The Centers for Medicare & Medicaid Services reports that 23.1 million Americans enrolled in health insurance through the Health Insurance Exchanges during the 2026 open enrollment period, maintaining near-record levels despite CMS terminating coverage for nearly 1.5 million people in 2025 due to ineligibility or unauthorized enrollment. Plan selection patterns shifted significantly, with Bronze plan enrollment jumping 10 percentage points to 40% while Silver plans dropped nearly 14 percentage points to 43%, suggesting consumers prioritized lower premiums. Nearly half of all enrollees had household incomes between 100-150% of the federal poverty level and received financial assistance. Illinois transitioned to a State-Based Exchange and the District of Columbia launched a Basic Health Program for 2026, reflecting continued evolution in how states manage health insurance marketplaces.
2026 Enrollment Figures and Program Stability
- ▪The District of Columbia launched a Basic Health Program for the 2026 Open Enrollment Period
- ▪Illinois transitioned to a State-Based Exchange for the 2026 Open Enrollment Period
- ▪The Health Insurance Exchanges 2026 Open Enrollment Report summarizes plan selection activity for plan year 2026 across the individual Exchanges in all 50 states and the District of Columbia
- ▪The Centers for Medicare & Medicaid Services plans to release 2026 Effectuated Enrollment data in spring 2026
- ▪23.1 million consumers selected or were automatically re-enrolled in coverage through HealthCare.gov and State-Based Exchanges during the 2026 Open Enrollment Period
- ▪The Centers for Medicare & Medicaid Services released the Health Insurance Exchanges 2026 Open Enrollment Report on March 27, 2026
CMS Fraud Prevention and Enforcement Actions
- ▪The Centers for Medicare & Medicaid Services ended advance payment of the premium tax credit or coverage for nearly 1.5 million people in 2025
- ▪The nearly 1.5 million people who had advance payment of the premium tax credit or coverage ended were found to be either ineligible for financial assistance or enrolled without their authorization on the HealthCare.gov platform
- ▪The Centers for Medicare & Medicaid Services took significant enforcement action in 2025 to identify and remove improper enrollments
Plan Selection Shifts and Affordability Trends
- ▪The Health Insurance Exchanges 2026 Open Enrollment Report includes a six-year overview of insurance agent- and broker-assisted enrollments for HealthCare.gov states for the first time
- ▪Nearly half of enrollees in the 2026 Open Enrollment Period had household incomes between 100-150% of the federal poverty level
- ▪Bronze plan enrollment increased by 10 percentage points compared to the 2025 Open Enrollment Period
- ▪The vast majority of enrollees with household incomes between 100-150% of the federal poverty level received financial assistance
- ▪Data on Health Savings Account-eligible plan selections became available to the public due to policy changes from the Working Families Tax Cut legislation
- ▪40% of enrollees in the 2026 Open Enrollment Period selected Bronze plans
Perspective of Centers for Medicare & Medicaid Services
- ▪CMS's 2025 enforcement actions to remove improper enrollments improved the integrity of the HealthCare.gov platform
- ▪The 23.1 million enrollment figure for 2026 demonstrates continued stability in the Health Insurance Exchanges marketplace
Perspective of State-Based Exchanges
- ▪Illinois's transition to a State-Based Exchange for 2026 represents an expansion of state-level control over health insurance marketplaces
Perspective of Lower-income enrollees
- ▪The 10 percentage point increase in Bronze plan enrollment for 2026 suggests cost-conscious consumers prioritized lower premiums over comprehensive coverage
- ▪Enrollees with household incomes between 100-150% of the federal poverty level rely heavily on financial assistance to afford Health Insurance Exchange coverage
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