ACA Enrollment Slips in Early 2026 as Premiums Rise

Early enrollment figures for Affordable Care Act marketplace plans show a decline from a year ago, an initial sign that the expiration of enhanced federal subsidies may be discouraging some consumers from signing up for health insurance as costs rise.

The Centers for Medicare & Medicaid Services reported late Monday that 22.8 million people have selected individual market coverage for 2026 through the federal and state marketplaces since open enrollment began Nov. 1. At the same point last year, about 23.6 million consumers had enrolled, a drop of roughly 800,000 plan selections.

The new CMS snapshot shows fewer first-time customers as well. About 2.8 million people are new to the marketplaces for 2026, down from roughly 3.1 million new enrollees at the same time last year.

Returning customers declined, too, with about 20 million people either selecting a plan for 2026 after having 2025 coverage or being automatically reenrolled.

CMS cautioned that the numbers are preliminary and reflect a moving target. The report includes sign-ups through Jan. 3 in the 30 states that use HealthCare.gov and through Dec. 27 in states and the District of Columbia that operate their own enrollment platforms.

Open enrollment for HealthCare.gov runs through Jan. 15 for coverage that begins Feb. 1, and several state-run marketplaces have extended deadlines. Illinois, which is operating its own marketplace for 2026, has said residents can enroll through Jan. 31.

Final totals are also likely to shift because some people who select plans never pay their first premium, and insurers can terminate coverage for nonpayment.

Marketplace sign-ups had climbed for four straight years through 2025, when nearly 24 million people ultimately selected coverage. Much of that growth was tied to enhanced premium tax credits enacted in 2021 and later extended, which reduced premiums for many enrollees and expanded eligibility for help.

Those enhanced subsidies expired Dec. 31, 2025, after months of debate in Congress did not produce another extension. Insurers set 2026 rates assuming the enhanced credits would end, leaving many consumers facing higher monthly premiums.

Jared Ortaliza, a marketplace policy analyst at KFF, said plan selections do not always translate into paid enrollments, meaning the subsidy expiration's full impact may not be clear until later in the year when effectuated enrollment is known.

The enrollment dip is also unfolding alongside renewed congressional action on the subsidies. The House passed legislation Jan. 8 to extend the enhanced tax credits for three years, sending the measure to the Senate, where its outlook remains uncertain.

Leslie Dach, chair of the nonprofit Protect Our Care, criticized the early drop and urged Congress to restore the enhanced credits, arguing that higher premiums risk pushing more people out of coverage. He blamed Republicans and President Donald Trump for allowing the subsidies to lapse.

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