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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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  • KFF Analysis Finds Physician Networks in ACA Marketplace Plans Vary Widely, and Enrollees Typically Pay More in Premiums to Access Broader Networks

    News Release

    A KFF analysis of physician networks in the Affordable Care Act’s Marketplace plans finds wide variations in the share of local practicing physicians who participate, with the least costly plans generally having a smaller share of physicians than more expensive plans. The analysis examines the breadth of physician networks listed in Marketplace plan directories in 2021 in nearly every county nationally in relation to the number of actively practicing physicians locally.  On average, Marketplace enrollees…

  • The Biden Administration’s Final Rule on Section 1557 Non-Discrimination Regulations Under the ACA

    Issue Brief

    This brief overviews the Biden Administration’s 2024 final rule implementing Section 1557 of the ACA, which is home to the law’s major nondiscrimination provisions. It provides a brief background on 1557 rulemaking and identifies key differences between this rule and the 2020 rule from the Trump Administration. It highlights two areas of growing interest impacted by the rule – nondiscrimination protections related to pregnancy and nondiscrimination protections for transgender people. Table 2 summarizes the major…

  • Tuve cobertura del mercado en 2025 y tengo que conciliar mis impuestos de este año. ¿Cuál es el máximo que tendría que reembolsar al IRS?

    FAQs

    Para el año fiscal 2025, si subestimó sus ingresos y recibió un subsidio para las primas anticipado mayor al que le correspondía, deberá reembolsar la diferencia entre el monto del crédito fiscal recibido y el monto al que tenía derecho. Sin embargo, si sus ingresos son inferiores a cuatro veces (400%) el nivel federal de pobreza, existen límites en dólares sobre el monto que deberá reembolsar para créditos pagados a las aseguradoras en su nombre.…

  • 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."

  • 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’m covered under my parents’ plan, and I’m pregnant. Will my parents’ plan cover my prenatal care and delivery?

    FAQs

    Federal laws require most employer-sponsored plans and all ACA-compliant individual insurance plans, including those available through the Marketplaces, to cover maternity services, including pregnancy, childbirth, and newborn care. Cost sharing may apply to some maternity services. Most private plans also must cover prenatal visits and screenings, folic acid supplements, tobacco cessation counseling and interventions, and breastfeeding services without any cost-sharing because they are considered preventive services. Some health plans are not required to cover all…

  • 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:…