ACA Enrollment Statistics 2026 show that 23.1 million people selected marketplace coverage during open enrollment, down roughly 5% from 2025’s record 24.3 million, while average premium payments net of subsidies rose 58% to $178 a month. Effectuated enrollment is falling further through the year as enhanced subsidies expired and premium verification rules pushed many consumers out of coverage.
ACA Enrollment in America 2026
ACA Enrollment track how many Americans signed up for Affordable Care Act marketplace coverage after Congress let the enhanced premium tax credits expire at the end of 2025. Those enhanced subsidies, first enacted in 2021, had capped premium payments at a percentage of income and helped push marketplace enrollment to an all-time high of 24.3 million people in 2025. Without that extension, insurers raised pre-subsidy premiums by a weighted average of more than 23% nationwide, and the combination of higher sticker prices and reduced subsidy value reshaped who signed up and who walked away.
The result is the sharpest single-year enrollment drop since the ACA marketplaces launched. The Centers for Medicare & Medicaid Services reported 23.1 million plan selections at the close of the 2026 open enrollment period, a decline of roughly 1.2 million people from the prior year. That headline number only tells part of the story. A separate effectuated-enrollment count, the figure that reflects people who actually paid their first premium and stayed covered, is running well below the open-enrollment total, and independent researchers expect it to fall further as the year continues.
Interesting Facts About ACA Enrollment in 2026
| Fact | Detail |
|---|---|
| Open enrollment plan selections (2026) | 23.1 million |
| 2025 record enrollment | 24.3 million |
| Year-over-year change | Down approximately 5% |
| Average monthly premium payment (net of credits) | $178, up from $113 in 2025 |
| Average premium increase net of credits | 58% |
| Share of enrollees receiving premium tax credits | 87% in 2026, down from 92% in 2025 |
| New enrollees in 2026 | 3.6 million, down 500,000 from 2025 |
| Auto-reenrolled consumers | 8.8 million |
| Effectuated enrollment (February 2026, HHS) | 19.2 million |
| KFF full-year 2026 projection | As low as 16.5 to 17.5 million |
Data source: Centers for Medicare & Medicaid Services; HHS Office of the Assistant Secretary for Planning and Evaluation; KFF.
These numbers come from three different vantage points on the same enrollment season, and reading them together avoids the most common mistake in coverage of this topic. CMS reports plan selections at the close of open enrollment, HHS reports effectuated enrollment once someone has paid, and KFF projects where the number lands by December once nonpayment and mid-year drop-off are factored in. All three point the same direction: down from 2025, with the size of the drop depending on how far into the payment and retention process you measure.
The gap between the 23.1 million open-enrollment figure and the 19.2 million February effectuated count is not a data error. It reflects real behavior: people select a plan in December or January, then some fail to pay their first premium, get dropped for eligibility issues under tighter verification rules, or find the new price unaffordable once the bill arrives. That gap is exactly why ACA Enrollment Statistics 2026 need more than one number to describe accurately.
Journalists and policy staffers who quote a single enrollment figure without specifying which stage of the process it measures tend to produce numbers that don’t match each other from one outlet to the next. A headline citing 23.1 million and another citing 19.2 million are both correct, they are just measuring different points in the same funnel. Anyone building a model, a budget projection, or a comparison against prior years should specify plan selections, effectuated enrollment, or a year-end projection every time a figure gets cited, since mixing them produces misleading year-over-year comparisons.
Marketplace enrollment counts, 2025 vs 2026 (millions)
2025 Record Total |████████████████████████████████████ 24.3
2026 Plan Selections |████████████████████████████████ 23.1
2026 Effectuated (Feb)|██████████████████████████ 19.2
2026 KFF Year-End Est.|███████████████████████ 17.5
ACA Enrollment Statistics 2026: Total Enrollees and Year-Over-Year Change
| Metric | 2025 | 2026 | Change |
|---|---|---|---|
| Open enrollment plan selections | 24.3 million | 23.1 million | -4.9% |
| Record status | All-time high | Sharpest single-year drop on record | — |
| Enrollment growth 2021–2025 | +12.9 million cumulative | N/A | Enhanced subsidy era |
| Effectuated enrollment (year-end 2025) | 22.1 million | Falling through the year | Declining |
Data source: Centers for Medicare & Medicaid Services 2026 Open Enrollment Report.
The 23.1 million figure represents the number of people who actively chose or were automatically placed into a marketplace plan by the close of the enrollment window, and it stands as the sharpest single-year decline in raw enrollment since the marketplaces opened. Enrollment had climbed for five straight years, growing by nearly 13 million people between 2021 and 2025 as the enhanced tax credits made coverage cheaper for households at every income level, including those earning above 400% of the federal poverty line who previously faced no premium cap at all.
That growth reversed the moment Congress let the credits lapse. The 2025 total of 24.3 million was never going to hold once premium payments net of subsidy jumped by double digits for most households, and the 2026 open-enrollment period confirms that reversal in the topline count. What the plan-selection number does not capture is payment behavior, which is why the effectuated figures later in this report tell a more complete story about actual coverage.
State-run marketplaces and Healthcare.gov states did not experience the decline evenly. States that operate their own exchanges generally offer extended enrollment windows and additional state-funded subsidy top-ups, which cushioned some of the national premium shock for their residents. States relying entirely on Healthcare.gov, by contrast, saw sign-ups track more closely with the federal subsidy cliff, since those consumers had no secondary safety net once the enhanced federal credits expired. That state-level split is a detail worth tracking separately from the national 23.1 million headline number, since it shapes how insurers price plans for the following year in each market.
Obamacare Premiums 2026: How Much Costs Rose This Year
Average monthly premium payment, net of tax credits
2025 |███████████████████ $113
2026 |██████████████████████████████ $178
| Premium Metric | 2025 | 2026 |
|---|---|---|
| Average monthly payment, net of credits | $113 | $178 |
| Increase, net of credits | — | 58% |
| Initial KFF projection if plans stayed the same | — | 114% increase |
| Weighted average pre-subsidy premium increase | — | 23%+ |
| Share choosing lower-premium bronze plans | Lower share | Higher share |
Data source: KFF analysis of Marketplace Open Enrollment Period public use files.
ACA Enrollment Statistics 2026 show premiums rose sharply, but not as sharply as first projected. KFF initially estimated that average payments net of subsidy would jump 114% if every enrollee kept the exact same plan they had in 2025. The actual increase came in lower, at 58%, because a meaningful share of consumers responded to the higher prices by switching to bronze-tier plans, which carry lower monthly premiums and higher deductibles. That behavioral shift softened the topline premium shock but pushed more households into plans with thinner coverage.
Insurers also raised list prices independent of the subsidy change, with pre-subsidy premiums up by a weighted average of more than 23% nationwide. That increase hits hardest for the group of enrollees who lost tax-credit eligibility entirely once the enhanced subsidies expired, since they now pay the full sticker price with no cap tied to income. Those consumers, concentrated above 400% of the federal poverty line, appear to have left the marketplace at a disproportionately high rate compared to subsidized enrollees.
For context on how healthcare cost pressure is showing up elsewhere in household budgets, the pattern lines up with what medical debt trends in the US have shown as out-of-pocket costs climb across insurance types, not just marketplace plans.
ACA Subsidies 2026: What Changed When Enhanced Tax Credits Expired
Share of enrollees receiving a premium tax credit
2025 |██████████████████████████████████ 92%
2026 |█████████████████████████████ 87%
| Subsidy Metric | 2025 | 2026 |
|---|---|---|
| Share receiving premium tax credits | 92% | 87% |
| Direction of change | — | First decline since 2020 |
| Enhanced subsidy status | Active | Expired end of 2025 |
| Original enhanced-subsidy enactment | 2021 | N/A |
| Prior cap for incomes above 400% FPL | 8.5% of income | Cap removed |
Data source: KFF analysis of CMS Marketplace Open Enrollment public use files.
The expiration of the enhanced premium tax credits is the single biggest driver behind this year’s ACA Enrollment Statistics 2026. Those credits, first enacted in 2021, had capped the benchmark silver-plan premium at 8.5% of household income for people earning above 400% of the federal poverty level, a group that previously received no assistance at all under the original 2010 ACA formula. When Congress did not renew the enhancement, that cap disappeared, and the share of marketplace enrollees receiving any tax credit fell from 92% to 87%, the first year-over-year decline in subsidy uptake since 2020.
An 87% subsidy rate still means the overwhelming majority of enrollees get some financial help, but the value of that help shrank for nearly everyone still eligible, since the enhancement itself is what made credits larger across every income tier. Households who previously paid nothing for a benchmark plan under a $0-premium scenario are among those most exposed to the $5 minimum monthly premium provision introduced under a 2025 marketplace integrity rule, a policy detail covered in more depth in this related breakdown of ACA marketplace.
New vs Returning Enrollees 2026: Auto-Reenrollment and New Sign-Ups
2026 enrollee composition (millions)
Auto-reenrolled |████████████████████████████ 8.8
Active reenroll |████████████████████████████████ 10.7
New enrollees |██████████ 3.6
| Enrollee Type | Count (2026) | Year-Over-Year Change |
|---|---|---|
| Auto-reenrolled | 8.8 million | Highest in state-run marketplace states |
| Actively reenrolled | 10.7 million | Chose a plan directly |
| New to the marketplace | 3.6 million | Down 500,000 from 2025 |
| Total plan selections | 23.1 million | Down 4.9% overall |
Data source: Centers for Medicare & Medicaid Services 2026 Open Enrollment data files.
Auto-reenrollment carries real risk this year because it can mask affordability problems until the premium bill actually arrives. Roughly 8.8 million people were rolled into a 2026 plan automatically, and that share runs highest in states that operate their own marketplace rather than relying on Healthcare.gov, since those states tend to have higher baseline retention infrastructure. The trouble is that auto-reenrollment does not require the consumer to confirm they can still afford the new premium, which helps explain why a meaningful share of auto-reenrolled consumers later fail to pay and drop out.
New enrollment, meanwhile, fell by 500,000 compared to 2025, landing at 3.6 million first-time sign-ups. That decline matters because new enrollees tend to skew younger and healthier than the returning population, and a shrinking new-enrollee pool worsens the overall risk mix in the marketplace risk pool. Fewer young, healthy new sign-ups combined with older, sicker enrollees staying put is the exact dynamic insurers point to when justifying further premium increases in future plan years.
Who Is Losing Coverage in 2026: Age, Income and State Breakdown
Share of the enrollment decline by age group
Ages 18-34 |█████████████████████████████ 46%
All other ages |█████████████████████████████████████ 54%
| Demographic Detail | 2026 Data |
|---|---|
| Total open-enrollment decline | 1.2 million people |
| Share of decline aged 18–34 | 46% (about 542,000 people) |
| Enrollees reporting higher costs (KFF survey) | 80% of returning enrollees |
| Enrollees who switched plans | About 30% |
| Enrollees who became uninsured | About 10% |
| Group most likely to have left entirely | Enrollees above 400% FPL who lost tax-credit eligibility |
Data source: KFF March 2026 marketplace enrollee survey; Commonwealth Fund analysis.
Younger adults account for nearly half of this year’s entire enrollment decline. Out of the 1.2 million-person drop in open-enrollment sign-ups, 542,000, or 46%, were people between the ages of 18 and 34. That concentration among younger enrollees is the demographic detail insurers and policy analysts watch most closely, because losing healthier, lower-cost enrollees while sicker, higher-cost enrollees stay in the pool tends to push premiums even higher in the following plan year, creating a self-reinforcing cycle.
A follow-up KFF survey conducted in March found that 80% of returning marketplace enrollees reported higher premiums, deductibles, or coinsurance on their 2026 plan compared to 2025. About 30% responded by switching to a different marketplace plan, typically trading a richer benefit design for a lower monthly premium, while roughly 1 in 10 returning enrollees ended up uninsured entirely. For a broader look at how these coverage gaps compare across the population, see this related data on Americans without health insurance, which tracks uninsured trends outside the marketplace-specific numbers covered here.
Effectuated Enrollment 2026: How Many Are Actually Paying and Staying Covered
Effectuated enrollment trajectory (millions)
End of 2025 |████████████████████████████████ 22.1
Feb 2026 |███████████████████████████ 19.2
KFF year-end |███████████████████████ 17.5
| Effectuated Metric | Figure |
|---|---|
| Effectuated enrollment, end of 2025 | 22.1 million |
| Effectuated enrollment, February 2026 | 19.2 million |
| Improper enrollments, 2025 | 5.6 million |
| Improper enrollments, 2026 | 2.6 million |
| Consumers who did not pay January premium (Wakely est.) | 14% |
| KFF year-end 2026 projection range | 16.5 to 17.5 million |
Data source: HHS Office of the Assistant Secretary for Planning and Evaluation; Wakely Consulting Group.
Effectuated enrollment, the count of people who actually paid their premium and remain covered, tells a starker story than the open-enrollment headline. HHS reported 19.2 million Americans enrolled in ACA exchange plans as of February 2026, down from 22.1 million at the end of 2025. The administration attributes most of that decline to stronger subsidy-verification efforts rather than falling demand, pointing to a drop in improper enrollments from 5.6 million in 2025 to 2.6 million in 2026 under a 2025 marketplace integrity rule that tightened eligibility checks and added a minimum $5 monthly premium pending confirmation of $0-premium eligibility.
Independent researchers expect the number to keep falling through the year. Wakely Consulting Group estimated that about 14% of enrollees did not pay their first premium in January, and KFF projects effectuated enrollment could settle between 16.5 million and 17.5 million by December, a drop of up to 21.5% from 2025 levels. Part of that integrity rule has already hit legal turbulence: a federal court ruling this year vacated several of its provisions pending appeal, which adds further uncertainty to where the final 2026 effectuated total lands.
Frequently Asked Questions
How Many People Enrolled in ACA Marketplace Plans in 2026?
23.1 million people selected a marketplace plan during the 2026 open enrollment period, down from the 2025 record of 24.3 million. Effectuated enrollment, which counts people who actually paid and kept coverage, was lower, at 19.2 million as of February.
Why Did ACA Enrollment Drop in 2026?
Enrollment fell mainly because Congress did not extend the enhanced premium tax credits that expired at the end of 2025. Average premium payments net of subsidy rose 58%, and tighter subsidy-verification rules also removed a share of previously improper enrollments.
How Much Did Obamacare Premiums Increase in 2026?
Average monthly premium payments net of tax credits rose from $113 in 2025 to $178 in 2026, a 58% increase. Pre-subsidy list prices from insurers rose by a weighted average of more than 23% nationwide.
Did ACA Subsidies Go Away in 2026?
The original ACA subsidies are still in place, but the enhanced subsidies added in 2021 expired at the end of 2025. That change removed the income cap for people earning above 400% of the federal poverty level and reduced credit value for most other enrollees.
How Many New People Signed Up for the ACA in 2026?
3.6 million people enrolled in a marketplace plan for the first time in 2026, a decline of 500,000 from the prior year.
What Percentage of ACA Enrollees Receive a Subsidy in 2026?
87% of 2026 marketplace enrollees receive some form of premium tax credit, down from 92% in 2025.
Will ACA Enrollment Keep Falling Through 2026?
Most analysts expect it to. KFF projects effectuated enrollment could fall to between 16.5 million and 17.5 million by the end of 2026 as unpaid premiums and affordability pressure continue to push people out of coverage.
Which Age Group Lost the Most ACA Coverage in 2026?
Adults aged 18 to 34 accounted for 46% of the entire enrollment decline, roughly 542,000 people, raising concerns about a less healthy overall risk pool for insurers.
Disclaimer: The data research report we present here is based on information found from various sources. We are not liable for any financial loss, errors, or damages of any kind that may result from the use of the information herein. We acknowledge that though we try to report accurately, we cannot verify the absolute facts of everything that has been represented.
