Up to 5 Million May Drop ACA Marketplace Coverage as Subsidies End
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An estimated 5 million people could drop their Affordable Care Act (ACA) marketplace health insurance this year following the expiration of enhanced federal subsidies. Enrollment already fell by about one million this year, and deductibles rose sharply. The projected decline is based on an analysis of federal and state data.
Facts First
- Up to 5 million people may drop ACA marketplace coverage this year, according to a KFF analysis.
- Enhanced premium tax credits expired at the end of last year after Congress failed to extend them.
- Marketplace enrollment is projected to fall from 22 million in 2025 to about 17 million in 2026.
- Deductibles rose by an average of $1,000 last year, a record increase.
- Approximately one million fewer people signed up for a plan this year compared to the previous year.
What Happened
A new analysis from the nonpartisan KFF projects that as many as 5 million people who buy health insurance on the Affordable Care Act (ACA) marketplaces may drop their coverage this year. This follows the expiration of enhanced premium tax credits at the end of last year and a drop in enrollment of about one million people for the current year. The analysis, which used data from the Centers for Medicare & Medicaid Services (CMS) and state marketplaces, projects total marketplace enrollment will decrease from 22 million in 2025 to approximately 17 million in 2026. The report also found that deductibles rose by an average of $1,000 last year, more than ever before.
Why this Matters to You
If you purchase your own health insurance through the ACA marketplace, your monthly premium is likely to be higher this year, and you may face a significantly larger deductible before your coverage begins. This could make it more difficult to afford necessary care or lead you to consider dropping your coverage altogether. For the broader insurance pool, a large-scale drop in enrollment could lead to further premium increases in the future, as the risk is spread across fewer people.
What's Next
The analysis suggests enrollment is likely to continue declining through 2026 unless policy changes are made. Congress attempted but failed to reach a compromise to extend the federal subsidies that kept premiums down, leaving the future of financial assistance uncertain. The projected trends may put pressure on lawmakers to revisit the issue of marketplace affordability.