People are paying significantly more for healthcare insurance following the expiration of enhanced premium tax credits for plans offered on the Affordable Care Act's Marketplace, according to new data from KFF.
Examining CMS and state-based Marketplace Open Enrollment reports, KFF reported a 37% increase in the average deductible for an ACA Marketplace plan. That translated into an increase of $1,027 per person, bringing the average cost to a record high of $3,786.
This is the steepest increase in ACA Marketplace deductibles ever, KFF stated.
More people getting health insurance through the Marketplace signed up for bronze plans this year after Congress did not extend enhanced premium tax credits that made premium prices cheaper. Bronze plans have lower premiums overall but higher deductibles.
Specifically, the share of people enrolling in bronze plans in 2026 increased to 9.2 million, or 40% of Marketplace enrollees, from 7.3 million, or 30%, in 2025. Meanwhile, the share of people selecting silver plans this year dropped to 9.8 million, or 43% of Marketplace enrollees, from 13.7 million, or 57%, in 2025.
Gold plan participation also increased this year, rising to 4.0 million people in 2026 from 3.2 million the previous year.
But silver plan enrollment is at an all-time low, KFF said, as this is the first time fewer than half of all ACA consumers selected a silver plan. These plans sit in middle of the metal tiers, providing moderate monthly premiums and offering consumers savings based on income.
This shift in Marketplace plan type is largely responsible for the increase in deductibles this year. If the distribution across the metal levels had stayed the same as last year, for example, the average deductible would have increased by just 6%, KFF said.
Marketplace enrollment plummets
However, many ACA Marketplace consumers are struggling to afford healthcare insurance without premium assistance. The enhanced premium tax credits had boosted subsidies for Marketplace consumers since 2021 by expanding eligibility to middle- and even some upper-income Americans.
The enhanced premium tax credits were a central issue in government funding fights over the past year. However, Congress allowed the temporary assistance to expire at the end of 2025, although lawmakers continue to push for a multi-year extension.
Now, about 87% of ACA Marketplace enrollees receive premium tax credits, down from 92% of enrollees in 2025.
The expiration has also affected ACA Marketplace enrollment, with KFF reporting a 23.1 million drop in plan sign-ups during the 2026 Open Enrollment Period. This was the sharpest single-year drop in enrollment ever, they said.
More losses are also likely, since the data did not account for enrollees who were automatically renewed. Some of these people will not pay their premiums, KFF explained, leading to mid-year attrition.
Already, fewer people paid their first month's premium, according to Wakely Consulting Group, which collaborated with KFF. They found that about 86% of people in the individual market paid in January 2026, down from over 90% in 2025. Although there was significant variation across states.
Wakely estimates that average effectuated enrollment in the individual market will decline by 17% to 26% through 2026.
How the expiration of enhanced subsidies affects enrollment
The numbers are not wholly unexpected, though. The Congressional Budget Office projected about a 25% decline in ACA Marketplace enrollment following the expiration of the enhanced premium tax credits.
More ACA Marketplace enrollees making over 400% of the federal poverty line are dropping coverage, the data indicated. These people were previously eligible for premium assistance, with payments for a benchmark silver plan capped at 8.5% of their income.
These enrollees accounted for only 7% of 2025 enrollment but nearly half of the decline in plan selections this year, KFF stated.
Lower-income consumers who still receive premium assistance also accounted for a large share of the enrollment decline. Sign-ups for those with incomes below 150% FPL dropped by about 4% compared to last year, while those with incomes between 150% and 250% FPL accounted for 30% of the drop in sign-ups.
This is just a sketch of ACA Marketplace enrollment this year, KFF explained. A more complete picture is still to come, they said. CMS will publish effectuated enrollment data later this year, although even that information will not be whole as returning enrollees have until late March to make premium payments.
Determining exactly how the expiration of the premium tax credits affected ACA Marketplace enrollment could take some time, KFF said. However, major payers, including Elevance Health and Centene, are already reporting significant attrition in their Marketplace enrollees in the first quarter.
Cigna and Aetna also announced over the last month that they are exiting the ACA Marketplace, while UnitedHealthcare plans to pull back from the market.
This massive retreat from the ACA Marketplace will disrupt the market, increase out-of-pocket costs and reduce provider choice for consumers. Reduced competition could also result in higher premiums, especially without subsidies to shield consumers.
Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.
