- ACA enrollment dropped by over 1 million people for the 2026 plan year.
- The decline follows the expiration of enhanced tax credits that lowered monthly premiums.
- Returning customers and new enrollees both saw significant decreases across 41 states.
(UNITED STATES) — The Centers for Medicare & Medicaid Services reported this week that 22.8 million to nearly 23 million people selected 2026 plans on the ACA Marketplace, a drop of more than 1 million from the record 24 million in 2025 after enhanced premium tax credits expired at the end of 2025.
The early enrollment totals marked the first downturn after several years of growth that analysts tied to richer subsidies for Obamacare Enrollees, which expanded eligibility for assistance and pushed down net monthly premiums for many households.
CMS counted selections across federal and state platforms after open enrollment closed January 15, 2026 for the federal platform and most states, while some state-based marketplaces extended their windows, including California.
The decline showed up most clearly among people already in Marketplace coverage. Returning customers totaled 19.5 million to 19.6 million, down 4.6 million from last year’s total and over 600,000 fewer renewals than 2025.
New customers dipped too, but by less. CMS reported 3.4 million new enrollees, down from 3.9 million last year.
The composition shift matters because returning customers typically make up the bulk of plan selections, and renewals can be sensitive to sudden changes in net premium bills when Tax Credits change from one year to the next.
Open enrollment timing also complicates comparisons across states. Most federal and state marketplaces ended sign-ups on January 15, 2026, but California and some other state-based marketplaces continued to accept enrollments after that date.
The policy behind the reversal traces to the end of enhanced premium tax credits that began with the 2021 American Rescue Plan and continued after Congress extended them through 2025 in the 2022 Inflation Reduction Act.
Those enhanced subsidies broadened who qualified for help and reduced what many people paid out of pocket after credits, supporting the record 2025 totals on the ACA Marketplace.
Once the enhanced credits ended, household costs rose sharply for many subsidized enrollees. KFF estimated out-of-pocket premiums more than doubled on average and increased by over $1,000 annually per person for many people who receive subsidies.
Enrollment before the subsidy expansion era ran far lower. Pre-pandemic enrollment hovered around 10.5 million annually, according to Pew Research Center.
State-by-state results showed declines across most of the country. Selections fell in 41 states plus D.C., with Texas standing out as a notable exception where enrollment rose by 200,000.
Several of the steeper percentage drops came in large states that had posted strong gains during the period of enhanced subsidies. North Carolina fell 22%, and Ohio fell 20%.
Pennsylvania’s state-based marketplace, Pennie, reported a particular slide among older enrollees, with over 15,000 fewer people aged 55-64. Pennie also reported 1,000 daily drops, mainly among those at 150-200% of the poverty level.
Pennie framed the decline among that income band with a specific example: $48,225-$64,300 for a family of four.
California’s pattern differed in ways that officials and insurers watch closely, because selection totals alone can mask shifts in who signs up and what coverage level they choose. California saw 31% fewer new enrollees, and over a third of those who did enroll selected low-coverage bronze plans.
The shift toward bronze plans matters because the bronze tier generally comes with lower premiums and higher cost-sharing, a tradeoff that can look more attractive when net premiums rise after changes to Tax Credits.
Even the CMS selection totals do not settle how many people will actually carry ACA coverage through the year. Selections measure how many people picked a plan by the deadline, not how many ultimately keep it after the first bills arrive.
Simon Haeder, associate professor of public health at Ohio State University, predicted further drops after open enrollment, saying many people held onto plans expecting congressional extension but higher bills will trigger more disenrollments.
Haeder also warned that automatic drops by April for unpaid premiums could further reduce coverage, potentially totaling millions uninsured.
KFF drew a similar distinction between early selections and the later, smaller number of people who become fully enrolled after payment behavior and attrition play out. The group said plan selections can overstate effectuated enrollment once nonpayment and later drop-offs are accounted for.
KFF also pointed to the magnitude of price changes after the enhanced credits ended, saying premium hikes averaged 114% for subsidized plans.
Insurers are watching whether higher premiums and shifting plan choices translate into lower paid membership over time, even if premium increases protect margins. Elevance anticipated 30% membership declines despite premium hikes protecting margins.
The next round of federal data will offer a clearer read on who left the ACA Marketplace and who stayed, beyond the initial selection counts. CMS expected a March/April report to add detail beyond the early totals, including more information about demographics and enrollment patterns.
A later report will focus more directly on paid coverage. CMS’s July 2026 snapshot typically reflects mid-March payments, providing a benchmark for effectuated enrollment after the first wave of bills, nonpayment, and cancellations has filtered the selection totals into the number of people actually covered.
