Affordable Care Act

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

Promotional image for KFF video How Affordable is the Affordable Care Act

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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  • ¿Hay alguna razón por la que el mercado no ajustaría y continuaría automáticamente mi subsidio para la prima al momento de la renovación?

    FAQs

    Si vive en un estado que utiliza cuidadodesalud.gov , cuando solicitó cobertura por primera vez, tuvo la oportunidad de autorizar al mercado a consultar sus datos de ingresos en línea, incluyendo sus declaraciones de impuestos, durante 1 a 5 años. Si no lo autorizó, su asistencia financiera NO se renovará automáticamente para el próximo año, y debe volver a aplicar. Si vive en un estado que opera su propio mercado de seguros, el proceso para…

  • I don’t have a checking account. Can the insurance company require that I get one and pay my premiums through automatic monthly withdrawals?

    FAQs

    No. Insurers offering coverage in the Marketplace are required to provide a variety of payment methods and cannot require a consumer to pay by automatic bank withdrawals (sometimes called electronic funds transfers, or EFT) or debit card. Federal rules require the insurer to also accept paper checks, cashier’s checks, money orders, and general-purpose pre-paid debit cards. These methods must be available to consumers for both the initial premium payment (at enrollment) and ongoing payments.

  • No sé cuánto tiempo hace que terminó mi Medicaid. ¿Hay una fecha límite para solicitar la cobertura del mercado?

    FAQs

    Sí, el período especial de inscripción por pérdida de Medicaid o CHIP es de 90 días en la mayoría de los estados. Esto significa que los consumidores tendrán hasta 90 días después de la pérdida de Medicaid o CHIP para inscribirse en el mercado de seguros. Si no solicita la cobertura del mercado dentro de este plazo, podría tener que esperar hasta el próximo período de inscripción abierta para hacerlo. Los estados que administran sus…

  • A Tale of Two Siblings, the ACA, and the Supreme Court

    From Drew Altman

    In a column published on The Huffington Post, Kaiser Family Foundation President and CEO Drew Altman shows how the U.S. Supreme Court’s decision to make the ACA Medicaid expansion a state option has upended the health insurance system for low and moderate income people in many states and discusses how the states and federal government can address the problem.

  • The Health-Cost Problem Is Coming Back

    From Drew Altman

    Drew Altman, in The Wall Street Journal’s Think Tank, discusses how the conversation will soon shift back to health-care costs from health coverage, because they are rising more sharply again. And as the discussion turns back, he says that because there is no national agreement on a strategy to address increasing costs, current efforts in the public and private sector, however fragmented and uncoordinated, will need to step up their game.

  • Report Provides Insights from Consumer Assisters on Improving Affordable Care Act’s Next Open Enrollment

    News Release

    A new report from the Kaiser Family Foundation and Robert Wood Johnson Foundation captures insights from those who helped consumers navigate the Affordable Care Act's first open enrollment period, including lessons for the second , which is set to start Nov. 15. “Taking Stock and Taking Steps: A Report from the Field after the First Year of Marketplace Consumer Assistance Under the ACA” draws on the experiences of 80 program leaders who participated in a…

  • Nine in Ten Uninsured Unaware that the Affordable Care Act’s Second Open Enrollment Period Starts in November

    News Release

    Most of Those Without Health Coverage Report Knowing Little or Nothing About the Insurance Marketplaces or About the Financial Assistance Available to Low- and Moderate-Income Families Broader Public Opinion on the Law Still Tilts Unfavorably, Though Gap Has Narrowed Since July and Returned to Pre-Rollout Levels With the second annual open enrollment period under the Affordable Care Act set to begin Nov. 15, the latest Kaiser Family Foundation tracking poll finds major gaps in the…

  • How Will the Uninsured in Georgia Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Georgia, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Georgia are eligible for Medicaid or financial assistance in…

  • How Will the Uninsured in Maryland Fare Under the Affordable Care Act?

    Fact Sheet

    This state report explains how the ACA expands coverage in Maryland, including a breakdown of how many uninsured people are eligible for Medicaid, how many are eligible for financial assistance to help them buy private insurance in the new Marketplace and how many will not receive any financial assistance at all. The report also details, in specific dollar figures, the income levels at which people in Maryland are eligible for Medicaid or financial assistance in…