ACA marketplace sign-ups fall as premium costs surge after subsidy cuts

CMS ended advance premium tax credit payments or coverage for nearly 1.5 million people found ineligible for financial assistance or enrolled without authorization on HealthCare.gov, even as 23.1 million people selected or were automatically re-enrolled in ACA Marketplace coverage for 2026. That total was down from 24.3 million in 2025, and it landed in a year when Trump officials have pushed fraud enforcement as the explanation for weaker enrollment.

In KFF’s analysis, 2026 was the first year since 2020 that ACA Marketplace enrollees did not have access to enhanced premium tax credits, and the expiration of those subsidies raised average premium payments for subsidized enrollees who stayed in the same plan by 114 percent, from about $888 in 2025 to $1,904 in 2026. Marketplace sign-up data did not show who actually paid their first bill, and many returning subsidized enrollees had a three-month grace period, meaning the full enrollment drop would not be visible until later in the spring.

In KFF’s March 19 follow-up survey, 51 percent of returning Marketplace enrollees said their health-care costs were “a lot higher” than last year. About 9 percent said they had dropped ACA coverage and were uninsured, while 28 percent had switched Marketplace plans, most because of high costs. In KFF’s survey, 55 percent of reenrollees were cutting or planning to cut spending on food or other basic household expenses to keep coverage, a figure that rose to 62 percent among people with chronic conditions.

The White House cast its anti-fraud campaign as a broad crackdown across federal benefit programs, including health care, in a May release. KFF’s enrollment analysis projected average monthly effectuated ACA Marketplace enrollment could fall to about 17.5 million in 2026, and possibly as low as 16.5 million, from 22.3 million in 2025. That would follow the enrollment surge that came after the enhanced subsidies were first enacted in 2021 and then extended through 2025.