Affordable Care Act coverage loss 2026 is now being measured in real data — and the numbers are severe. A comprehensive analysis published Tuesday by KFF, drawing on CMS data, state-based marketplace reports, Wakely Consulting Group enrollment projections, and KFF’s own survey research, documents the aftermath of the enhanced premium tax credit expiration that took effect at the end of 2025. Average monthly effectuated enrollment could fall to 17.5 million people — down from 22.3 million in 2025 — and could be as low as 16.5 million. Premium payments rose 58% on average. The average deductible surged $1,027 to a record $3,786. Up to 5.8 million Americans could lose their ACA Marketplace coverage by year’s end.
What Happened: The Enhanced Tax Credits That Expired
The enhanced premium tax credits established by the American Rescue Plan in 2021 and extended through 2025 by the Inflation Reduction Act significantly expanded ACA Marketplace affordability, driving enrollment to record highs. When those enhancements expired at the end of 2025, premium payments rose sharply for many enrollees, particularly those with incomes above 400% FPL who had been newly eligible for subsidies under the enhanced credits.
Under the enhanced premium subsidies, people with incomes above 400% of the federal poverty level had their premium payments for a benchmark silver plan capped at 8.5% of income. That cap disappeared when the credits expired. The result was the sharpest premium increase this market has ever recorded in a single year, a cascade of plan downgrade decisions that drove deductibles to historic highs, and a wave of coverage loss concentrated among the exact population the enhanced credits had most recently brought in.
How Many People Are Losing ACA Coverage?
Plan sign-ups fell by over a million to 23.1 million people during the 2026 Open Enrollment Period — the sharpest single-year drop since the ACA Marketplaces launched. But KFF’s analysis makes clear that sign-up data understates the full scope of coverage loss.
Effectuated enrollment — the number of people who actually pay their premiums and maintain active coverage — is expected to fall even further than previous years as 2026 unfolds. Based on Wakely Consulting Group’s analysis of January 2026 premium payment data, individual market enrollment could decline by between 17% and 26% compared to 2025. Applied to ACA Marketplaces, that translates to a potential drop of 3.8 to 5.8 million people, with the midpoint estimate landing at a loss of approximately 4.8 million enrollees.
A KFF survey conducted in late February and early March 2026 confirmed the scale of the emerging crisis: 9% of 2025 Marketplace enrollees had already become uninsured. One in six returning enrollees — 17% — reported they were not confident they could afford their premiums for the entire year. Four percent of returning enrollees had not yet paid their first month’s premium when surveyed.
Who Is Losing Coverage: The Subsidy Cliff and Young Adults
The Affordable Care Act coverage loss 2026 data reveals two groups bearing a disproportionate share of the coverage losses.
The most dramatic concentration of loss is among consumers just above the “subsidy cliff” — those with incomes between 400% and 500% of the federal poverty level. This group represented just 3% of 2025 plan selections but accounted for 27% of the drop in sign-ups from 2025 to 2026. Plan sign-ups for this group fell by 44%, representing over 321,000 people. Overall, consumers with incomes above the subsidy cliff made up just 7% of 2025 enrollment but nearly half — 48% — of the decline in plan selections.
Young adults ages 18 to 34 accounted for more of the decrease in plan sign-ups than any other age group. Sign-ups in this group declined by 542,000, or 8%, from 6.7 million in 2025 to 6.2 million in 2026 — comprising 46% of the total decline in ACA Marketplace sign-ups. This pattern aligned with insurer predictions from 2025 rate filings, which projected that younger, healthier adults would leave the Marketplace disproportionately when facing higher premiums without enhanced subsidies.
State-by-State: Where Coverage Loss Is Worst
Marketplace plan selections declined in 41 states in 2026. The states with the largest percentage drops were North Carolina at 22%, Ohio at 20%, West Virginia at 17%, and Indiana, Delaware, and Arizona each at 16%.
A small number of states bucked the national trend. New Mexico saw an 18% increase in plan selections, largely attributed to the state’s supplemental financial assistance program that temporarily replaces the entirety of the lost federal premium assistance. State-based exchanges that had their own premium subsidy programs and more robust outreach efforts generally retained higher shares of enrollees than federally-facilitated exchanges. This state-by-state divergence illustrates that the Affordable Care Act coverage loss 2026 crisis is not uniform — it is being partially mitigated in states that chose to build independent subsidy infrastructure.
Premium Payments: Up 58% on Average
The average monthly premium payment among consumers net of tax credits rose 58% from $113 to $178 per month in 2026. KFF had previously projected that premium payments would increase by 114% on average for subsidized ACA enrollees staying in the same plan. The actual 58% increase is lower than that projection for two interconnected reasons: many enrollees downgraded to cheaper bronze plans with higher deductibles, and those facing the steepest premium increases — particularly those above the subsidy cliff — left the market at disproportionately high rates.
The share of people receiving premium tax credits fell from 92% in 2025 to 87% in 2026 — the first decline in subsidy uptake since 2020. This reflects both the loss of financial assistance eligibility for those above 400% of poverty and the disproportionate exit from the market by that population.
Deductibles: A $1,027 Per-Person Surge to a Record $3,786
The single most alarming number in KFF’s Affordable Care Act coverage loss 2026 analysis is not the enrollment drop or the premium increase. It is the deductible figure.
Average ACA Marketplace deductibles grew by over a thousand dollars per person — a 37% increase — from $2,759 in 2025 to a record high of $3,786 in 2026. This marks the steepest increase in average Marketplace deductibles ever recorded since the markets launched in 2014. The primary driver is the mass shift from silver plans to bronze plans.
The share of people selecting bronze plans increased from 30% (7.3 million people) in 2025 to 40% (9.2 million people) in 2026. Meanwhile, the share selecting silver plans fell from 57% (13.7 million people) to 43% (9.8 million people) — a record low and the first time fewer than half of ACA consumers selected a silver plan. If the distribution of plan selections had remained the same as in 2025, the average deductible would have gone up just 6% to $2,912. The additional $874 above that level is the direct cost of the mass downgrade from silver to bronze.
What a $3,786 Deductible Actually Means
A $3,786 average deductible is not abstract. It means the average ACA Marketplace enrollee in 2026 must spend $3,786 out of pocket on covered medical services before their insurance pays anything beyond preventive care. For the 9.2 million people now on bronze plans, that deductible is almost certainly higher than the $3,786 average.
For a household that selected bronze because it was the only option they could afford at the new premium level, the $3,786 deductible represents a financial exposure that effectively makes insurance unaffordable to actually use. A person who cannot afford the monthly premium on a silver plan cannot afford to meet a $3,786 deductible in a single year. The Affordable Care Act coverage loss 2026 story is not just about people who left the market — it is also about the millions who stayed but now hold coverage that provides substantially less financial protection than what they had in 2025.
The California Data: One in Five Renewers Terminated Coverage
California, the nation’s largest state-based Marketplace, provides the starkest early-year evidence of what the Affordable Care Act coverage loss 2026 looks like in the real data. The cancellation rate among consumers who renewed coverage increased roughly six percentage points from 2025 such that nearly one in five renewing consumers actively terminated their plans before the end of March or had their coverage cancelled due to nonpayment.
Maryland health officials expect that in the coming months, high premium payments will prompt even more people to either actively cancel their plans or be terminated for nonpayment. The cancellation wave is not over — it is a rolling event that will continue building through the second half of 2026 as more enrollees exhaust their ability to pay.
Broader Implications: The Largest ACA Coverage Loss Since Launch
The Affordable Care Act coverage loss 2026 data documents what happens when the policy decision is made to allow health insurance subsidies to expire. It does not happen quietly. It happens in the form of 5.8 million people losing coverage, a $1,027 average deductible increase, a $3,786 annual financial exposure that functionally prices many bronze-plan holders out of using their insurance, and a generation of young adults aged 18 to 34 — who entered the marketplace because subsidies made it affordable — leaving in disproportionate numbers. Whether Congress acts to restore some form of enhanced premium assistance before year’s end is the policy question that will determine whether 2026’s enrollment collapse is a temporary disruption or a permanent structural reset. For more on the biggest stories in health policy and consumer affairs, visit The Tech Marketer.
Latest Updates
The Affordable Care Act coverage loss 2026 data was published Tuesday, May 19. Here is where to follow the full analysis:
- KFF has the complete enrollment, premium, and deductible analysis drawing on CMS data, Wakely Consulting Group projections, and KFF survey research — including state-by-state plan selection data, income-group breakdowns, and the full demographic picture of who is losing coverage. Read more at KFF
- The Washington Post has the full national news coverage of the KFF findings, including reporting on millions expected to lose ACA coverage as costs and premiums spike, and what the enrollment collapse means for the health insurance market going forward. Read more at Washington Post
- NPR has the full audio and text report on ACA health insurance price increases in 2026, including interviews with affected enrollees and policy experts on the implications of the enhanced tax credit expiration. Read more at NPR
FAQ: Affordable Care Act Coverage Loss 2026
1. How many people are losing ACA Marketplace coverage in 2026? KFF estimates average monthly effectuated ACA Marketplace enrollment could fall to approximately 17.5 million people in 2026 — down from 22.3 million in 2025 — and could be as low as 16.5 million. That represents a potential drop of 3.8 to 5.8 million people. The decline stems from the expiration of enhanced premium tax credits at the end of 2025 that had held premiums affordable for millions of enrollees.
2. Why did ACA premiums increase so sharply in 2026? The enhanced premium tax credits established by the American Rescue Plan in 2021 and extended through 2025 by the Inflation Reduction Act expired at the end of 2025. Those credits had capped premium payments for a benchmark silver plan at 8.5% of income for people above 400% of the federal poverty level and significantly reduced premiums for lower-income enrollees. Average monthly premium payments net of tax credits rose 58% from $113 to $178 per month when the enhancements expired.
3. Why have ACA deductibles hit a record high in 2026? Average ACA Marketplace deductibles surged 37% from $2,759 to a record $3,786 in 2026 — a $1,027 per-person increase and the steepest single-year rise since the ACA Marketplaces launched in 2014. The primary driver is a mass shift from silver plans (which have moderate premiums and reduced deductibles for lower-income enrollees) to bronze plans (which have lower premiums but much higher deductibles). The share of enrollees selecting bronze plans rose from 30% to 40%.
4. Who is most affected by ACA coverage loss in 2026? Two groups are bearing disproportionate shares of the loss. Consumers with incomes between 400% and 500% of the federal poverty level — who lost subsidy eligibility entirely — made up just 3% of 2025 enrollment but accounted for 27% of the sign-up decline. Young adults ages 18 to 34 accounted for 46% of the total enrollment decline, dropping 542,000 sign-ups, as healthier younger consumers left the market when premiums rose.
5. Which states saw the biggest drops in ACA Marketplace enrollment in 2026? Marketplace plan selections declined in 41 states in 2026. The largest percentage drops were in North Carolina (down 22%), Ohio (down 20%), West Virginia (down 17%), and Indiana, Delaware, and Arizona (each down 16%). New Mexico bucked the trend with an 18% increase in plan selections, attributed to a state supplemental assistance program that replaced the lost federal premium subsidy.
