ACA Marketplace deductibles increased by over $1K: KFF

Marketplace enrollment plummets

However, many ACA Marketplace consumers are struggling to afford healthcare insurance without premium assistance. The enhanced premium tax credits had boosted subsidies for Marketplace consumers since 2021 by expanding eligibility to middle- and even some upper-income Americans.

The enhanced premium tax credits were a central issue in government funding fights over the past year. However, Congress allowed the temporary assistance to expire at the end of 2025, although lawmakers continue to push for a multi-year extension.

Now, about 87% of ACA Marketplace enrollees receive premium tax credits, down from 92% of enrollees in 2025.

The expiration has also affected ACA Marketplace enrollment, with KFF reporting a 23.1 million drop in plan sign-ups during the 2026 Open Enrollment Period. This was the sharpest single-year drop in enrollment ever, they said.

More losses are also likely, since the data did not account for enrollees who were automatically renewed. Some of these people will not pay their premiums, KFF explained, leading to mid-year attrition.

Already, fewer people paid their first month's premium, according to Wakely Consulting Group, which collaborated with KFF. They found that about 86% of people in the individual market paid in January 2026, down from over 90% in 2025. Although there was significant variation across states.

Wakely estimates that average effectuated enrollment in the individual market will decline by 17% to 26% through 2026.

How the expiration of enhanced subsidies affects enrollment

The numbers are not wholly unexpected, though. The Congressional Budget Office projected about a 25% decline in ACA Marketplace enrollment following the expiration of the enhanced premium tax credits.

More ACA Marketplace enrollees making over 400% of the federal poverty line are dropping coverage, the data indicated. These people were previously eligible for premium assistance, with payments for a benchmark silver plan capped at 8.5% of their income.

These enrollees accounted for only 7% of 2025 enrollment but nearly half of the decline in plan selections this year, KFF stated.

Lower-income consumers who still receive premium assistance also accounted for a large share of the enrollment decline. Sign-ups for those with incomes below 150% FPL dropped by about 4% compared to last year, while those with incomes between 150% and 250% FPL accounted for 30% of the drop in sign-ups.

This is just a sketch of ACA Marketplace enrollment this year, KFF explained. A more complete picture is still to come, they said. CMS will publish effectuated enrollment data later this year, although even that information will not be whole as returning enrollees have until late March to make premium payments.

Determining exactly how the expiration of the premium tax credits affected ACA Marketplace enrollment could take some time, KFF said. However, major payers, including Elevance Health and Centene, are already reporting significant attrition in their Marketplace enrollees in the first quarter.

Cigna and Aetna also announced over the last month that they are exiting the ACA Marketplace, while UnitedHealthcare plans to pull back from the market.

This massive retreat from the ACA Marketplace will disrupt the market, increase out-of-pocket costs and reduce provider choice for consumers. Reduced competition could also result in higher premiums, especially without subsidies to shield consumers.

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.