Affordable Care Act enrollment is dropping sharply after enhanced premium tax credits expired at the end of 2025. Georgia saw a 28% drop in premium payments in April 2026 versus April 2025. Wakely Consulting Group estimates average 2026 enrollment will be 17% to 26% lower than 2025. Premiums increased 26% on average while deductibles grew 37%, from $2,759 to $3,786, the steepest increase in history.
ACA enrollment decline
- ▪Wakely Consulting Group estimates that average Affordable Care Act enrollment will end up being 17% to 26% lower in 2026 than in 2025
- ▪Affordable Care Act sign-ups were down in January 2026 by about 1.2 million from the 2025 record enrollment
- ▪Michelle Anderson is a director at Wakely Consulting Group and co-author of a May 2026 report on Affordable Care Act enrollment trends
- ▪Approximately 23 million people enrolled in the Affordable Care Act for 2026
Premium payment failure rates
- ▪States served by the federal Affordable Care Act marketplace had premium payment rates of 82% to 84% in January 2026
- ▪New Mexico was the only state in Charles Gaba's sample that saw an increase in the percentage of people making Affordable Care Act premium payments in 2026
- ▪New Jersey had an 11.6% premium payment failure rate as of April 2026
- ▪Georgia saw a 28% drop in people paying Affordable Care Act premiums in April 2026 compared with April 2025
- ▪States that run their own Affordable Care Act exchanges had a 92% premium payment rate in January 2026
- ▪NOTUS reported on May 12, 2026 that internal Centers for Medicare & Medicaid Services data showed roughly 21% of people using the federal Affordable Care Act marketplace in 30 states failed to pay their share of January 2026 premiums
- ▪Washington state had a 15.7% premium payment failure rate as of February 2026
- ▪New Mexico set aside state money to fully make up for lower federal Affordable Care Act subsidy amounts in 2026
- ▪An average 86% of Affordable Care Act enrollees made their first premium payment in January 2026, according to Wakely Consulting Group analysis of data from 75 insurers
Premium increases
- ▪Affordable Care Act enrollees faced premiums that increased on average by 26% in 2026
Deductible increases
- ▪A KFF analysis released on May 19, 2026 found that the average Affordable Care Act plan deductible grew by 37% or over $1,000, from $2,759 in 2025 to $3,786 in 2026
- ▪Sign-ups for bronze-level Affordable Care Act plans jumped from 30% to 40% of total plan selections, growing from 7.3 million in 2025 to 9.2 million people in 2026
Insurer rate projections
- ▪Many of the Trump administration's proposed 2027 Affordable Care Act changes were approved with some modifications, including allowing for higher annual deductibles in some types of coverage
- ▪Michelle Anderson of Wakely Consulting Group does not expect an average 26% premium increase for 2027 like the one seen in 2026
- ▪The Trump administration released the initial 2027 Affordable Care Act proposal in mid-February 2026 and did not finalize it until May 15, 2026
- ▪Michelle Anderson of Wakely Consulting Group expects ongoing uncertainty and predicted decline in Affordable Care Act enrollment to play a role in setting 2027 premium rates
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