ACA Marketplace Enrollment Falls as Enhanced Subsidies Expire

Enrollment in Affordable Care Act marketplace plans fell to 17.5 million this year from more than 22 million in 2025 after enhanced federal subsidies expired. During the 2026 open enrollment period, sign-ups and renewals declined by about one million. Officials estimate an additional four million people will lose coverage as enrollees stop paying higher premiums.

Enhanced premium tax credits that had covered costs above 8.5 percent of income for people above 400 percent of the federal poverty line ended at the start of 2026. Individuals and families above that threshold now pay the full price of their plans.

Income caps for premium tax credits also rose slightly for people between 100-138 percent and 400 percent of the federal poverty line. Insurance premiums themselves increased due to inflation, adding hundreds to thousands of dollars in annual costs for many enrollees.

Enrollment fell more than 20 percent in South Carolina and between 15 and 20 percent in Ohio, Indiana, West Virginia, Oklahoma, Oregon, and Arizona. The number of enrollees with incomes between 400 and 500 percent of the federal poverty line dropped 44 percent, while those above 500 percent fell 27 percent.

Some states reported enrollment gains. Texas saw a 5 percent increase, while Massachusetts and Connecticut each rose 4 percent. One state legislature allocated $40 million to offset the loss of federal subsidies. Employer-sponsored insurance costs are also rising, with one analysis projecting a nearly 7 percent increase this year linked in part to higher use of certain medications.