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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.

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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  • I’m leaving my job and will be eligible for COBRA. Can I shop for coverage and subsidies on the Marketplace instead?

    FAQs

    Yes, leaving your job and losing eligibility for job-based health coverage will trigger a special enrollment opportunity for Marketplace coverage that lasts for 60 days. During that period, you can apply for a Marketplace health plan and depending on your income, you may qualify for premium tax credits and cost-sharing reductions. If your state uses the federally facilitated Marketplace (HealthCare.gov), you will need to provide proof of the coverage loss to be eligible for the…

  • I’m offered health insurance at work, but it’s not very good. I’m applying for better coverage and subsidies in the Marketplace. The application asks whether I’m offered health coverage through a...

    FAQs

    The term “minimum value” means that your job-based health insurance plan would cover at least 60% of an average group of people’s covered health costs. In addition, employer plans must provide substantial coverage for hospitalization and for physician care to meet the “minimum value” test. Most employer plans will meet this test, but some may not. The Marketplace application includes a form with questions about job-based coverage. You should take this form to your employer…

  • Do I need a referral to go to my OBGYN?

    FAQs

    Most health plans must allow enrollees to see their OBGYN without a referral from their primary care doctor. Check with your plan or state insurance department.

  • My income is low enough that I qualify for advanced premium tax credits (APTCs), but I have never filed a federal tax return before. Can I still receive APTCs?

    FAQs

    If this is your first time applying for premium tax credits, then yes. There is no requirement to have filed a tax return for any prior year to qualify for premium tax credits. However, because you have never filed a federal tax return, you will likely have to provide additional documentation (such as pay stubs or a work contract) to the Marketplace within 90 days to verify your projected household income for premium tax credits. …

  • Most Democratic Voters Want To Hear Candidates Discuss Health Costs and Future of Health Programs; More Republicans Focused on Fraud

    KFF Health Tracking Poll: Public Views on Fraud in Government Health Programs

    Poll Finding

    As the 2026 midterms approach, health care costs remain voters' top health priority, but fraud in government health programs, including Medicaid and Medicare, is resonating with Republican voters, 55% of whom say it's extremely important for candidates to address. Most voters say there is at least “some” fraud in government health programs, but larger shares say there is fraud in the tax system, defense, and foreign aid, while the smallest share sees fraud in the…

  • Change in February effectuated enrollment, by state, 2025-2026

    How Has ACA Marketplace Enrollment Changed Across States in 2026?

    Issue Brief

    Following several years of rapid enrollment growth in the Affordable Care Act (ACA) Marketplaces that corresponded with temporary enhanced premium tax credits, enrollment fell for the first time in seven years in 2026, when those tax credits expired. Every state except for New Mexico saw a drop in ACA Marketplace enrollment from 2025 to 2026. State-based Marketplaces that run their own enrollment platforms, including those that partially offset the expiring federal enhanced tax credits, generally…

  • Poll: Costs Are the Top Health Care Issue for Voters in the Midterms, But Fraud Tops Republicans’ List As Trump Administration Pushes Crackdown

    News Release

    Health care costs top the list of voters’ health care priorities for the midterm elections, though more than half of Republican voters say it is extremely important for candidates to discuss the issue of fraud in government health programs, according to a new KFF Health Tracking Poll. Most voters say there is at least “some” fraud in government health programs, but larger shares of voters see fraud in the tax system, defense, and foreign aid…

  • KFF Health Tracking Poll: Health Care Costs, Expiring ACA Tax Credits, and the 2026 Midterms

    Poll Finding

    Looking ahead to the midterm elections, health care costs are the public’s top economic concern, and many voters say the issue will have a major impact on their vote. On health care issues, including the cost of health care, voters currently trust Democrats more than Republicans, though neither party has an advantage on addressing the overall cost of living. Following the expiration of the ACA enhanced tax credits, two-thirds of the public say Congress did…

  • BTD Health Policy in 2026

    Health Policy in 2026

    From Drew Altman

    In a new column, President and CEO Dr. Drew Altman forecasts eight things to look for in health policy in 2026. “First and foremost,” he writes, “is the role health care affordability will play in the midterms.” And, he notes: “The average cost of a family policy for employers could approach $30,000 and cost sharing and deductibles will rise again after plateauing for several years.”