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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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  • President Trump’s Record on Health Care

    Issue Brief

    This issue brief provides a detailed overview of the Trump Administration’s record on health care issues relating to: the Administration’s response to the COVID-19 pandemic, the ACA and private insurance markets, Medicaid, Medicare, reducing prescription drug and other health care costs, sexual and reproductive health, mental health and substance use, immigration and health, long-term care, HIV/AIDS policy, and LGBTQ health.

  • Can immigrants get help paying premiums and/or cost-sharing for health insurance in the Marketplaces?

    FAQs

    Most lawfully present immigrants can usually get tax credits to help pay premiums and cost-sharing for health insurance through the Marketplaces. Like citizens, they can get premium tax credits that vary on a sliding scale, based on income. Generally, people must have income at least as high as 100% of the federal poverty level ($15,650 for a single adult or $32,150 for a family of four) in 2026 to qualify for premium tax credits. People…

  • I entered estimated income information for next year on my Marketplace application. I expect my income next year will be much lower than it was this year because I had to change jobs. HealthCare.gov say...

    FAQs

    A data match issue means the Marketplace is not able to verify the information on your application based on the data it has available to them. Usually, when this happens, HealthCare.gov will temporarily determine that you are eligible for tax credits, based on the income that you attested you expect to earn next year, but it will require you to send additional documentation. People are typically given up to 90 days to submit documentation. If…

  • When can I enroll in Marketplace health plan coverage?

    FAQs

    This FAQ was updated January 14, 2026, to reflect newly extended Open Enrollment deadlines in Connecticut, Illinois, and Pennsylvania. In general, you can only enroll in Marketplace health plan coverage during the annual Open Enrollment period. For 2026 coverage, the Open Enrollment period in most states begins November 1, 2025, and closes at the end of the day on January 15, 2026. The following states have different Open Enrollment end dates: Idaho: December 15 Massachusetts:…

  • Compramos seguro en el mercado en nuestro estado, pero nuestro hijo va a la universidad en otro. Queremos tenerlo en nuestro plan. ¿Podemos hacerlo?

    FAQs

    Sí. Su hijo puede inscribirse en su plan familiar del Mercado, incluso si vive fuera del estado. Sin embargo, es posible que su hijo deba regresar a casa para acceder a la atención dentro de la red de su plan. Si reciben servicios de atención médica en otro estado, los proveedores de salud pueden estar fuera de la red de su plan, y es posible que usted tenga que pagar copagos o coseguros de costos…

  • How Medicaid Section 1115 Waivers Are Evolving: Early Insights About What to Watch

    Issue Brief

    While efforts to pass major federal legislation to repeal and replace the Affordable Care Act (ACA) and restructure and reduce federal Medicaid financing may be on hold temporarily, the focus of the Centers for Medicare and Medicaid Services (CMS) and states is expected to turn to achieving significant Medicaid program changes through Section 1115 demonstration waivers. This issue brief presents three questions to help analyze the evolution of federal waiver policy as new waiver proposals…

  • Eliminating the ACA Medicaid Expansion Match Could Reduce Total Medicaid Spending by Up To $1.9 Trillion Over 10 Years and End Coverage for 20 Million People 

    News Release

    A new KFF analysis finds that a congressional proposal to significantly cut federal spending on the Affordable Care Act’s Medicaid expansion could reduce total Medicaid spending by up to nearly one-fifth, or $1.9 trillion, over a 10-year period, and end Medicaid coverage for as many as 20 million people.The impacts would be felt in both blue and red states and could effectively reverse and end the Medicaid expansion in most or all states that have…

  • With or Without ACA Repeal, ACA and Medicaid Cuts are Looming

    Perspective

    In this JAMA Health Forum post, Executive Vice President Larry Levitt explores why the incoming Trump administration and Republican majorities in Congress are likely to pursue budget cuts in Medicaid and the Affordable Care Act and why such efforts are likely to boost the number of uninsured Americans.

  • A quote in green text against a white background reads, "The math is conclusive: Major cuts to Medicaid are the only way to meet the House’s budget resolution requirements. There are a myriad of options available for cutting Medicaid, but all of them would leave the states facing  difficult choices to raise revenues or cut spending."

    The Math is Conclusive: Major Medicaid Cuts Are the Only Way to Meet House Budget Resolution Requirements

    Quick Insights

    The CBO letter confirms early expectations, finding that over the next 10 years, 93% of non-Medicare spending in the E&C [House Energy & Commerce Committee] jurisdiction is from the federal share of Medicaid spending…Even if E&C eliminated all non-Medicaid and CHIP spending, the committee would need to cut federal spending on Medicaid and CHIP by well over $700 billion, nearly 10% of projected spending.