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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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  • ¿Cómo se comprobará el estatus de ciudadanía e inmigración de un individuo?

    FAQs

    Solo a los miembros de una familia que está aplicando para un seguro de salud se les solicita proveer prueba de ciudadanía y estatus migratorio. Los que aplican también deben proveer un número de Seguro Social, si lo tienen. El estatus migratorio o de ciudadanía de los solicitantes de un seguro de salud se verificará electrónicamente con varios sistemas, incluyendo la Administración del Seguro Social, el Departamento de Seguridad Nacional y SAVE (Systematic Alien Verification…

  • ¿Los planes del mercado cubren la atención dental?

    FAQs

    Depende de su edad. La cobertura dental para menores de 18 años es un "beneficio de salud esencial", lo que significa que debe estar disponible para todos sus hijos, ya sea como parte de un plan de salud o a través de un plan dental independiente, aunque no es obligatorio adquirirla. La cobertura dental para adultos no se considera un beneficio de salud esencial, por lo que los planes del Mercado de Seguros Médicos no…

  • Soy elegible para recibir beneficios de salud en el trabajo, pero quiero ver si puedo obtener una mejor oferta en el mercado. ¿Puedo hacer eso?

    FAQs

    Siempre puede comprar cobertura en el mercado, asumiendo que cumple con otros requisitos de elegibilidad, pero si tiene acceso a una cobertura a través del trabajo que se determina que es asequible (no más del 9,9% del ingreso del hogar en 2026), es posible que no califique para los subsidios para ayudar a pagar las primas. Puede encontrar más información en esta sección.

  • Analysis Examines the Affordable Care Act’s Impact on Nearly All Americans

    News Release

    A week after the 2020 elections, the Supreme Court is scheduled to hear arguments on a legal challenge, supported by the Trump administration, that seeks to overturn the Affordable Care Act, an outcome that would have major effects throughout the health care system as the law’s provisions have affected nearly all Americans in some way. A KFF analysis examines key provisions of the 2010 law that have changed the nation’s health care system, including what’s…

  • Brief Examines the COVID-19 Crisis’ Implications for Americans’ Mental Health

    News Release

    Nearly half (45%) of adults across the country say that worry and stress related to the coronavirus (COVID-19) pandemic are hurting their mental health, an early sign that the health and economic crises is likely to increase mental health problems and further stretch the system’s capacity. A new issue brief explores how the crises and related measures to protect public health, including social distancing, business and school closures, and shelter-in-place orders, are likely to affect…

  • A Reconfigured U.S. Supreme Court: Implications for Health Policy

    Issue Brief

    U.S. Supreme Court decisions shape health policy in important ways. The nomination of Judge Amy Coney Barrett, if confirmed, is expected to establish a solid 6:3 conservative majority that could affect case outcomes in several areas. This issue brief considers the potential implications of a reconfigured Court for health policy issues, including those already on the Court’s docket for the coming term and those that the Court may choose to consider in this term or…

  • The Effects of Ending the Affordable Care Act’s Cost-Sharing Reduction Payments

    Issue Brief

    This analysis estimates that total federal spending on Affordable Care Act marketplace subsidies would rise $2.3 billion, or 23 percent, in 2018 if payments for the cost-sharing reduction program were eliminated and insurers increased premiums to compensate. Established to reduce out-of-pocket costs for marketplace enrollees with lower incomes, the cost-sharing payments are being challenged in a lawsuit from the U.S. House.

  • The Virginia Health Care Landscape

    Fact Sheet

    This fact sheet provides an overview of the population health, health coverage, and health care delivery system in Virginia in the era of health reform under the Affordable Care Act (ACA).

  • The Affordable Care Act and Insurance Coverage in Rural Areas

    Issue Brief

    Rural populations face disparities compared to metropolitan populations in health care. While rural individuals were not more likely to be uninsured than metropolitan counterparts pre-Affordable Care Act, they were poorer and less likely to have private insurance. With coverage changes in the ACA involving an expansion of Medicaid for poor and near-poor populations, decisions by states with large rural populations may cause rural residents to have disparate access to coverage, which may exacerbate cost and…

  • What Women Think of the Core Issue in the Hobby Lobby Case

    From Drew Altman

    This was published as a Wall Street Journal Think Tank column on June 30, 2014. The Supreme Court decision upholding Hobby Lobby’s ability to refuse to cover certain contraceptive services based on its owners’ religious beliefs has set off a wave of analysis of what the decision means. That will not be resolved anytime soon. But we do know what women think of the policy issue at the core of the case. Overall, by a margin of…