ACA Marketplace enrollment stayed high, but subsidy changes may raise costs
More than 23 million people selected or were automatically re-enrolled in ACA Marketplace coverage for 2026, according to CMS. But for many households, the end of enhanced pandemic-era savings on December 31, 2025, may mean higher monthly premiums even while enrollment remains strong.
ACA Marketplace enrollment stayed near record levels in 2026, but that does not mean coverage is getting cheaper for everyone. The Centers for Medicare & Medicaid Services said 23.1 million people selected or were automatically re-enrolled in Marketplace coverage for the year.
At the same time, enhanced premium tax credits that had lowered many people’s monthly costs ended on December 31, 2025. For some households, that may mean a higher bill even if they stayed insured or kept the same plan.
Why strong enrollment can still come with more cost pressure
CMS said 2026 enrollment remained high, but its report also shows changes in who enrolled and what they chose. More people selected bronze and gold plans, while the share selecting silver plans fell. CMS also said nearly half of enrollees had household incomes between 100% and 150% of the federal poverty level, and most people in that group received financial help.
That matters because Marketplace savings depend on expected income, household size, and the plans available in a given area. If any of those details change, the amount of financial help can change too.
Who is most likely to feel the shift
The people most likely to notice the change are current Marketplace enrollees who relied on subsidies, especially households with changing income or family size. CMS said automatic re-enrollments were lower in 2026 than in 2025, while active plan selections increased. KFF has noted that the end of enhanced premium tax credits makes it harder to predict how many people will stay in Marketplace coverage, and that early enrollment data may not fully capture later coverage losses.
In a follow-up survey, KFF found that many Marketplace enrollees were worried about higher premiums and other costs, and some said the price of coverage made it harder to afford routine care, prescriptions, or emergency care.
What to check in your application
HealthCare.gov says the amount of your premium tax credit depends on your estimated household income and household size. It also says plan premiums can change, so even if your income stays the same, your tax credit can still be different.
That means it is worth checking three things:
- Income: Make sure the estimate reflects what you expect to earn this year.
- Household size: Report changes if someone joins or leaves your household.
- Plan options: Compare plans again, because premiums and savings can shift from year to year.
HealthCare.gov says people should update their application right away after income or household changes. If the Marketplace uses outdated information, you could get too much help during the year and owe money back at tax time.
What readers can do now
If you are enrolled in a Marketplace plan, log in and review your application, even if you do not plan to switch plans. HealthCare.gov says you can report life changes, update your application, and compare available plans in the same account.
Also watch for automatic re-enrollment notices. If you do nothing, you may stay enrolled in a plan, but the premium and subsidy calculation may not match your current situation.
What is still uncertain
The full effect of the end of enhanced subsidies may take time to show up in coverage decisions and affordability. CMS says more enrollment data will continue to be released, and consumer reactions may still evolve as people review their options and weigh the higher cost of coverage.
Sources
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