ACA Marketplace Enrollment Projected to Fall by 5 Million in 2026

Enrollment in Affordable Care Act marketplaces is projected to fall by about 5 million people this year, according to a new analysis from KFF, the nonpartisan health research organization. The report estimates enrollment will decline from 22 million in 2025 to about 17 million in 2026.

About one million fewer people signed up for a plan this year compared to the year before, but the analysis projects further losses as some enrollees drop coverage.

A major reason for the projected drop is the expiration of enhanced premium tax credits at the end of last year. Congress did not reach a deal to extend the extra federal assistance that had kept premiums lower. "Costs went up and a lot of people dropped their plans," said Cynthia Cox, a co-author of the analysis and director of KFF's Program on the ACA.

The report analyzed data from the Centers for Medicare & Medicaid Services, state-based marketplaces, KFF survey data, and estimates from Wakely Consulting Group. Although much of the information is still preliminary, the analysis projects a sharp enrollment decline.

Those who kept their plans are paying more, either through higher premiums or higher deductibles or both, Cox said. Last fall, KFF projected that premiums were doubling on average. The new report found deductibles rose last year more than they ever had before, by an average of $1,000.

Most of the 5 million people dropping out of the marketplaces likely became uninsured, Cox said. People without coverage face higher costs when they need medical care and risk financial strain from major accidents or serious diagnoses.

Insurance companies appear to have anticipated the enrollment changes, Cox said. It is possible the current situation represents a one-year adjustment after the extra premium subsidies expired. Insurance companies will file their rates for next year soon, which will indicate whether costs will rise again or stabilize.