ACA Marketplace Enrollment Falls 13% as Subsidies Lapse

ACA Marketplace Enrollment Drops by 3 million to 19.2M After Premium Tax Credits Expire 

Washington, D.C., United States — June 30, 2026 — New federal data show that U.S. Affordable Care Act (ACA) Marketplace enrollment fell 13% in 2026 after enhanced premium tax credits expired at the start of the year, reducing effectuated enrollment from a record 22.1 million people in 2025 to 19.2 million in February 2026. The decline matters because the ACA Marketplaces serve as a coverage option of last resort for individuals without affordable employer plans who are ineligible for Medicare or Medicaid. 

Main Development 

The figures, drawn from a Health and Human Services (HHS) report on 2026 effectuated enrollment, represent the first decline in ACA Marketplace enrollment since the first Trump administration, following several years of record growth tied to the enhanced tax credits. The credits, which capped premium payments and extended assistance to enrollees with incomes above four times the poverty level, expired after 2025. 

Their expiration left enrollees facing an average premium payment increase of 114% to retain the same plan. Many shifted to bronze plans with higher deductibles; the net result was a 58% rise in premium payments and a 37% increase in deductibles, equivalent to more than $1,000 per person. 

Effectuated enrollment, which accounts for whether members actually paid their premiums, captured a steeper coverage loss than earlier signup data, which had shown only a 5% decline. Most returning enrollees had until March 31, 2026, to complete payments before coverage was retroactively terminated. 

Key Highlights: 

• Effectuated ACA Marketplace enrollment fell 13%, from 22.1 million in 2025 to 19.2 million in February 2026. 

• The average premium payment increase to keep the same plan reached 114% after enhanced tax credits expired. 

• Net premium payments rose 58% and deductibles increased 37%, exceeding $1,000 per person. 

• A KFF survey found 73% of returning enrollees worried about affording emergency or hospital care, while enrollment could erode further to about 17.5 million by year-end. 

Analyst Insight: 

NMSC analysts note that affordability pressures of this scale could reshape demand patterns across the broader Health Insurance Market, is projected to reach USD 3,974 billion by 2030, growing at a CAGR of 7.0%. Analysts at Next Move Strategy Consulting observe that rising premiums—identified in the report as a key market restraint—may accelerate consumer migration toward lower-cost coverage tiers and digital, AI-enabled distribution channels. 

Industry Outlook: 

With enhanced subsidies no longer in place, enrollment may continue to soften through 2026, and insurers participating in the Marketplaces are likely to recalibrate plan design, pricing, and risk-pool assumptions. The trajectory of future policy decisions in Washington will remain a central variable for both enrollment stability and insurer profitability. 

Source: KFF

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Prepared By: Sanyukta Deb