculator estimates how much out-of-pocket premium payments would increase for families without the enhanced credits. The projected premium increases are estimated based on family income, zip code, size, ages, and 2026 ACA Marketplace premiums.

  • Responding to Federal Medicaid Reductions: Which States Are Most at Risk?

    Issue Brief

    A new KFF analysis examines a range of measures that may make it harder for states to respond to possible federal Medicaid cuts and finds that six states (Kentucky, Mississippi, Missouri, New Mexico, South Carolina, and West Virginia) rank in the top five for multiple risk categories. Across four broad categories of measures that could affect demand for Medicaid and states’ abilities to raise revenue or reduce spending—population demographic characteristics, health status of Medicaid enrollees,…

  • How Much and Why ACA Marketplace Premiums Are Going Up in 2026

    Issue Brief

    This analysis of initial rate filings from all 50 states and DC shows ACA Marketplace insurers are proposing a median premium increase of 18% for 2026, more than double last year’s 7% median proposed increase. The analysis includes proposed rate changes by state and insurer.

  • 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 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.

  • I notice Marketplace plans are labeled “Bronze,” “Silver,” “Gold,” and “Platinum.” What does that mean?

    FAQs

    Plans in the Marketplace are separated into categories — Bronze, Silver, Gold, or Platinum — based on the amount of cost sharing they require. Cost sharing refers to health plan deductibles, copays, and coinsurance. For most covered services, you will have to pay some of the cost, at least until you reach the annual out-of-pocket limit on cost sharing. Preventive health services, however, are covered without cost-sharing. In the Marketplace, Bronze plans have the highest…

  • Mi empleador ofrece beneficios de salud pero no contribuye mucho para la prima. No puedo pagar mi parte. ¿Puedo solicitar cobertura y subsidios en el mercado?

    FAQs

    Siempre puede comprar cobertura de salud en el mercado. Sin embargo, si le ofrecen beneficios de salud del empleador, no puede calificar para subsidios en el mercado a menos que su cobertura a través del empleador se considere inasequible. Si su parte de la prima para la cobertura en el plan de su empleador es del 9.96% o más de su ingreso familiar de 2026, se considera inasequible y puede solicitar créditos fiscales para las…

  • Mi marido quiere hacerse una vasectomía, pero cuando averigué con nuestro plan, me dijeron que cubre mi esterilización pero que deberíamos pagar parte de los costos de la vasectomía. ¿Cuál es la razón?

    FAQs

    Los anticonceptivos, incluida la esterilización, están cubiertos solo para mujeres como servicios preventivos por los planes que cumplen con ACA. Dado que la esterilización para hombres no se considera un servicio preventivo según la Ley de Cuidado de Salud a Bajo Precio (ACA), la ley federal no requiere que los planes cubran las vasectomías. Sin embargo, nueve estados (California, Illinois, Maryland, Nueva Jersey, Nueva York, Nuevo Mexico, Oregon, Vermont y Washington) requieren planes de salud…

  • Health Insurer Financial Performance in 2024

    Issue Brief

    This analysis of trends in health insurers’ financial data shows that insurers’ gross margins per enrollee dipped slightly in 2024 across four markets, remaining highest in the Medicare Advantage market, followed by the individual (non-group) market, the fully insured group (employer) market, and Medicaid managed care. The analysis also examines insurers’ medical-loss ratios across the four markets.