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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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  • Where can I get help with my Marketplace application?

    FAQs

    All Marketplaces are required to offer "Navigator" programs to help consumers review their plan choices, complete their application, or apply for financial assistance. Navigators can also assist consumers applying for Medicaid or CHIP. Additionally, Navigators can help consumers with post-enrollment support, such as appealing Marketplace decisions. Navigators are paid by the Marketplace, not by health plans, and they must complete Marketplace training and be free from conflicts of interest. You may also be able to…

  • Tengo cerca de 60 años y me inscribí en un plan del mercado para tener cobertura de seguro de salud hasta que cumpla los requisitos para Medicare a los 65. ¿Qué sucede cuando me inscribo en Medicare?

    FAQs

    Cuando cumpla 65 años, debe inscribirse en Medicare y notificar a su plan del mercado que ahora califica para la cobertura de Medicare. Su cobertura del mercado no se cancelará automáticamente cuando cumpla 65 años y se registre en Medicare, pero si recibe subsidios para ayudarlo a pagar su prima del plan de mercado, su elegibilidad para estos créditos fiscales terminará cuando comience su parte A de Medicare (las personas con Medicare no son elegibles…

  • El año pasado recibí subsidios para las primas. Sin embargo, al final del año, mis ingresos totales resultaron ser inferiores al nivel mínimo de ingresos para acceder a los subsidios. ¿Tendré que devolv...

    FAQs

    No, no tendrá que reembolsar los subsidios para las primas al presentar su declaración de impuestos anticipada, siempre que estos se hayan autorizado y pagado durante al menos un mes del año. Existe una regla especial para proteger a las personas en su situación. En este caso, si el mercado determinó que sus ingresos estimados lo hacían elegible para los subsidios al momento de su inscripción, pero aunque posteriormente sus ingresos cayeran por debajo del…

  • Voy a ir a una universidad que ofrece planes de salud estudiantiles. ¿Puedo seguir teniendo cobertura bajo el plan de salud de mis padres como dependiente o tengo que tener la cobertura estudiantil?

    FAQs

    Puede permanecer en el plan familiar hasta que cumpla 26 años si sus padres tienen cobertura a través del empleador, o hasta el final del año en el que cumple 26 si tienen un plan del mercado de seguros. La elegibilidad para los beneficios de salud a través de su propio trabajo no lo vuelve "no elegible" para estar cubierto como dependiente en el plan de sus padres.

  • Getting the Most Bang for Our Health Reform Buck: Enrolling and Retaining Everyone Who’s Eligible

    Event Date:
    Event

    As Congress looks for ways to increase access to health care, existing programs such as Medicaid and the Children's Health Insurance Program are often overlooked. Yet enrolling those who are eligible for such programs is one of the easiest ways to expand coverage. This briefing, co-sponsored by Alliance for Health Reform and the Pharmaceutical Research and Manufacturers of America (PhRMA), looked at ways to streamline recruitment and enrollment, while exploring how expanding Medicaid and CHIP…

  • The Independent Payment Advisory Board: A New Approach to Controlling Medicare Spending

    Issue Brief

    In 2010, the Patient Protection and Affordable Care Act authorized the creation of the Independent Payment Advisory Board (IPAB) to help control the growth in Medicare costs. Beginning in 2014, IPAB will issue recommendations to lower Medicare costs in the event that spending exceeds targets established in the health care reform law. This brief explains how the Independent Payment Advisory Board will be structured, the process and timelines for IPAB to make recommendations to achieve…

  • The Role of Medicaid for Adults With Chronic Illnesses

    Fact Sheet

    This report and related fact sheets provide data on spending, utilization, and access to care among low-income nonelderly adult Medicaid beneficiaries with chronic illnesses. Four fact sheets provide detail for beneficiaries with diabetes, respiratory disease, cardiovascular disease, and behavioral health conditions The reports show that, despite relatively high prevalence of chronic conditions and, correspondingly, relatively high spending and utilization rates, Medicaid beneficiaries with chronic illness report better access to care than their uninsured counterparts, many…

  • Pulling it Together: When Premiums Go Up 39%

    Perspective

    Our group that works on health care cost issues just updated an analysis that sheds light on what’s really happening to people in the individual health insurance market, the issue Secretary Sebelius, a former Kansas insurance commissioner, and others have put in the spotlight by calling on Anthem and other insurance companies to account for their proposed high premium increases. The analysis shows that people buying health insurance on their own in the individual market…

  • Rate Review: Spotlight on State Efforts to Make Health Insurance More Affordable

    Other Post

    The Patient Protection and Affordable Care Act creates a new federal role to examine “unreasonable increases” in the premiums charged for certain individual and small group health plans. Under the health reform law, the U.S. Department of Health and Human Services (HHS) will work with state insurance departments to conduct an annual review of unreasonable rate increases, and insurers must provide justification for such increases to HHS and to the public via their websites. The…