ACA Enrollment Trends in 2026 Reveal Early Declines and State Patterns

Preliminary data from national and state sources show that Affordable Care Act (ACA) Marketplace plan selections in early 2026 are down compared with the same period in 2025, marking a noticeable shift after years of expansion.

Across the country, roughly 23 million people selected ACA Marketplace coverage during the recent open enrollment period — approximately 5% fewer than at the same point last year. This early decline represents one of the first sustained pullbacks in enrollment since the expansion of premium subsidies in the early 2020s.

Why Enrollment Is Falling

The most significant factor behind the enrollment decline is the expiration of enhanced premium tax credits at the end of 2025. These credits had substantially lowered net premiums and expanded eligibility for millions of Americans. Without them, many households face much higher monthly costs, making coverage less affordable and prompting some individuals to delay or forgo enrollment entirely.

Analyses from independent health policy researchers project that millions of people could lose subsidy eligibility or see their premiums rise sharply in 2026, potentially pushing some into the uninsured category. This policy shift has reshaped consumer decisions and marketplace dynamics.

State Enrollment Patterns — Major Markets Compared

The national trend masks significant variation between states, highlighting the uneven impact of cost pressures and local market conditions:

Ohio:
Enrollment appears to be down markedly year‑over‑year, with approximate declines in the 20% range. Higher premiums and reduced subsidy support are cited as primary contributors.

North Carolina:
One of the steeper drops among large states, with enrollment down by an estimated 22% compared with early 2025 figures.

Oregon:
Early reporting indicates a significant drop in ACA participation — roughly 15% lower than last year — as consumers face rising prices without enhanced subsidies.

West Virginia, Indiana, Delaware, Arizona:
These states are also showing double‑digit enrollment declines in the neighborhood of 15%, reflecting common affordability challenges across multiple regions.

Missouri:
Enrollment is down an estimated 12%, with consumers responding to higher out‑of‑pocket premiums.

Kansas:
A moderate early decline of around 10% has been reported as net costs rise.

Florida:
Preliminary figures point to roughly 10% fewer signups versus last year, equivalent to hundreds of thousands of potential enrollees not returning to coverage.

Texas:
In contrast to many states, Texas has shown modest growth or stabilization in ACA enrollment, with selection counts increasing slightly compared with 2025. Local market factors and outreach efforts appear to be mitigating broader national headwinds.

Premiums and Affordability Pressures

With enhanced tax credits no longer in effect, net ACA premiums have risen for many consumers. Insurers pricing 2026 plans have factored in higher overall healthcare costs and a changing risk pool, with average premiums increasing compared with prior years in many regions. These affordability pressures are a recurring theme in conversations with consumers and agents alike.

Many individuals and families who saw significant support under the prior subsidy regime are now confronting premiums that represent a greater share of household income — forcing difficult decisions about coverage continuation, plan choice, or opting out altogether.

Policy Environment and Market Outlook

Efforts by lawmakers to extend enhanced premium tax credits through legislative action have so far failed to coalesce into an agreement, leaving the ACA framework for 2026 without additional federal subsidy support. The resulting policy uncertainty is a major factor influencing both consumer behavior and market pricing.

Looking ahead, federal and state exchanges are expected to publish more detailed enrollment breakdowns later in the spring, which will offer deeper insights into the demographic, income, and plan‑level patterns shaping the 2026 Marketplace.

What This Means for Agents

For insurance professionals focused on the under‑65 segment, these enrollment trends signal a tighter and more complex market:

• National enrollment is softer compared with last year’s record levels, underscoring rising coverage costs.
• State enrollment declines in markets such as Ohio, North Carolina, Oregon, and Florida highlight affordability gaps that agents must navigate.
• Texas’s relative growth suggests localized strategies can influence consumer decisions even in tough environments.
• Policy uncertainty around premiums and subsidies continues to shape client affordability choices and decision timelines.

Agents who understand these market shifts can position themselves to better assist clients navigating cost pressures, subsidy expirations, and plan trade‑offs as the 2026 coverage year unfolds.