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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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  • 2024 Calculadora del Mercado de Seguros Médicos

    Feature

    2024 Esta calculadora ilustra las primas (el costo mensual de su seguro) y subsidios para las personas que compran seguro médico por su propia cuenta en el nuevo mercado de seguros de salud (o de intercambio) creado por la Ley de Cuidado de Salud a Bajo Precio (Affordable Care Act, ACA, en inglés). Con esta calculadora, usted puede introducir diferentes niveles de ingresos, edades, y el tamaño de su familia para obtener un estimado de…

  • 2024 Health Insurance Marketplace Calculator

    Interactive

    The Health Insurance Marketplace Calculator, updated with 2024 premium data, provides estimates of health insurance premiums and subsidies for people purchasing insurance on their own in health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA).

  • Consumer Survey Highlights Problems with Denied Health Insurance Claims

    Issue Brief

    This Data Note includes major findings from the KFF Consumer Survey on consumer experiences with claim denials. Among those who used the most health care over the past year, 27% experienced a denied claim. More consumers with private insurance experienced denied claims compared to Medicaid or Medicare.

  • Consumer Problems with Prior Authorization: Evidence from KFF Survey

    Issue Brief

    This Data Note highlights findings from the KFF Consumer Survey on problems consumers have experienced with prior authorization requirements. Overall, those with Medicaid, those who are higher utilizers of care, and those who seek certain types of care such as care for a mental health condition or diabetes encountered more problems with prior authorization over the past year.

  • KFF Examines Challenges in Navigating Coverage for Opill, the First Over-the-Counter Daily Oral Contraceptive Pill, Coming to Market Next Year 

    News Release

    As Opill—the first over-the-counter daily oral contraceptive pill in the United States—is expected to be available for purchase in early 2024, new research conducted by KFF examines barriers to its accessibility for consumers and challenges in providing insurance coverage for it. Based on interviews with nearly 80 representatives from private insurance plans, state Medicaid programs, chain pharmacies, and other key groups, the report provides a deeper view into the operational challenges in expanding access to…

  • Insurance Coverage of OTC Oral Contraceptives: Lessons from the Field

    Report

    This report is based on 35 structured interviews conducted from January to August 2023, with nearly 80 experts and key players such as pharmacists, health plans, and state Medicaid officials involved in the coverage and provision of OTC contraception in seven states with one or more of these coverage approaches (IL, NJ, NM, NY, OR, UT, and WA). It discusses the challenges and successes in coverage under private health insurance and Medicaid and reviews policy…

  • Already at Record High, ACA Marketplace Enrollment Could Increase Further

    News Release

    Enhanced Marketplace subsidies have continued to drive up enrollment in the individual market, and the loss of Medicaid coverage by millions of people could contribute to this trend, according to a new KFF analysis. Meanwhile, enrollment in non-ACA-compliant plans is at a record low. As of early 2023, an estimated 18.2 million people have individual market coverage, the highest since 2016. Individual market enrollment grew by about 29% between early 2020 and early 2023 —…

  • As ACA Marketplace Enrollment Reaches Record High, Fewer Are Buying Individual Market Coverage Elsewhere

    Issue Brief

    This analysis looks at how many people are signed up for each type of individual ACA Marketplace coverage—both on- and off-Marketplace and with or without subsidies—as of early 2023 based on federal enrollment data and administrative data insurers report to state regulators, as compiled by Mark Farrah Associates. The number of people enrolled in compliant and non-compliant plans was also evaluated.

  • The 4 Arguments You Will Hear Against Drug Price Negotiation

    Perspective

    As the Biden administration begins the process of negotiation drug prices for Medicare as authorized in the Inflation Reduction Act, KFF's Larry Levitt probes some of the arguments against it and the policy and political implications of the debate in this New York Times op-ed column.