ACA Marketplace Enrollment Now Projected To Fall By About 5 Million In 2026
KFF released an analysis on Tuesday, May 19, 2026, projecting ACA marketplace enrollment will drop from about 22.3 million in 2025 to roughly 17.5 million in 2026.[1]
KFF found the average annual deductible rose by more than $1,000 and the average monthly premium payment increased by about $65 for 2026 plans, with many people shifting to lower-tier, higher-deductible options.[1] Cynthia Cox of KFF says most of the roughly 5 million people leaving the marketplaces likely became uninsured rather than obtaining other coverage.[2]
On Jan. 1, 2026, enhanced COVID-era premium tax credits expired after a congressional deal to extend them collapsed, a change KFF links to the steep enrollment drop.[2] Many consumers were auto-renewed into 2025 plans that became substantially more expensive in 2026, and some are losing coverage mid-year when they can no longer afford monthly premiums.[1]
The Trump administration has said federal anti-fraud efforts explain much of the 2026 enrollment declines.[1] KFF's pricing-and-subsidy analysis challenges that account and notes insurers appear to have anticipated the enrollment and risk-shift effects, suggesting the 2026 changes may be a one-year shock.[2] KFF's projection represents a decline of more than 20 percent in marketplace enrollment from 2025 to 2026.[1]
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📌 Key Facts
- The KFF analysis, published on Tuesday, May 19, 2026 (Central), projects ACA marketplace enrollment will fall from about 22.3 million in 2025 to roughly 17.5 million in 2026 — a decline of nearly 5 million people (more than 20%).
- KFF attributes the sharp enrollment drop primarily to the Jan. 1, 2026 expiration of the enhanced premium tax credits after a congressional deal to extend them collapsed.
- Cynthia Cox of KFF says most of the roughly 5 million people leaving the marketplaces likely became uninsured rather than obtaining other coverage.
- KFF finds remaining enrollees are paying more: the average annual deductible rose by more than $1,000 and the average monthly premium payment increased by about $65 for 2026 plans, with many shifting into lower‑tier, higher‑deductible options.
- Cox says insurers appear to have anticipated enrollment and risk‑shift effects reasonably well, suggesting the 2026 changes may be a one‑year shock rather than the start of repeated large price corrections, pending 2027 rate filings.
- Many consumers were auto-renewed into 2025 plans that became substantially more expensive in 2026, and some are losing coverage mid‑year when they can no longer afford monthly premiums.
- Middle‑income enrollees, who earn too much for remaining low‑income subsidies but not enough to comfortably absorb higher premiums, are disproportionately dropping coverage in 2026, KFF finds.
- States that run their own ACA exchanges are retaining a higher share of enrollees than states that rely on the federal marketplace.
- The Trump administration has publicly maintained that federal anti‑fraud efforts are responsible for much of the 2026 enrollment drop; KFF's pricing‑ and subsidy‑focused analysis implicitly challenges that characterization.
📰 Source Timeline (3)
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- The KFF analysis, published around Tuesday, May 19, 2026, projects nationwide ACA marketplace enrollment will fall from 22.3 million in 2025 to about 17.5 million in 2026, a decline of nearly 5 million people and more than 20%.
- KFF finds the average enrollee's annual deductible has increased by more than $1,000 and the average monthly premium payment has risen by $65 for 2026 plans.
- KFF attributes much of the enrollment drop and cost jump to the Jan. 1, 2026 expiration of enhanced COVID-era premium subsidies that had helped the vast majority of marketplace enrollees.
- The report notes that many consumers were auto-renewed into 2025 plans that became substantially more expensive in 2026; some are losing coverage mid-year when they can no longer afford their monthly premiums.
- KFF reports that middle-income enrollees, who earn too much for remaining low-income subsidies but not enough to comfortably absorb higher premiums, are disproportionately dropping coverage in 2026.
- The analysis finds states running their own ACA exchanges are retaining a higher share of enrollees than states that rely on the federal marketplace.
- The Trump administration has publicly maintained that federal anti-fraud efforts are responsible for most of the 2026 enrollment drop-offs, a characterization KFF's pricing- and subsidy-focused analysis implicitly challenges.
- On May 19, 2026, KFF released an analysis projecting ACA marketplace enrollment will fall from about 22 million in 2025 to roughly 17 million in 2026, a decline of about 5 million people.
- KFF links the sharp enrollment drop primarily to the expiration of enhanced premium tax credits at the end of 2025, after a congressional deal to extend them collapsed.
- Cynthia Cox of KFF says most of the roughly 5 million people leaving the marketplaces likely became uninsured rather than obtaining other coverage.
- KFF finds that people who remained on ACA plans are paying more through higher premiums, higher deductibles, or both, and that many moved to lower-tier, higher-deductible plans.
- The report says deductibles for ACA marketplace plans rose by about $1,000 last year, the largest average increase KFF has recorded.
- Cox says insurers appear to have anticipated the enrollment and risk-shift effects relatively well, suggesting the 2026 changes may be a one-year shock rather than the start of repeated large price corrections, pending 2027 rate filings.