ACA marketplace enrollment declines as subsidies expire in 2026

CMS’s latest 2026 enrollment numbers for the Affordable Care Act (ACA) marketplaces indicate a relatively moderate drop-off from 2025, although the final tally could look notably different.

The agency reported this week that 23.1 million were enrolled at the close of open enrollment for Healthcare.gov and the state-run marketplaces. That’s a 4.9% decline from 2025, when enrollment reached a record 24.3 million.

Going into 2026, the big policy change was Congress’s inability to extend the 2021 enhanced subsidies for buying marketplace insurance. In its most recent estimate, issued at the request of Democratic leaders in September 2025, the Congressional Budget Office projected that renewing the subsidies in time for open enrollment would mean a difference of 2 million enrollees in 2026.

What CMS’s 2026 marketplace enrollment data shows

Such a gap or greater remains possible, even as CMS notes that 2026 enrollment is higher than 2024 (22.1 million).

The 2026 numbers still do not reflect people who are automatically reenrolled in a marketplace plan and then drop out after failing to pay their monthly premium. CMS says that data will be available in the summer.

According to data files, more than 8.8 million people were auto enrolled for 2026, while 10.7 million actively reenrolled in a plan and 3.6 million are new to the marketplaces. New enrollments were down by 500,000 year-over-year.

Data files show that auto-reenrollment tends to be highest in states that run their own marketplaces rather than using Healthcare.gov. The highest shares of auto-reenrollment relative to 2026 overall enrollment are seen in Washington, D.C. (88%), Vermont (79%) and Rhode Island (76%), for example, whereas Utah (25.1%), South Dakota (25.5%) and Arkansas (26.3%) have the smallest such shares.

How subsidy expiration reshaped coverage and premiums

Among the changes after expiration of the enhanced subsidies are a limit on subsidy eligibility to households with incomes between 100% and 400% of federal poverty, along with higher net premiums for most subsidy recipients. The share of enrollees receiving a subsidy dropped from 92% in both 2024 and 2025 to 87% for 2026, according to CMS’s latest numbers.

When factoring in subsidies, the average monthly premium across the marketplaces is $178, up from $113 in 2025. The average nonsubsidized premium is $746, up from $612. Marketplace insurers announced hikes in baseline premiums going into open enrollment, citing projected uncertainty around enrollment, as well as increases in the cost of healthcare.

One factor mitigating the year-over-year change in net premiums likely was the availability in a handful of states of funding to stem the decrease in the federal subsidies. One such state was New Mexico, where enrollment increased by 18.1% year-over-year.

Among other states with enrollment increases to this point are Texas (5.2%), Connecticut (3.7%) and Massachusetts (3.7%), although auto-reenrollments factor in significantly for the latter two and in Washington, D.C., where enrollment rose by 7.5%.

States with some of the steepest enrollment decreases include North Carolina (21.9%), Ohio (19.5%), West Virginia (16.7%), Indiana (16.5%), Arizona (15.6%) and Delaware (15.6%).

Shifts in plan selection and cost-sharing dynamics

Migration of enrollees from silver to bronze plans appeared to help curb the nationwide premium increase for 2026.

Silver plans remained the most popular in open enrollment, at 9.85 million enrollees, followed by bronze plans at 9.15 million and gold plans at 3.97 million. However, silver plans as a share of all plan selections dropped from 56% to 43% year-over-year.

Only silver plans are eligible for cost-sharing reduction (CSR) payments, which reduce out-of-pocket costs for healthcare and are available to enrollees with income between 100% and 250% of federal poverty. The share of enrollees in CSR-eligible plans dropped from 51% in 2025 to 37% this year.

Bronze plans as a share of all selections increased from 30% in 2025 to 40% this year. The maximum out-of-pocket cap in that tier is $10,600 for 2026.

Despite regulations to make catastrophic coverage plans more accessible, those plans accounted for less than 1% of 2026 enrollments.

CMS notes that marketplace-plan selections by low-income households are significantly higher in 2026 relative to 2021. Roughly 46% of plan selections were by people with income between 100% and 150% of federal poverty, compared with 32% five years ago, which had been the most recent open-enrollment period without the enhanced subsidies.

Impact of CMS enforcement and fraud controls

CMS chalks up much of the reported year-over-year enrollment decrease to fraud prevention, saying 1.5 million people were either deemed to be ineligible for premium assistance or found to have been enrolled in Healthcare.gov marketplace plans without their knowledge. Such checks had been paused since the start of the COVID-19 pandemic.

Among the group that fell off the rolls due to CMS’s enforcement protocols, more than 1 million lost subsidy eligibility because they were concurrently enrolled in Medicaid or did not adhere to file-and-reconcile requirements.

“Many of these consumers subsequently ended their coverage voluntarily or had their coverage ended due to nonpayment of premiums due,” CMS wrote.

In addition, certain lawfully present immigrants with incomes under 100% of federal poverty were rendered ineligible for subsidies as a result of the legislation known as the One Big Beautiful Bill Act.

As part CMS’s anti-fraud efforts, coverage also was canceled for roughly 250,000 enrollees whom agents or brokers had enrolled without the consumer’s authorization.

How consumers feel about the changes

Consumer sentiment suggests an increase in financial strain stemming from the costs of marketplace insurance in 2026.

In a breakdown of data from a survey of more than 1,100 respondents who had a marketplace plan in 2025, KFF reported that 80% of enrollees said their premiums, deductibles or coinsurance and copays are higher than last year, and 51% said those costs are “a lot higher.” And 17% were not confident they will be able to maintain their premium payments throughout 2026.

Nearly three-quarters (73%) said they are “very worried” or “somewhat worried” about being able to cover costs for emergency care or hospitalizations, while just under half voiced the same concern about routine medical visits (49%) and prescription drugs (45%).

Among 2025 marketplace enrollees, almost 1 in 10 (9%) said they were now uninsured, while 28% had switched to a different plan.

Asked who shoulders responsibility for the increase in the cost of marketplace insurance, 70% said they place “a lot of blame” on insurers. Others viewed as culpable are congressional Republicans (54%), President Donald Trump (53%), drug companies (52%), congressional Democrats (34%), hospitals (30%), doctors (12%) and employers (8%).

When including responses that at least “some blame” is merited, all categories except doctors and employers were cited by more than 80% of respondents, topped by insurers at 98%.