Missouri ACA Marketplace Sees Enrollment Decline and Rising Premiums in Early 2026

Missouri’s Affordable Care Act (ACA) marketplace is facing a critical period as enrollment falls and premiums rise in early 2026. The expiration of enhanced federal premium tax credits has left thousands of residents with fewer affordable options, forcing difficult choices about coverage and out-of-pocket costs.

Enrollment Drops Amid Expired Subsidies

After years of growth supported by expanded federal tax credits, Missouri saw an estimated 12 percent drop in ACA enrollment compared with early 2025. Roughly 366,000 residents remain enrolled, down from approximately 417,000 last year.

The expiration of pandemic-era subsidies is the key driver of this decline. Many middle-income households that previously relied on enhanced financial support are now facing substantially higher net premiums. For some, monthly costs have risen by hundreds of dollars, creating a real affordability barrier and prompting some to leave the marketplace entirely.

Premiums and Market Dynamics

Premium increases have compounded the problem. Insurers in Missouri submitted filings for double-digit rate hikes for the 2026 plan year, pushing the statewide average premium increase above 23 percent before subsidies.

Market participation is further affected by insurer withdrawals and reduced plan offerings. Some carriers have scaled back service areas, particularly in rural counties, which has limited plan availability and narrowed consumer choice. The combination of higher premiums and fewer options is creating tangible stress for many households.

Impact on Consumers

The effects are widespread. Independent contractors, freelancers, small business owners, and middle-income families are among the most impacted. Rising premiums and shrinking options have led some residents to choose higher-deductible plans, reduce coverage levels, or forego enrollment altogether.

Rural populations face additional challenges. Limited competition among carriers in less populated areas means fewer affordable plan options, further exacerbating coverage gaps. Families in these regions often must weigh access to care against financial feasibility.

Broader Implications for Health Access

Missouri already had a significant uninsured population before 2026. The decline in ACA enrollment risks increasing that number and widening disparities in access to care. Families who lose coverage may delay preventive care, routine medical services, or chronic condition management, increasing long-term health and financial risks.

Experts note that Missouri’s situation mirrors national trends in states that saw declines after the expiration of enhanced subsidies. The combined effect of rising costs and reduced support is reshaping the individual insurance market and putting pressure on residents who rely on ACA coverage as a primary safety net.

Looking Forward

As Missouri moves further into 2026, policymakers, insurers, and health advocates are closely monitoring enrollment trends and the impact of premium increases. Without additional interventions, affordability challenges are expected to persist, and some residents may remain uninsured or underinsured.

The state’s ACA marketplace is at a crossroads. Residents face rising costs and shrinking options, highlighting the limits of relying solely on ACA coverage. Policymakers and health leaders will need to explore solutions to help ensure that Missourians have access to affordable, reliable health coverage in a changing market.