ACA Marketplace Costs Jump in 2026 After Enhanced Subsidies Expire: Sign-Ups Fall Over 1 Million and Net Premiums Rise 58%, KFF Finds

The first year without the enhanced Affordable Care Act subsidies is showing up in enrollment, in premiums and in the type of coverage people choose. The enhanced premium tax credits, created by the American Rescue Plan Act in 2021 and extended through 2025 by the Inflation Reduction Act, expired at the end of 2025. This article draws on a May 19, 2026 analysis by KFF, a health policy research organisation, supplemented by KFF's earlier projections and reporting on 2026 benchmark premiums. An earlier version of this article combined several different figures, including a 114% increase and a 22 million count of subsidised enrollees, in ways the sources do not support, so the numbers below have been corrected and labelled as to what they measure. It is general information, not insurance or financial advice.

How much did premiums rise? Two different measures are often confused. The first is the sticker price of plans. According to figures reported by Becker's Payer Issues, citing KFF, the average increase in benchmark premiums, meaning the second-lowest-cost silver plan used to set subsidies, was 26% for 2026, with Arkansas at 69% and Alaska the only state with a decrease, at 1%. The second is what people actually pay after subsidies, known as the net premium. KFF's May 2026 analysis found that average monthly net premiums for all consumers rose 58%, from $113 to $178.

What happened to the 114% figure? In a September 30, 2025 issue brief, KFF estimated that average annual premium payments for subsidised enrollees would rise 114%, from $888 in 2025 to $1,904 in 2026, if the enhanced credits expired. That estimate assumed people kept the same plan, and the brief said it excluded state subsidies. KFF's later analysis says actual increases were smaller than that projection because many enrollees switched to bronze plans and because the groups facing the biggest increases left the market at higher rates. So the 114% was a projection for a particular group under particular assumptions, not an observed average.

How many people enrolled? KFF reports that plan selections fell by more than 1 million to 23.1 million, the sharpest single-year drop since the Marketplaces opened. Plan selections are not the same as people who pay and keep coverage. KFF cites Wakely, an actuarial firm, estimating that average monthly effectuated enrollment could be about 17.5 million in 2026, with a possible low of 16.5 million, compared with 22.3 million in 2025. Wakely's range implies a fall of 17% to 26% in individual market effectuated enrollment. The Congressional Budget Office projected average 2026 Marketplace enrollment of 16.9 million, a contraction of roughly 25%. Wakely estimated that about 86% of January 2026 individual market enrollees paid their first premium.

Who left? The decline was concentrated at both ends of the income scale. People with incomes of 400% to 500% of the federal poverty level made up 3% of 2025 sign-ups but 27% of the drop, with sign-ups down 44%, or more than 321,000. Combined with those above 500%, people above 400% of poverty were 7% of 2025 enrollment but 48% of the decline. They had lost access to any subsidy under the original law once the enhanced credits expired. At the other end, enrollment below 150% of poverty fell by about 441,000, or 4%, which was 37% of the decline. By age, enrollment among 18 to 34 year olds fell by 542,000, or 8%, from 6.7 million to 6.2 million, 46% of the total fall. Plan selections fell in 41 states, with the largest percentage drops in North Carolina (22%), Ohio (20%) and West Virginia (17%), while New Mexico rose 18%, which KFF links to a state programme that fully backfills lost federal assistance.

How did coverage change? Many people traded down. Bronze plans rose from 30% of selections (7.3 million) to 40% (9.2 million). Silver fell from 57% to 43%, a record low. Gold rose from 13% to 17%. The average deductible rose 37%, from $2,759 to $3,786, the steepest increase since 2014. KFF says that with the 2025 metal-level mix, the increase would have been about 6%, so the shift to lower-premium, higher-deductible plans accounts for most of the rise. The share of consumers in plans with cost-sharing reductions, which lower deductibles for lower-income buyers, fell to a record-low 37%.

What do surveys show? A KFF follow-up survey in late February to early March 2026 found that 9% of 2025 enrollees had become uninsured, 4% of returning enrollees had not paid their first premium, and 17% were not confident they could afford premiums for the full year. In California, a board report from April 16, 2026 showed cancellations among renewing consumers up by about 6 percentage points, with nearly one in five having terminated or been cancelled for non-payment by the end of March.

Is there a risk spiral? Analysts worry that if healthier people leave, the remaining pool becomes costlier and premiums rise further, which pushes more people out. The KFF material we reviewed documents who left and what plans people chose, but it does not conclude that a spiral is under way, and we cannot say how health costs among remaining enrollees have developed. Insurers will show that when they file 2027 rates, and readers should watch those filings and the Centers for Medicare & Medicaid Services' effectuated enrollment reports.

What should consumers do? Compare the total cost, including premium, deductible and out-of-pocket maximum, not only the premium. Check whether a state offers subsidies. Remember that a bronze plan with a very high deductible can leave a household exposed to large bills. Consumers with questions about eligibility should use official marketplace tools or an independent navigator.

This article summarises published research and reporting and is not insurance, tax or financial advice.