Affordable Care Act enrollment could fall to 17.5 million Americans in 2026.
The average Affordable Care Act (ACA) Marketplace deductible saw the steepest increase in history-growing by 37% or more than $1,000, from $2,759 in 2025 to $3,786 in 2026 as enhanced premium tax credits expired, according to an analysis by KFF, a nonpartisan health policy organization which also runs a health-related news service. The full analysis is available here.
Between 2021 and 2025, Americans searching for healthcare coverage in the ACA Marketplace 2010 benefited from premium tax credits put in place by the American Rescue Plan in 2021 and extended through 2025 by the Inflation Reduction Act. These measures expanded ACA affordability, pushing enrollment to record highs. When those subsidies expired at the end of 2025, insurance premium payments rose for many enrollees, particularly those with incomes above 400% of the federal poverty line, who had been newly eligible for subsidies under the enhanced credits. In Alaska, a one-person household is at 400% of the federal poverty line if they earn $79,640 per year.
KFF's analysis draws on data from the Centers for Medicare & Medicaid Services and state-based Marketplace (SBM) Open Enrollment reports, as well as KFF survey data and individual market enrollment estimates from Wakely Consulting Group, to examine indicators of how the expiration of enhanced premium tax credits has affected enrollment levels, plan selections, and out-of-pocket costs in 2026. You can see CMS data here: https://bit.ly/4nI40EE
After the enhanced tax credits ended, many Marketplace shoppers chose lower-premium, higher-deductible plans. Between 2025 and 2026, sign-ups for bronze plans jumped from
of total plan selections-growing from 7.3 million to 9.2 million people.
At the same time, sign-ups for silver Marketplace plans, which have higher premiums and lower cost-sharing, hit the lowest levels in the program's history. Silver plan sign-ups fell from 57% to 43%, from 13.7 million to 9.8 million people. The share of Marketplace enrollees who signed up for cost-sharing reduction (CSR) silver plans-which reduce out-of-pocket costs for deductibles, copayments, and coinsurance for lower income enrollees-also fell to the lowest level on record: 37%.
Higher deductible plans have lower premiums, but they result in bigger out-of-pocket costs for patients, which KFF says can strain household budgets and lead to medical debt and poorer access to care.
The analysis also looked at how ACA Marketplace enrollment could fall. Enrollment could decline by 21.5% or nearly five million people this year.
About 23 million people signed up for Marketplace plans during the 2026 Open Enrollment Period-over a million fewer than in 2025 and the sharpest single-year drop in raw numbers since the ACA Marketplaces launched-and more enrollment declines are likely this year due to higher out-of-pocket premiums with the enhanced tax credits expired.
