As we move through 2026, the Affordable Care Act (ACA) market is going through a noticeable reset. After a few years of expanded federal subsidies that made coverage more affordable, those extra savings expired at the end of 2025, and people are starting to feel it.
Even with those changes, enrollment hasn’t dropped as sharply as some expected. About 23 million people signed up for coverage this year, down roughly 5% from 2025’s record high. So while the market is shifting, it’s not collapsing.
Here are the key results and changes for 2026 based on data as of March/April 2026:
1. Expiration of Enhanced Subsidies (The “Subsidy Cliff”)
- Higher Costs: The temporary, enhanced subsidies that lowered premiums for 2021–2025 expired on Dec. 31, 2025. As a result, average premium payments for subsidized enrollees are expected to more than double in 2026.
- Return of the “Cliff”: The income cap for subsidies has returned, meaning households with incomes above 400% of the federal poverty level (FPL) no longer qualify for premium tax credits.
- Impact: A March 2026 KFF survey found that 1 in 10 people who had ACA coverage in 2025 are now uninsured. Many others are switching to cheaper, lower-tier “bronze” plans with higher deductibles.
2. Enrollment Trends and Data
- Initial Drop: Preliminary data indicates about 1.4 million fewer people signed up for 2026 coverage compared to 2025.
- State Variations: While 41 states saw declines, some, including Texas, experienced record-high enrollment, partly driven by state-level policies or population growth.
- Re-enrollment: Nearly 20 million people were returning customers, with many having been automatically renewed in December.
- Final Numbers Pending: Because of a 3-month grace period for non-payment, the final “activated” enrollment (those who actually pay their premiums) for 2026 will not be fully known until the summer of 2026.
3. Premium Increases (2026)
- Higher Rates: Insurers raised premiums by a median of 18% for 2026, driven by rising medical costs, the expiration of enhanced tax credits, and expected changes in the risk pool.
- “Double Whammy”: Many enrollees face both a premium increase (due to medical inflation) and a reduction in their subsidy (due to the expiration of the enhanced tax credits).
4. New Policy Changes (2026)
- Stricter Rules: Stricter income verification and compliance rules are in place, making it harder to stay enrolled without documentation.
- Special Enrollment: The “continuous” special enrollment period for low-income individuals (under 150% FPL) was terminated.
- No Year-Round Enrollment: The year-round enrollment privilege for low-income individuals has ended; they must now enroll during the standard Nov 1–Jan 15 window.
- HSA-Eligible Plans: Changes in 2026 make Health Savings Account (HSA)-eligible plans available to more consumers.
5. Political and Legal Context
- Debate Over Subsidies: Democrats in Congress have pushed for an extension of the enhanced subsidies, but Republican control of the House and Senate has made a deal difficult, as many cite costs and fraud concerns.
- Increased Uninsured Rate: The Congressional Budget Office (CBO) projected that 2.2 million more people would be uninsured in 2026 without an extension.
What to watch next
The full impact of these changes isn’t clear yet. We’ll get a better sense this summer when final enrollment numbers come in, especially how many people stick with coverage as higher premiums take hold.
For now, one thing is clear: affordability remains the biggest pressure point in the individual market. And as costs shift, so do the choices people have to make.