U.S. — Enrollment in Affordable Care Act (ACA) marketplace plans declined by 13% for 2026, according to data released Friday by the Department of Health and Human Services. Five million people who had signed up for ACA marketplace coverage disenrolled or did not pay their premiums.

The marketplace data covers the 29 states that use the Healthcare.gov platform. "The main takeaway is that enrollment is down 13% from last year," said Cynthia Cox, director of KFF's Program on the ACA. Premium costs for ACA plans doubled on average from 2025 to 2026.

Enhanced premium tax credits expired after Republican lawmakers did not extend them. Democrats initiated a government shutdown in October 2025 during negotiations regarding the extension of these tax credits. "While the Trump administration attributes this drop in enrollment to their attempts to address fraud, this coverage loss happened at the same time millions of people faced double or even triple digit increases in their premium payments with the expiration of enhanced tax credits," Cox said.

The Trump administration attributes the decrease in ACA enrollment to efforts to address fraud. The Paragon Health Institute has theorized that growth in ACA enrollment resulted from fraud. Stacey Pogue, a senior research fellow at the Georgetown Center on Health Insurance Reforms, contested this theory. "I don't see data that point to that conclusion that a 5 million person drop can be explained by allegations of fraud," Pogue said. She added, "There's lots of evidence pointing to people making decisions based on what they can pay each month."

Cigna announced it will not participate in ACA markets the following year. "I think there are still enough people buying ACA marketplace coverage and that's going to keep these markets working," Cox said. She also said, "At this point, we don't see any parts of the country that are at risk of having no insurance company." Early insurance rate filings for 2027 show that rates are projected to increase again next year.

Why It Matters

The reported decline in ACA marketplace enrollment for 2026 indicates a reduction in the number of individuals covered through the federal health insurance marketplace. This change occurs with expiring enhanced premium tax credits and an average doubling of premium costs between 2025 and 2026. The differing interpretations from government officials and health policy experts regarding the cause of the enrollment drop reflect ongoing discussions about the factors influencing health insurance coverage in the United States.

Looking ahead, initial insurance rate filings for 2027 suggest a continued increase in premium rates. The decision by Cigna not to participate in future ACA markets represents a change in the competitive landscape, while experts indicate that no regions are currently at risk of having no insurance providers.