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2026 ACA enrollment lags by 1.5M signups amid subsidy fight
ACA marketplace enrollment decreased for the first time since 2020, potentially due to lapsed premium subsidies.
Affordable Care Act marketplace enrollment is down for 2026, with the Centers for Medicare and Medicaid Services reporting that 22.8 million consumers have signed up for individual market health insurance coverage for this year.
That's down from the 23.6 million enrollees who purchased a plan on the ACA exchanges for 2025. Although CMS did not provide an explanation for the lower enrollment, it could be due to the lapse in advanced premium subsidies that caused a spike in marketplace plan prices.
Still, the 22.8 million enrollment figure for 2026 is the second-highest in exchange history. According to KFF, 2025 was a record-breaking year for ACA marketplace enrollment. In 2024, 21.4 million people had enrolled in a marketplace plan, while in 2023, that figure was 16.3 million.
This year's signups were mostly concentrated among individuals who'd already had ACA exchange plans before. Specifically, 20 million of the 2026 open enrollments were among people who had active coverage in 2025. This year saw only 2.8 million new signups.
Most of the plan signups this year happened on the federal marketplace, CMS said. Specifically, there were 15.6 million marketplace plan selections in the 30 states using the Healthcare.gov platform. In the 20 states that use state-based exchanges, there were 7.2 million signups.
Is this year's lower enrollment a signal of what's to come?
This year marks the first year since the pandemic that ACA open enrollment numbers aren't growing. In 2020, enrollment numbers were at 11.4 million and they saw modest growth in 2021 to 12 million.
But in 2022, those numbers surged to 14.5 million enrollments, due in large part to more plans being available on the marketplaces.
And, as noted above, enrollment continued growing in 2023 and 2024, reaching historic levels in 2025.
This growth in enrollment coincides with the introduction of enhanced premium subsidies passed as part of the American Rescue Plan Act of 2021. These subsidies helped offset the cost of marketplace premiums, making the plans accessible to more people.
Now, with the lapse of the subsidies and no solution in sight, the industry can expect a downswing in enrollment, as already observed in 2026.
Sara Heath has reported news related to patient engagement and health equity since 2015.
