What We Know So Far About 2026 ACA Marketplace Enrollment, Premiums, and Deductibles
The enhanced premium tax credits established by the American Rescue Plan in 2021 and extended through 2025 by the Inflation Reduction Act significantly expanded Affordable Care Act (ACA) Marketplace affordability, driving enrollment to record highs. When those enhancements expired at the end of 2025, premium payments rose sharply for many enrollees, particularly those with incomes above 400% FPL who had been newly eligible for subsidies under the enhanced credits.
This analysis draws on data from the Centers for Medicare & Medicaid Services(CMS) 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 early indicators of how the expiration of enhanced premium tax credits has affected effectuated enrollment levels (i.e., enrollment among people who have paid their premiums), plan selections, and out-of-pocket costs in 2026.
Key Findings
Based on reports to date of sign-ups and premium payments, average monthly effectuated ACA Marketplace enrollment could fall to about 17.5 million people in 2026 and could be as low as 16.5 million people, down from 22.3 million people in 2025.
A disproportionately large share of the drop in sign-ups (27%) is among people with incomes just above the “subsidy cliff” (between 400%-500% FPL), despite this group making up just 3% of plan selections in 2025.
Premium payments from enrollees increased by an average of 58% from $113 to $178 per month. This is lower than the 114% increase KFF projected if everyone had stayed in the same plan because many people bought down to higher-deductible plans and because those just past the subsidy cliff with the steepest increases dropped ACA coverage at higher rates. Additionally, the 114% increase was among people receiving a tax credit whereas the 58% increase is among all consumers, including the most number who did not receive a tax credit in 2025.
Average ACA Marketplace deductibles increased by 37% (or $1,027 per person) to a record high of $3,786 in 2026. This is the steepest increase in deductibles ever seen in this market and largely reflects the shift from silver plans with reduced deductibles for lower-income enrollees to bronze plans with very high deductibles.
Who Dropped ACA Marketplace Coverage?
While there is no publicly available effectuated enrollment data broken out by income, the plan selection data indicate that a large share of the drop in ACA Marketplace coverage is among consumers above 400% of the federal poverty level (FPL), where eligibility for premium tax credits ends (“subsidy cliff”). Under the enhanced premium subsidies, people with incomes above 400% of the poverty level had their premium payments for a benchmark silver plan capped at 8.5% of income. People with incomes above 400% up to 500% FPL, who represented just 3% of 2025 sign-ups, accounted for 27% of the drop in sign-ups from 2025 to 2026. Plan sign-ups for this group fell by 44% (over 321,000 people). Those with incomes above 500% FPL accounted for an additional 21% of the difference.
Increases in Premium Payments
In 2026, the average monthly premium payment among consumers net of tax credits (including those who did not receive premium tax credits) rose 58% from $113 to $178 in 2025. With the expiration of enhanced premiums tax credits, KFF previously estimated that premium payments would increase by 114% on average for subsidized ACA Marketplace enrollees to keep their same plan in 2026. However, as discussed more below, many Marketplace enrollees bought down to bronze plans (with lower premiums and higher deductibles). Additionally, people with the steepest increases in premiums — those who lost eligibility for tax credits entirely — appear to have left the market at a disproportionately high rate.
Increase in Deductibles
To offset these increases in premium payments with the expiration of enhanced premium tax credits, a number of consumers switched to bronze plans, which have lower premiums but higher deductibles. The share of people selecting bronze plans increased from 30% (7.3 million people) in 2025 to 40% (9.2 million people) in 2026, while the share selecting gold plans rose from 13% (3.2 million people) to 17% (4.0 million people). Meanwhile, the share of ACA marketplace consumers selecting a silver plan fell from 57% (13.7 million people) to 43% (9.8 million people), marking a record low and the first time fewer than half of ACA consumers have selected a silver plan.