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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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  • Me gusta mi plan de mercado tal como es. ¿Se mantendrá igual el año que viene?

    FAQs

    Depende. Las aseguradoras pueden hacer cambios a los planes cada año. Lo más probable es que la prima de su póliza actual cambie el próximo año. También puede haber otros cambios como en los deducibles o copagos para algunos servicios. En algunos casos, una aseguradora puede dejar de ofrecer un plan particular y ofrecerle nuevas opciones, en su lugar. Poco antes de que comience la inscripción abierta, debe recibir un aviso de su compañía de…

  • ¿Qué pasa si termino necesitando atención de un doctor que está fuera de la red de mi plan?

    FAQs

    Los planes no están obligados a cubrir la atención recibida de un proveedor que no pertenece a la red, aunque algunos planes del mercado lo hacen, al menos en cierta medida. Si recibe atención fuera de la red, podría ser costoso para usted. En general, los planes que brindan una opción fuera de la red cubren dicha atención a una tasa más baja (por ejemplo, se puede reembolsar el 80% de los costos dentro de…

  • Five Things to Know about the Renewal of Extra Affordable Care Act Subsidies in the Inflation Reduction Act

    Policy Watch

    As part of the Inflation Reduction Act, the Senate recently passed a three-year extension (through 2025) of enhanced subsidies for people buying their own health coverage on the Affordable Care Act Marketplaces. The enhanced subsidies increase the amount of financial help available to those already eligible and also newly expand subsidies to middle-income people, many of whom were previously priced out of coverage. Here’s what to know about the likely renewal of these subsidies:

  • 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…

  • Compré anticonceptivos de emergencia de venta libre en mi farmacia y pensé que mi seguro los cubriría, pero terminé teniendo que pagar el costo total de mi bolsillo. ¿Por qué no lo cubre mi seguro?

    FAQs

    La anticoncepción de emergencia es uno de los métodos aprobados por la Administración de Drogas y Alimentos (FDA) para mujeres que debe estar cubierto por la mayoría de los planes de salud, incluidos los que se venden en el mercado de seguros. Sin embargo, debe ser recetada por un profesional de salud para que la mayoría de los planes la cubran. Si no tiene una receta, probablemente tendrá que pagar el costo total de su…

  • 2026 Medical Loss Ratio Rebates

    Issue Brief

    Insurers estimate they will pay $759.2 million in Medical Loss Ratio (MLR) rebates in 2026 to select individuals and employers that purchase their health coverage, according to a KFF analysis of preliminary data reported to state regulators. The estimated rebate for 2024 is less than rebates issued in most prior years.

  • An image of text is an excerpt from Cynthia Cox's quick take which reads, "While the Trump administration attributes this drop in enrollment to their attempts to address fraud, this coverage loss happened at the same time millions of people faced steep increases in their premium payments — often in the double or even triple digits — with the expiration of enhanced tax credits."

    ACA Marketplace Enrollment Is Down By 3 Million After Big Jump in Premium Payments

    Quick Insights

    Enrollment dropped 13% following the expiration of enhanced premium tax credits at the beginning of this year. Enrollment fell from a high of 22.1 million people in 2025 to 19.2 million people in February 2026. While the Trump administration attributes this drop in enrollment to their attempts to address fraud, this coverage loss happened at the same time millions of people faced steep increases in their premium payments – often in the double or even…

  • ACA Deductible FI

    What We Know So Far About 2026 ACA Marketplace Enrollment, Premiums, and Deductibles

    Issue Brief

    This analysis examines early indicators of how the expiration of enhanced premium tax credits has affected effectuated enrollment levels (i.e., enrollment among people who have paid their premiums), plan selections, and out-of-pocket costs in 2026, drawing on plan selection and effectuated enrollment data from the Centers for Medicare & Medicaid Services (CMS) and state-based Marketplace (SBM) Open Enrollment reports, as well as KFF survey data and individual market enrollment estimates from Wakely Consulting Group.

  • We’ve Never Seen Health Care Cuts This Big

    Perspective

    In this July 1 column for The New York Times Opinion section, KFF Executive Vice President for Health Policy Larry Levitt explains how the budget reconciliation bill passed by the Senate on July 1 is effectively a partial repeal of the Affordable Care Act (ACA) and, if signed into law, the resulting reductions in Medicaid and ACA Marketplace coverage would make it "the biggest rollback in federal support for health coverage ever."

  • Trends in the Use of Hospital and Provider Quality Ratings

    Poll Finding

    With a renewed emphasis on health care quality driven by the Affordable Care Act, this polling data note examines historical trends in Americans' reliance on quality ratings and how their perceptions have changed over time. Data Note (.pdf)