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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?

The ACA MarketplaceS

In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year 

ACA Marketplace insurers are proposing a median premium increase of 14% for 2027— indicating a likely second consecutive year of double-digit increases, according to a new analysis of preliminary rate filings in 16 states and DC. If these increases hold, typical premiums for insurers participating in the ACA Marketplaces would jump by more than one-third between 2025 and 2027.

The Average Marketplace Deductible Grew by About $1,000 Per Person in 2026, With More Enrollees Shifting to Higher-Deductible Plans as Enhanced Tax Credits Expired

The average Affordable Care Act (ACA) Marketplace deductible experienced the steepest increase in history—growing by 37% or over $1,000, from $2,759 in 2025 to $3,786 in 2026 as enhanced premium tax credits expired, according to a new KFF analysis. After the enhanced tax credits ended, many Marketplace shoppers shifted toward lower-premium, higher-deductible plans.

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  • Does my student health plan have to cover birth control, and if not, what are my options?

    FAQs

    It depends on the type of coverage your college or university provides. “Fully-insured” plans are required to provide, without cost sharing, access to all FDA-approved birth control (“contraceptive”) methods, sterilization procedures, and patient education and counseling prescribed by a health care provider. If your student health plan is “self-insured,” coverage of birth control services depends on which state you live in. Check with your college or university to find out what type of student health…

  • I’m a young adult and I need health insurance. What are my coverage options?

    FAQs

    A number of options may be available to you: If your annual income is $21,597 or less in 2026 (138% federal poverty level for a single adult), you may qualify for Medicaid coverage. Not all states have elected to expand Medicaid eligibility to this income level. Check with a navigator or another type of assister using Find Local Help, or check with your state Marketplace to learn more about Medicaid eligibility in your state.  If…

  • I’m under 26 and eligible to be covered as a dependent under my mom’s job-based policy. Mom no longer claims me as a tax dependent – I file my own taxes, though my income isn’t very high. If subsidized...

    FAQs

    Yes. Although the general rule is that people are not eligible for Marketplace subsidies when they are also eligible for affordable job-based health coverage, a young adult is eligible for premium tax credits in the Marketplace as long as they are not claimed as a tax dependent by their parents. The availability of dependent coverage under your parents' health plan does not affect your eligibility for premium tax credits in the Marketplace.

  • I’m uninsured. Am I required to get health insurance?

    FAQs

    While there is no longer a federal tax penalty for being uninsured, some states (CA, MA, NJ, and RI) and DC have adopted individual mandates with state tax penalties for not having health insurance. One state (VT) also has an individual mandate but does not impose a tax penalty for not having coverage. Check with your tax advisor or state insurance department for more information. Regardless of the penalty, it is important to have health insurance if…

  • I notice Marketplace plans are labeled “Bronze,” “Silver,” “Gold,” and “Platinum.” What does that mean?

    FAQs

    Plans in the Marketplace are separated into categories — Bronze, Silver, Gold, or Platinum — based on the amount of cost sharing they require. Cost sharing refers to health plan deductibles, copays, and coinsurance. For most covered services, you will have to pay some of the cost, at least until you reach the annual out-of-pocket limit on cost sharing. Preventive health services, however, are covered without cost-sharing. In the Marketplace, Bronze plans have the highest…

  • How long after I enroll in a plan will coverage take effect?

    FAQs

    During Open Enrollment in HealthCare.gov and some other states, if you enroll in a private health insurance plan by December 15 and make your first premium payment by the due date specified by your plan, your new health coverage will start January 1. If you sign up after December 15, your coverage will begin on February 1. If you sign up for a Marketplace plan during a special enrollment period, your coverage will usually take…

  • Can I buy a plan in the Marketplace if I don’t have a green card?

    FAQs

    Potentially, yes. You must be a lawfully present immigrant who is eligible for coverage, such as a lawful permanent resident (green card holder), certain types of visa holders, or a refugee or asylee. Deferred Action for Childhood Arrivals (DACA) is no longer considered an eligible immigration status for health coverage through the Marketplaces. You can find more information about qualifying statuses here.   You can also shop for health insurance outside of the Marketplace in…

  • I’m eligible for health benefits at work, but want to see if I can get a better deal on the Marketplace. Can I do that?

    FAQs

    You can always shop for coverage on the Marketplace, assuming you meet other eligibility requirements, but if you have access to job-based coverage that is determined to be affordable (no more than 9.96% of your household income in 2026), you won’t qualify for premium tax credits. Browse more questions in the Employer-Sponsored Health Coverage and the Marketplace section.

  • Mi empleador ofrece beneficios de salud pero no contribuye mucho para la prima. No puedo pagar mi parte. ¿Puedo solicitar cobertura y subsidios en el mercado?

    FAQs

    Siempre puede comprar cobertura de salud en el mercado. Sin embargo, si le ofrecen beneficios de salud del empleador, no puede calificar para subsidios en el mercado a menos que su cobertura a través del empleador se considere inasequible. Si su parte de la prima para la cobertura en el plan de su empleador es del 9.96% o más de su ingreso familiar de 2026, se considera inasequible y puede solicitar créditos fiscales para las…