As expected, the expiration of the Affordable Care Act's premium tax credits at the end of 2025 has had a significant impact on both enrollment and affordability.
After the credits ended, many Marketplace shoppers shifted toward lower-premium, higher-deductible plans, according to KFF research. Between 2025 and 2026, sign-ups for bronze plans jumped from 30% to 40% of total plan selections, growing from 7.3 million to 9.2 million people.
Meanwhile, sign-ups for silver Marketplace plans, which have higher premiums and lower cost-sharing, hit the lowest levels in the program's history. Silver plan sign-ups fell from 57% to a record-low 43%, dropping from 13.7 million to 9.8 million people. The share of Marketplace enrollees who signed up for cost-sharing reduction silver plans, which reduce out-of-pocket costs for deductibles, copayments and coinsurance for lower-income enrollees, also fell 37%, which is the lowest level on record.
However, researchers cautioned that the data are incomplete and could change.
"All the information available so far on the demographics of people who left the ACA Marketplace and the increase in premium payments and deductibles is based on plan selections, not effectuated enrollment," according to KFF. "Even among those who do effectuate coverage, some could lose it during the year if they cannot afford to continue their premium payments. As a result, a complete picture of how the expiration of enhanced premium tax credits reshaped who has coverage and what kind of plan they hold may not be available for some time."
KFF reached these conclusions based on currently available data:
- Based on reports to date of sign-ups and premium payments, average monthly effectuated ACA Marketplace enrollment could fall to about 17.5 million people in 2026 and could be as low as 16.5 million people, down from 22.3 million people in 2025.
- A disproportionately large share of the drop in sign-ups (27%) is among people with incomes just above the "subsidy cliff" (between 400% and 500% of the federal poverty line), despite this group making up just 3% of plan selections in 2025.
- Premium payments from enrollees increased by an average of 58%, from $113 to $178 per month. This is lower than the 114% increase KFF projected if everyone had stayed in the same plan, because many people switched to higher-deductible plans and because those just past the subsidy cliff with the steepest increases dropped ACA coverage at higher rates. Additionally, the 114% increase was among people receiving a tax credit, while the 58% increase is among all consumers.
- Average ACA Marketplace deductibles increased by 37% (or $1,027 a person) to a record high of $3,786 in 2026. This is the steepest increase in deductibles ever seen in this market and largely reflects the shift from silver plans with reduced deductibles for lower-income enrollees to bronze plans with very high deductibles.
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