ACA Marketplace Plans Shift Toward Higher Deductibles in 2026
The Affordable Care Act Marketplace recorded 23.1 million plan selections or automatic re-enrollments for 2026, but the mix of coverage changed sharply. More consumers selected bronze plans, which generally have lower monthly premiums but higher deductibles, while silver-plan selections fell below half of the market for the first time.
The Centers for Medicare & Medicaid Services released its 2026 Open Enrollment Report on March 27. It covers plan-selection activity through the HealthCare.gov platform and state-based exchanges in all 50 states and the District of Columbia. The report counted about 1.2 million fewer selections than in 2025, a decline of 5%.
Selections are not the same as active coverage
The 23.1 million figure represents consumers who selected a plan or were automatically re-enrolled. It does not mean that all of those consumers paid their premiums and maintained active coverage.
CMS said effectuated-enrollment data, which reflects coverage after premiums are paid, would be released later. Consumers can select a plan, fail to pay the first premium or stop paying during the year.
KFF’s analysis, drawing on enrollment and premium-payment information as well as estimates from Wakely Consulting Group, projected that average effectuated Marketplace enrollment could fall to about 17.5 million people in 2026, with a possible range as low as 16.5 million. That is an estimate, not a final federal count.
Bronze gained ground while silver lost share
CMS reported that bronze plans accounted for 40% of 2026 selections, up from 30% in 2025. Silver plans fell from 56% to 43%, while gold plans rose from 13% to 17%.
The change followed the expiration of enhanced premium tax credits at the end of 2025. Those credits, first established by the American Rescue Plan and later extended through 2025 by the Inflation Reduction Act, had lowered premium obligations for many Marketplace households. When the enhanced credits expired, some consumers moved to plans with lower monthly premiums, while others selected richer gold coverage or left the Marketplace.
Subsidy expiration was not the only factor affecting the 2026 total. CMS also said it ended advance premium tax credits or coverage for nearly 1.5 million people on the HealthCare.gov platform after identifying ineligible or unauthorized enrollments. Those program-integrity actions are separate from the expiration of the enhanced credits.
Plan availability, household income, state policies, insurer pricing and expectations about medical care also affect a consumer’s choice. Bronze plans generally have lower premiums, but they can require people to pay more before the plan begins covering many services. A lower premium does not necessarily mean a lower overall cost for someone who needs substantial care.
Average deductibles rose by more than $1,000
KFF found that the average Marketplace deductible increased 37%, from $2,759 in 2025 to $3,786 in 2026. That is an increase of $1,027 per person.
KFF also found that average monthly premium payments rose 58%, from $113 to $178. The figures include consumers with and without premium tax credits. The increase was lower than the 114% rise KFF projected for tax-credit recipients who stayed in the same plans because many consumers moved into higher-deductible plans and some people facing the largest increases dropped Marketplace coverage.
That tradeoff can make a plan easier to fit into a monthly budget while exposing a household to greater costs after a diagnosis, hospital visit, prescription change or other substantial use of care.
Why silver plans can matter for lower-income households
Metal levels are not a simple ranking of quality. They describe how a plan generally divides expected medical costs between the insurer and the enrollee. Bronze plans generally cover a smaller share of expected costs, while gold plans generally cover more. Silver plans fall between them, but they can provide especially valuable help to people who qualify for cost-sharing reductions.
Cost-sharing reductions lower deductibles, copayments and coinsurance for eligible consumers who choose a silver plan. They are different from premium tax credits and generally are available only when an eligible consumer selects a silver plan.
CMS reported that 37% of 2026 Marketplace selections included cost-sharing reductions, down from the prior year as silver-plan selections declined. Consumers who may qualify should check specifically whether a silver plan with these added protections is available before choosing bronze based only on its monthly price.
What Marketplace consumers should check
- Compare the annual premium with the deductible, expected copayments and coinsurance.
- Review the annual out-of-pocket maximum. It limits covered in-network spending but does not eliminate premiums or every possible charge.
- Confirm that doctors, hospitals and prescriptions are included in the plan’s network and formulary.
- Check whether the household qualifies for premium tax credits or cost-sharing reductions.
- Update income estimates carefully. Premium tax credits are tied to household income and may be reconciled on a federal tax return.
- If a premium becomes difficult to pay, contact the Marketplace or insurer promptly. Unpaid premiums can lead to a loss of coverage.
CMS reported that 87% of 2026 selections included advance premium tax credits, while 37% included cost-sharing reductions. Later effectuated-enrollment data should show how many selections became paid, active coverage and how much enrollment declined during the year.
For now, the enrollment total shows continued demand for Marketplace coverage. The plan mix shows the pressure many consumers are facing: keeping the monthly premium manageable may mean accepting greater financial exposure when medical care is needed.
Sources
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