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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.

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.

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

    Fact Sheet

    This state report explains how the ACA expands coverage in Massachusetts, 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 Massachusetts are eligible for Medicaid or financial assistance in…

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

    Fact Sheet

    This state report explains how the ACA expands coverage in New Hampshire, 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 New Hampshire are eligible for Medicaid or financial…

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

    Fact Sheet

    This state report explains how the ACA expands coverage in North Carolina, 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 North Carolina are eligible for Medicaid or financial…

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

    Fact Sheet

    This state report explains how the ACA expands coverage in North Dakota, 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 North Dakota are eligible for Medicaid or financial…

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

    Fact Sheet

    This state report explains how the ACA expands coverage in Tennessee, 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 Tennessee are eligible for Medicaid or financial assistance in…

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

    Fact Sheet

    This state report explains how the ACA expands coverage in Vermont, 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 Vermont are eligible for Medicaid or financial assistance in…

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

    Fact Sheet

    This state report explains how the ACA expands coverage in Virginia, 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 Virginia are eligible for Medicaid or financial assistance in…

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

    Fact Sheet

    This state report explains how the ACA expands coverage in Wisconsin, 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 Wisconsin are eligible for Medicaid or financial assistance in…

  • An Introduction to Medicaid and CHIP Eligibility and Enrollment Performance Measures

    Issue Brief

    The Centers for Medicare & Medicaid Services (CMS) recently established 12 new Medicaid and CHIP eligibility and enrollment performance indicators for states to report beginning in October 2013. These indicators provide insight into the performance of new eligibility and enrollment policies established under the Affordable Care Act (ACA). In December 2013, CMS released initial reports for a subset of the indicators. This brief provides an overview of the new performance indicators; the initial data; and…

  • Coverage for Abortion Services and the ACA

    Issue Brief

    This issue brief, Coverage of Abortion Services and the Affordable Care Act (ACA), summarizes the major coverage provisions of the ACA that are relevant for women of reproductive age, reviews current federal and state policies on Medicaid and insurance coverage of abortion services as they relate to the ACA, and presents national and state estimates on the availability of abortion coverage for women who are newly eligible for Medicaid or private coverage through the Marketplaces…