Affordable Care Act

The ACA MarketplaceS

What We Know about Trump’s $500 ACA Checks and the User Fees Funding Them

This analysis examines the $500 checks that the Trump administration is sending to some Affordable Care Act Marketplace enrollees and the user fees that are paying for them. The checks are going to about 1 million enrollees in the 30 states that rely on the federal HealthCare.gov Marketplace who are not receiving any tax credits this year.

Individual Market Enrollment Declined by 18% Since June 2025

Individual Market Enrollment Fell 18%, Suggesting Continued ACA Marketplace Losses

Enrollment in the individual health insurance market fell by 18%—over 4.6 million people—from 25.2 million in June 2025 to 20.5 million in June 2026. Falling individual market enrollment suggests further decline in ACA Marketplace enrollment this year, since Marketplace enrollees represent the vast majority of individual market coverage. The enrollment decline coincides with the expiration of the enhanced premium tax credits and other policy changes that are expected to reduce enrollment.

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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  • What happens if I’m late with a monthly health insurance premium payment?

    FAQs

    It depends on whether you are receiving advanced premium tax credits. If you receive a premium tax credit, your insurer must provide a 90-day grace period to pay all past-due premiums. If the amount owed for all outstanding premium payments is not paid in full by the end of the grace period, the insurer can terminate coverage. However, the grace period only applies if you have paid at least one month’s premium within the current…

  • Can I pay my health insurance premium with a credit card, debit card, money order, or cash?

    FAQs

    All insurers in the Marketplace are required to accept money orders, checks, pre-paid debit cards, and electronic funds transfers (EFT), which are digital direct deposits. Some states may also require insurers to accept credit card or debit card payments. Many insurers in other states accept debit and credit cards even though they are not federally required to.

  • I am a recent immigrant, and 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.

  • I want to enroll in a Marketplace family plan to cover myself, my spouse, and our children. How will my family premium be calculated?

    FAQs

    Family premiums will reflect the composition of family members; in most states, this includes their ages and any tobacco use. To calculate a “family premium,” insurers will add together a separate premium for each adult age 21 and older. Insurers can charge a separate premium for up to three children under age 21. For example, if you have four children under age 21, your family premium will reflect two adult premiums and only three child…

  • Can I be charged more because of my age?

    FAQs

    Yes, in most states, you can be charged more based on your age, but within certain limits. For example, older adults in their sixties can be charged up to three times more than younger adults (e.g., in their early twenties). Some states have established lower limits or a complete prohibition on “age rating,” a federal policy that applies to all individual health insurance plans and those offered by fully-insured small employers, whether sold on or…

  • 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 can I compare covered benefits in different Marketplace plans?

    FAQs

    Although all Marketplace health plans are required to cover the ten categories of essential health benefits, insurers in many states have flexibility to modify coverage for some of the specific services within each category, subject to approval by their Marketplace. All health plans must provide consumers with a Summary of Benefits and Coverage (SBC) to make it easier to compare differences in health plan benefits and cost sharing. It is also available for each plan…

  • My child goes to college in another state, but we want him on our Marketplace family plan. Can we do that?

    FAQs

    Yes. Your child can join your Marketplace family plan, even if they live out of state. However, your child may need to return home to access care within your plan’s provider network. If they get health care services in another state, the provider may be outside your plan’s network, and you may have to pay higher cost sharing for non-emergency services. Your child may be eligible to buy coverage in the state where they attend…

  • 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…