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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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  • I work full-time for an employer that offers me health benefits, but doesn’t cover spouses. Is that allowed? Can my spouse apply for coverage and subsidies in the Marketplace?

    FAQs

    While employers with 50 or more workers who do not offer health benefits to full-time workers and their dependent children could be subject to a penalty, there is no requirement for employers to offer health benefits to the spouses of full-time workers. Because your spouse is not offered health benefits through your job, they may be eligible to apply for coverage and premium tax credits through the Marketplace if they do not have another offer…

  • What happens with the premium tax credits if we want different Marketplace plans for different family members?

    FAQs

    Assuming you are part of one application, the members of your household can enroll in separate plans in a health insurance Marketplace. For example, you may want separate plans because a grown child lives in another part of the state or because your spouse needs a plan with a different provider network than the one you chose. The premium tax credit will be allocated to the plans in which different family members enroll. However, if…

  • How do I apply for premium tax credits?

    FAQs

    Start by applying for coverage online at HealthCare.gov, via paper application by mail, or by contacting the Marketplace call center and applying over the phone. Applying online is likely the fastest of these options. To apply online, you will need to create a secure personal account with a login ID and password. Click here for information on setting up your online account or here for information on help applying for coverage. The application will ask…

  • Do Marketplace plans cover dental care?

    FAQs

    It depends on your age. Dental coverage for children ages 18 and under is an "essential health benefit," meaning it must be available to any children you have, either as part of a health plan or through a separate dental plan, though you are not required to buy it. Dental coverage for adults is not considered an essential health benefit, so Marketplace plans don’t have to offer it.

  • What health plans are offered through the Marketplace?

    FAQs

    All health plans offered through the Marketplace must meet the requirements of “qualified health plans.” This means they will cover essential health benefits, limit the amount of cost sharing (such as deductibles and co-pays) for covered benefits, cover certain preventive services at no cost to consumers, and satisfy all other consumer protections required under the Affordable Care Act. Health plans vary in the benefits they cover and the level of cost sharing required. Plans are…

  • Tengo más de 65 años y estoy cubierto por Medicare, pero me pregunto si puedo comprar uno de los planes de salud ofrecidos a través del mercado y cancelar mi cobertura de Medicare. ¿Es esa una opción pa...

    FAQs

    Si tiene Medicare, debe mantenerlo. Las compañías que venden planes del mercado tienen prohibido venderle estos planes si saben que está cubierto por Medicare. (Esto aplica incluso si tiene un plan de Medicare Advantage, un plan de medicamentos de la Parte D de Medicare o uno de Medigap)

  • ¿Pueden los inmigrantes inscribirse en Medicaid o en el Programa de Seguro de Salud Infantil (CHIP)?

    FAQs

    La mayoría de los inmigrantes con un estatus migratorio "que califica" y que cumplen con los requisitos de los programas de Medicaid y CHIP, como los ingresos y la residencia estatal, pueden inscribirse en Medicaid o CHIP después de haber estado en los Estados Unidos por 5 años o más. Aquí se puede encontrar una lista de "estatus que califican". Algunos grupos de inmigrantes legalmente presentes no tienen que esperar cinco años antes de poder…

  • ¿Necesito una orden para ir a mi ginecólogo?

    FAQs

    La mayoría de los planes de salud deben permitir que las personas inscritas consulten a su ginecólogo/a sin una orden de su médico de cabecera. Consulte con su plan o con el departamento de seguros de su estado.

  • Solía tener cobertura a través del plan de mis padres, pero lo abandoné el año pasado cuando conseguí otra cobertura. Ahora la perdí y quiero volver a tener el seguro con mis padres… ¿Puedo hacerlo?

    FAQs

    Sí, puedes volver al plan de tus padres hasta que cumplas 26 años si tienen cobertura a través del trabajo, o antes de que finalice el año en que cumplas 26 si tienen cobertura del mercado de seguros. No tienes que esperar hasta el próximo período de inscripción abierta para inscribirte. El plan de tus padres debe ofrecerte una oportunidad especial para volver a inscribirte porque perdiste tu otra cobertura. Si tus padres obtienen su…

  • ¿Qué es un plan “grandfathered” (exento)? ¿Cómo sé si tengo uno?

    FAQs

    Los planes "grandfathered" (exentos) son los que existían el 23 de marzo de 2010 y se han mantenido básicamente igual. Los planes de salud "grandfathered" no están obligados a proporcionar todos los beneficios y protecciones al consumidor que se requieren de otros planes de salud. Por ejemplo, podría no cubrir los servicios de salud preventiva, podría cobrar primas más altas según el estado de salud o el género, y podría excluir la cobertura para afecciones…