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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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  • Faces of the Medicaid Expansion: How Obtaining Medicaid Coverage Impacts Low-Income Adults

    Report

    The Affordable Care Act (ACA) seeks to fill the longstanding gap in Medicaid coverage for low-income adults by expanding eligibility to a minimum floor of 138% of the federal poverty level (FPL), or $24,344 for a family of 3 in 2012. However, the Supreme Court ruling on the ACA effectively made implementation of the Medicaid expansion a state choice. If a state does not expand Medicaid, poor uninsured adults in that state will not gain…

  • Poll: Obamacare Is Not a Big Issue With Midterm Voters

    From Drew Altman

    In this column for The Wall Street Journal’s Think Tank, Drew Altman analyzes recent polling data on the Affordable Care Act and discusses why it will not be a significant factor in next week’s midterm election.

  • Explaining the 2015 Open Enrollment Period

    Issue Brief

    The brief provides an overview of what consumers can expect during the second annual Open Enrollment period under the Affordable Care Act (ACA), which runs from November 15, 2014 through February 15, 2015. It is the second opportunity for uninsured individuals to enroll in private insurance coverage, premium tax credits and cost sharing subsidies and the first time that people newly insured in 2014 can renew their health plan coverage and subsidies. It also overlaps…

  • The ACA’s Basic Health Program Option: Federal Requirements and State Trade-Offs

    Report

    The Patient Protection and Affordable Care Act (ACA) gives states the option to implement a Basic Health Program (BHP) that covers low-income residents through state-contracting plans outside the health insurance marketplace, rather than qualified health plans (QHPs). In March 2014, the Centers for Medicare & Medicaid Services (CMS) issued final regulations on the requirements for a BHP and the methodology for calculating federal payments to states. States can choose to implement BHP beginning in 2015.…

  • More Than Four in Ten Uninsured Don’t Know Basic Health Insurance Terms, Fewer Understand Complex Coverage Concepts

    News Release

    Kaiser Family Foundation Provides Consumer Resources to Fill Knowledge Gaps as the Second Open Enrollment Period Nears for the Affordable Care Act’s Marketplaces With open enrollment for the Affordable Care Act’s health insurance marketplaces days away, findings from a new Kaiser Family Foundation survey suggest that some people who stand to benefit from the law struggle to understand how coverage works. The survey finds more than four in 10 uninsured people could not correctly identify…

  • Change in Benchmark Silver Premiums, 2014 – 2015

    Feature

    Change in Benchmark Silver Premiums 2015 MAP_HI_and_MA.ppt Download Source Kaiser Family Foundation analysis of data from Healthcare.gov and insurer rate filings to state regulators. For more information see  “Analysis of 2015 Premium Changes in the Affordable Care Act’s Health Insurance Marketplaces” Sept. 2014.

  • Snapshots: Trends in Employer-Sponsored Health Insurance Offer Rates for Workers in Private Businesses

    Issue Brief

    Most Americans receive their health insurance through their own job or the job of a family member; an offer of coverage at work is an important determinant of the likelihood of having private health insurance. This analysis examines the percentage of nonelderly, full-time adult workers (age 18 through 64) in private firms who were offered health insurance at their current primary job and how that changed over the period from 1995 to 2005. The condition…

  • Snapshots: Comparison of Expenditures in Nongroup and Employer-Sponsored Insurance: 2004-2007

    Issue Brief

    Data from the insurance industry and reviews of premiums offered through on-line sellers show that premiums for nongroup health insurance are lower than premiums reported on national surveys for employer-sponsored health insurance (ESI).  This paper uses pooled data from the 2004 through 2007 Medical Expenditure Panel Survey to compare the insurance payments for and out-of-pocket payments by people with nongroup health insurance and people with ESI.  While premiums for non-group coverage are lower than ESI…

  • The Flip Side of Higher Premiums: Better Coverage

    Perspective

    Time Magazine's recent cover story on health care – "Bitter Pill" by Steven Brill – has focused attention on hospital prices, especially for people paying out of their own pockets. This is not a new issue, but certainly one that deserves attention. However, what has been lost in the ensuing commentary on high hospital prices is that Brill’s article is as much about inadequate insurance, which is the reason why the patients he writes about…

  • The Requirement to Buy Coverage Under the Affordable Care Act

    Other Post

    Note:  Congress eliminated the federal tax penalty for not having health insurance, effective January 1, 2019. Along with changes to the health insurance system that guarantee access to coverage to everyone regardless of pre-existing health conditions, the Affordable Care Act includes a requirement that many people be insured or pay a penalty. This simple flowchart illustrates how that requirement (sometimes known as an "individual mandate") works.     >>Download the PDF