ACA Marketplace Enrollment Falls by 1.2 Million After Enhanced Credits Expire

Enrollment in Affordable Care Act marketplaces fell by 1.2 million people in 2026, the first decline in four years, after enhanced premium tax credits expired at the end of 2025. KFF released an analysis Tuesday estimating that 4.8 million to 5.8 million people could lose coverage this year.

The drop is concentrated among households just above the subsidy cliff, who accounted for 48 percent of the decline despite representing only 7 percent of 2025 enrollment.

Average monthly premium payments rose by 58 percent, or $65 on average. Marketplace plan selections fell in 41 states, with North Carolina, Ohio and Indiana recording the largest drops. Adults ages 18-34 showed the largest enrollment decrease. Analysts had expected younger adults to be most affected because they are less likely to have employer-sponsored coverage.

The Centers for

Medicare and Medicaid Services reported that it ended advance premium tax credit payments or coverage for nearly 1.5 million people in 2025 after identifying improper enrollments. The agency said the actions protected taxpayers and removed people found ineligible or enrolled without authorization.

Congress did not reach a deal to extend the enhanced credits before they expired. Enrollment had grown for four straight years while the credits were in place, with many plans offering $0 premiums.

“Overall, consumers with incomes known to be above the subsidy cliff made up just 7% of 2025 enrollment but nearly half (48%) of the decline in plan selections from 2025 to 2026." KFF said the actual share of consumers above the subsidy cliff may be higher because income data is unknown for about 1 million enrollees.”