Updated November 2026, using final 2026 Open Enrollment data. 23,130,860 people selected a plan on the Affordable Care Act (ACA) Marketplaces for 2026, down from 24,319,713 in 2025, the first large decline since the Marketplaces opened. Plan selections fell in 41 states and rose in nine states and the District of Columbia. The expanded premium tax credits that had lowered premiums since 2021 expired at the end of 2025, and the average premium consumers paid after tax credits rose from $113 to $178 a month.
The table below shows, for every state, 2026 and 2025 plan selections, the share of enrollees receiving a premium tax credit, the average full premium and the average premium after tax credits. The data come from the Centers for Medicare & Medicaid Services (CMS) 2026 Open Enrollment State-Level Public Use File.
Key Findings
- Largest declines: North Carolina (-21.9%), Ohio (-19.5%), West Virginia (-16.7%), Indiana (-16.5%), Delaware (-15.6%).
- Where enrollment grew: New Mexico (+18.1%), District of Columbia (+7.5%), Texas (+5.2%), Massachusetts (+3.7%), Connecticut (+3.7%), Maryland (+3.4%), Rhode Island (+3.2%), Idaho (+2.6%), Louisiana (+1.2%), Pennsylvania (+1.0%).
- Largest Marketplaces: Florida (4,538,772), Texas (4,172,233), California (1,927,371), Georgia (1,324,295), North Carolina (761,457).
- Net premiums rose 58%. The average monthly premium after tax credits went from $113 to $178. The average full premium, before tax credits, rose from $619 to $741.
- More bronze plans. Bronze selections rose from 30% to 40% of plans nationally, and the average deductible rose 37%, to $3,786, according to KFF.
What Changed in 2026
From 2021 through 2025, expanded premium tax credits capped benchmark premiums at 8.5% of income for higher earners and made many plans free for lower-income enrollees. When Congress let them expire, people above 400% of the federal poverty level (FPL) lost tax credits altogether, and everyone else paid a larger share of income. KFF found enrollees above 400% FPL accounted for 27% of the 2026 decline, and young adults ages 18 to 34 for 46%.
Plan selections are not the same as paid coverage. A plan selection counts once a consumer picks a plan; coverage starts only after the first premium is paid. KFF estimates average paid (effectuated) Marketplace enrollment could fall to about 17.5 million in 2026, from 22.3 million in 2025. CMS publishes effectuated enrollment later in the year.
ACA Marketplace Plan Selections and Premiums by State, 2026
“HC.gov” states use HealthCare.gov; “SBE” states run their own exchange. Premiums are monthly averages across all plan selections. Blank cells were suppressed by CMS.
| State | Exchange | Plan Selections 2026 | Plan Selections 2025 | Change | New Consumers 2026 | Share With Tax Credit | Avg. Premium Before Credit | Avg. Net Premium 2025 | Avg. Net Premium 2026 |
|---|---|---|---|---|---|---|---|---|---|
| Alabama | HC.gov | 455,776 | 477,838 | -4.6% | 60,346 | 91% | $743 | $65 | $126 |
| Alaska | HC.gov | 26,079 | 28,736 | -9.2% | 4,584 | 74% | $1,043 | $223 | $344 |
| Arizona | HC.gov | 357,144 | 423,025 | -15.6% | 56,742 | 83% | $688 | $113 | $229 |
| Arkansas | HC.gov | 160,307 | 166,639 | -3.8% | 29,746 | 87% | $839 | $124 | $162 |
| California | SBE | 1,927,371 | 1,979,504 | -2.6% | 235,055 | 82% | $737 | $187 | $264 |
| Colorado | SBE | 277,238 | 282,481 | -1.9% | 37,335 | 69% | $673 | $205 | $318 |
| Connecticut | SBE | 156,745 | 151,151 | +3.7% | 26,902 | 79% | $1,030 | $223 | $277 |
| Delaware | HC.gov | 44,663 | 52,931 | -15.6% | 6,758 | 81% | $901 | $217 | $320 |
| District of Columbia | SBE | 16,053 | 14,930 | +7.5% | 3,522 | 19% | $815 | $610 | $725 |
| Florida | HC.gov | 4,538,772 | 4,735,415 | -4.2% | 725,149 | 95% | $806 | $67 | $106 |
| Georgia | SBE | 1,324,295 | 1,510,852 | -12.3% | 192,032 | 89% | $777 | $74 | $164 |
| Hawaii | HC.gov | 23,380 | 24,606 | -5.0% | 4,130 | 71% | $778 | $252 | $372 |
| Idaho | SBE | 120,426 | 117,373 | +2.6% | 15,959 | 76% | $509 | $129 | $202 |
| Illinois | SBE | 448,568 | 465,985 | -3.7% | 74,773 | 85% | $816 | $190 | $230 |
| Indiana | HC.gov | 300,049 | 359,240 | -16.5% | 42,907 | 83% | $623 | $120 | $222 |
| Iowa | HC.gov | 123,304 | 136,833 | -9.9% | 17,687 | 76% | $615 | $141 | $235 |
| Kansas | HC.gov | 192,811 | 200,046 | -3.6% | 26,335 | 89% | $779 | $106 | $160 |
| Kentucky | SBE | 89,028 | 97,374 | -8.6% | 15,624 | 80% | $797 | $180 | $288 |
| Louisiana | HC.gov | 296,648 | 292,994 | +1.2% | 31,342 | 91% | $759 | $72 | $144 |
| Maine | SBE | 58,523 | 64,678 | -9.5% | 8,577 | 74% | $913 | $245 | $340 |
| Maryland | SBE | 255,612 | 247,243 | +3.4% | 47,815 | 67% | $542 | $184 | $284 |
| Massachusetts | SBE | 403,624 | 389,191 | +3.7% | 56,744 | 72% | $594 | $198 | $325 |
| Michigan | HC.gov | 497,064 | 531,083 | -6.4% | 64,637 | 81% | $657 | $131 | $222 |
| Minnesota | SBE | 139,251 | 151,512 | -8.1% | 24,417 | 50% | $639 | $307 | $437 |
| Mississippi | HC.gov | 313,392 | 338,159 | -7.3% | 62,394 | 95% | $816 | $41 | $131 |
| Missouri | HC.gov | 365,734 | 417,000 | -12.3% | 46,284 | 87% | $724 | $91 | $173 |
| Montana | HC.gov | 73,255 | 77,221 | -5.1% | 10,443 | 78% | $729 | $151 | $230 |
| Nebraska | HC.gov | 128,492 | 136,684 | -6.0% | 14,833 | 87% | $800 | $114 | $217 |
| Nevada | SBE | 104,286 | 110,687 | -5.8% | 20,911 | 82% | $659 | $152 | $234 |
| New Hampshire | HC.gov | 66,024 | 70,337 | -6.1% | 11,751 | 56% | $553 | $230 | $342 |
| New Jersey | SBE | 509,192 | 513,217 | -0.8% | 77,970 | 82% | $734 | $179 | $277 |
| New Mexico | SBE | 83,103 | 70,373 | +18.1% | 12,863 | 82% | $842 | $152 | $299 |
| New York | SBE | 210,704 | 221,534 | -4.9% | 31,868 | 43% | $812 | $532 | $636 |
| North Carolina | HC.gov | 761,457 | 975,110 | -21.9% | 125,794 | 87% | $755 | $97 | $180 |
| North Dakota | HC.gov | 41,014 | 42,901 | -4.4% | 5,230 | 78% | $591 | $145 | $229 |
| Ohio | HC.gov | 469,616 | 583,443 | -19.5% | 73,309 | 83% | $665 | $126 | $233 |
| Oklahoma | HC.gov | 261,887 | 307,989 | -15.0% | 33,769 | 91% | $727 | $78 | $161 |
| Oregon | HC.gov | 118,372 | 139,688 | -15.3% | 16,801 | 60% | $741 | $272 | $426 |
| Pennsylvania | SBE | 501,459 | 496,661 | +1.0% | 81,373 | 80% | $742 | $187 | $251 |
| Rhode Island | SBE | 43,446 | 42,117 | +3.2% | 9,818 | 82% | $649 | $155 | $246 |
| South Carolina | HC.gov | 587,567 | 631,948 | -7.0% | 84,654 | 89% | $655 | $73 | $139 |
| South Dakota | HC.gov | 50,951 | 54,721 | -6.9% | 6,685 | 83% | $684 | $125 | $211 |
| Tennessee | HC.gov | 569,310 | 642,867 | -11.4% | 92,921 | 90% | $838 | $72 | $141 |
| Texas | HC.gov | 4,172,233 | 3,966,226 | +5.2% | 764,316 | 93% | $709 | $57 | $89 |
| Utah | HC.gov | 387,336 | 421,890 | -8.2% | 46,063 | 90% | $571 | $70 | $120 |
| Vermont | SBE | 30,344 | 32,862 | -7.7% | 2,492 | 77% | $1,090 | $220 | $364 |
| Virginia | SBE | 370,086 | 388,856 | -4.8% | 58,469 | 78% | $575 | $135 | $215 |
| Washington | SBE | 290,109 | 308,227 | -5.9% | 51,635 | 64% | $738 | $288 | $343 |
| West Virginia | HC.gov | 55,879 | 67,113 | -16.7% | 6,922 | 89% | $1,314 | $101 | $208 |
| Wisconsin | HC.gov | 291,336 | 313,579 | -7.1% | 39,582 | 78% | $784 | $167 | $250 |
| Wyoming | HC.gov | 41,545 | 46,643 | -10.9% | 5,503 | 87% | $1,217 | $134 | $235 |
| United States | 23,130,860 | 24,319,713 | -4.9% | 3,603,771 | 87% | $741 | $113 | $178 |
Some states changed exchange platforms between years, and Georgia moved from HealthCare.gov to its own exchange, Georgia Access, in 2025. Plan selections include people who were automatically re-enrolled.
What To Do If Your Premium Went Up
- Update your income on your Marketplace application; a lower estimate can raise your tax credit.
- Compare a silver plan with cost-sharing reductions against bronze before you switch, because the deductible gap can be thousands of dollars.
- Check whether you now qualify for Medicaid or the Children’s Health Insurance Program (CHIP).
- Look for a special enrollment period if you lose job-based coverage, move or have a baby.
- Get free help from a Marketplace navigator; HealthCare.gov lists local assisters.
For insurer news and premium filings, follow our Health Insurance Coverage hub. Insurers that left or entered Marketplaces are listed in our List of Health Insurance Companies, and claim denial rates for each HealthCare.gov insurer are in our claim denial rankings.
Source
CMS, 2026 and 2025 Open Enrollment Period State-Level Public Use Files; KFF, “What We Know So Far About 2026 ACA Marketplace Enrollment, Premiums, and Deductibles” (May 2026). Change figures are Health Plan News calculations.