Between Nov. 1 and Jan. 3, 22.8 million people signed up for 2026 individual Affordable Care Act Marketplace health insurance coverage, according to the latest update from the Centers for Medicare & Medicaid Services (CMS).
That includes 15.6 million Marketplace plan selections in the 30 states using the HealthCare.gov platform for the 2026 plan year and 7.2 million plan selections in the 20 states and the District of Columbia with state-based exchanges (SBEs) that are using their own eligibility and enrollment platforms. Total nationwide plan selections include 2.8 million consumers who are new to Marketplace coverage for 2026.
At this time last year, almost 23.6 million consumers had open-enrolled in Marketplace coverage — including 3.2 million new enrollees.
Last week, members of the U.S. House passed an ACA premium subsidy bill — despite opposition from House Republican leadership — that would keep the temporary high-level of premium subsidies in place beyond 2025 for three more years. The loss of the subsidy boost caused the average exchange plan user's out-of-pocket cost for premiums to double, and it pushed out-of-pocket costs for some older, higher-income families to more than $40,000 per year, from about $7,000 per year in 2025.
The House needs support from a two-thirds majority in the Senate in order for the bill to advance. President Donald Trump has indicated he “might” sign the bill if it crosses his desk.
One open question is what will happen when the people who signed up for the 2026 coverage start getting bills and have to pay for the coverage.
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