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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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  • El seguro de salud, explicado: ¡los YouToons lo tienen cubierto!

    Video

    El seguro de salud, explicado: ¡los YouToons lo tienen cubierto! desglosa conceptos de seguros como primas, deducibles y redes de proveedores.  Explica cómo las personas pagan por su cobertura y cómo obtener cuidado médico y medicamentos recetados con distintos tipos de seguros de salud, incluyendo HMOs y PPOs.

  • Proposed Medicaid Expansion in Utah

    Fact Sheet

    This fact sheet provides a summary of the proposal to expand Medicaid in Utah. This has not been officially submitted to CMS and needs state legislative approval before it could be implemented.

  • Assessing Americans’ Familiarity With Health Insurance Terms and Concepts

    Poll Finding

    With the approaching launch of the second open enrollment period for the Affordable Care Act’s (ACA) health insurance marketplaces and at a time when open enrollment is also happening for many job-based plans, the Kaiser Family Foundation conducted a nationally representative survey of 1,292 U.S. adults to shed light on Americans’ understanding of basic health insurance terms and concepts, and to identify gaps in awareness that could lead to difficulties for some individuals as they…

  • Health Care Use and Chronic Conditions Among Childless Adult Medicaid Enrollees in Arizona

    Issue Brief

    Under the Affordable Care Act (ACA), beginning in 2014, Medicaid eligibility will expand to 133% of the federal poverty level for nearly all individuals. Arizona is one of the few states that already cover adults without dependent children in Medicaid through a longstanding Section 1115 waiver. This report, based on 2007 Medicaid claims data for adult Medicaid enrollees in Arizona, provides an analysis of health care utilization and health conditions for childless adults and compares…

  • Oral Health in the U.S.: Key Facts

    Fact Sheet

    This fact sheet provides data on oral health care coverage and access for children, nonelderly adults and Medicaid beneficiaries, including state-by-state data on measures such as the share of adults who have had a dental visit within the past year. Fact Sheet (.pdf)

  • Health Care and the Middle Class: More Costs and Less Coverage

    Report

    This analysis paper examines the availability, affordability and stability of the health insurance coverage of the American middle class, defined as those with incomes of $44,000 to $88,000 for a family of four. It also addresses the growing burden of health care costs for the middle class, the adequacy of today's health insurance plans to protect them from large medical bills, and the difference both make as individuals and families make health care decisions for…

  • Research Brief: Insurance Coverage and Access to Care in Primary Care Shortage Areas

    Issue Brief

    As both federal and state governments gear up to implement the Patient Protection and Affordable Care Act (ACA), concerns about the supply and distribution of physicians, particularly primary care physicians, are being raised. In many areas of the country, there is a shortage of primary care physicians, and some worry about whether the current workforce can meet the growing demand for services that will likely accompany coverage expansions. To inform provider workforce issues related to…

  • I entered the U.S. lawfully and I’m over 65, but I don’t qualify for Medicare. Can I apply for coverage and subsidies in the Marketplace? Will my premium be higher because I’m over age 65?

    FAQs

    You can currently purchase Marketplace coverage and qualify for subsidies depending on your income. Deferred Action for Childhood Arrivals (DACA) recipients are no longer eligible for health coverage through the Marketplaces, and starting in 2027, certain other lawfully present immigrants will no longer be eligible for subsidized Marketplace coverage. Premiums for Marketplace plans can vary by age unless states decide otherwise. In most states, your premium (before taking into account tax credits) could be up…

  • What happens if I just make up an income level that I know will qualify me for financial assistance?

    FAQs

    That’s not advisable. The Marketplace will check the information you provide against a number of databases (including IRS data, Social Security data, wage databases, and others). If the information you provide is very different from what’s in these databases, you may be asked to provide additional documentation. In addition, at the end of the Application for Health Coverage and Help Paying Costs, you will have to sign that you have provided true answers to all…