Average monthly enrollment in the Affordable Care Act (ACA) Marketplace is expected to decline sharply in 2026 following the expiration of enhanced federal premium tax credits that had helped drive record coverage levels in recent years.
According to estimates based on data from the Wakely Consulting Group and federal Marketplace reports, average effectuated enrollment — referring to consumers who actually pay premiums and maintain active coverage — could fall to around 17.5 million in 2026, down from 22.3 million in 2025. In a worst-case scenario, enrollment could decline to as low as 16.5 million.
That would amount to a drop of between 17% and 26%, or roughly 3.8 million to 5.8 million fewer insured Americans compared with last year.
Sharpest enrollment decline since ACA launch
Open enrollment sign-ups fell by more than one million people to 23.1 million during the 2026 enrollment period, marking the steepest single-year decline since ACA Marketplaces launched.
However, analysts warn that plan selections do not fully reflect actual coverage because many consumers fail to pay premiums after signing up. Wakely Consulting estimates that only about 86% of January enrollees paid their first month’s premium in 2026.
Federal analysts and insurers expect additional coverage losses throughout the year as rising premiums force more consumers to drop plans or miss payments.
End of enhanced tax credits drives affordability crisis
The sharp decline follows the expiration of enhanced premium tax credits introduced under the American Rescue Plan in 2021 and extended through 2025 by the Inflation Reduction Act.
Those subsidies had expanded financial assistance to millions of middle-income Americans and capped benchmark premium payments at 8.5% of income for many households.
Without those enhanced subsidies, average monthly premium payments rose dramatically in 2026. Consumers now pay an average of $178 per month after subsidies, up 58% from $113 in 2025.
Analysts said the increase would have been even larger if many consumers had not switched to lower-cost, higher-deductible plans.
Consumers above subsidy cliff hit hardest
The report found that Americans earning just above the subsidy eligibility threshold were disproportionately affected.
Consumers with incomes between 400% and 500% of the federal poverty level accounted for only 3% of Marketplace sign-ups in 2025, but represented 27% of the overall decline in coverage in 2026.
Plan selections among this group fell by 44%, or more than 321,000 people.
Overall, consumers above the so-called “subsidy cliff” accounted for nearly half of the decline in Marketplace enrollment despite making up a relatively small share of total enrollees.
Deductibles jump to record highs
As premiums increased, many consumers shifted from silver plans to cheaper bronze plans with significantly higher out-of-pocket costs.
The share of consumers selecting bronze plans rose from 30% in 2025 to 40% in 2026, while silver plan enrollment fell to a record low of 43%.
As a result, average ACA Marketplace deductibles surged by 37%, rising from $2,759 in 2025 to a record $3,786 in 2026 — the steepest increase since the ACA marketplaces were created.
Low-income consumers eligible for cost-sharing reductions also increasingly moved away from silver plans, despite those plans offering much lower deductibles.
Young adults leaving coverage at high rates
Young adults ages 18 to 34 accounted for the largest share of enrollment losses.
Marketplace sign-ups in that age group declined by roughly 542,000 people, or 8%, representing nearly half of the overall drop in enrollment.
Insurers had previously warned that younger and healthier consumers would be among the first to leave the Marketplace if subsidies expired because they are more sensitive to premium increases.
State-level differences emerge
Marketplace enrollment declined in 41 states, with North Carolina, Ohio and West Virginia experiencing some of the steepest drops.
However, a few states managed to stabilize or even grow enrollment through additional state-funded subsidy programs. New Mexico recorded an 18% increase in Marketplace sign-ups after implementing supplemental financial assistance programs to offset the loss of federal subsidies.
Analysts cautioned that the full impact of the subsidy expiration may not become clear until later in 2026 as additional consumers lose coverage due to nonpayment or rising healthcare costs.
