ACA coverage fell in 2026 as subsidies expired, with Florida hit hardest

Affordable Care Act Marketplace coverage declined sharply in 2026 after enhanced premium tax credits expired, with Florida recording the largest numerical loss in the nation.

Florida still had just over 3.8 million Marketplace enrollees, more than any other state, but about 443,000 fewer people had ACA coverage than a year earlier, according to an Associated Press analysis of federal data. The state’s experience illustrates the broader affordability pressure facing people who buy health insurance on their own.

What the federal data shows

The Centers for Medicare & Medicaid Services reported that 23.1 million consumers selected or were automatically re-enrolled in 2026 Marketplace plans. That included 15.8 million people through HealthCare.gov and 7.4 million through state-based exchanges.

Those figures are plan selections, not a final count of people who maintained active coverage. Consumers generally must pay their first premium before coverage takes effect, and some selections or automatic re-enrollments do not become lasting coverage.

CMS said total plan selections fell 5% from the 2025 enrollment period. HealthCare.gov selections fell 8%, while selections through state-based exchanges held comparatively steady at 7.4 million, up from 7.2 million in 2025.

Using federal data that tracks whether consumers paid premiums and retained coverage, the AP found that about 2.6 million fewer Americans had ACA plans in February 2026 than in February 2025. The data does not show whether every person who left the Marketplace became uninsured. Some may have moved to employer coverage, Medicaid, CHIP or another option.

Why Florida stands out

Florida’s loss was the largest in raw numbers because the state has the country’s largest Marketplace population. AP reported that Florida’s reliance on ACA coverage is tied in part to its lack of Medicaid expansion and its large populations of construction, hospitality, small-business and other workers without traditional employer coverage.

Other states saw steeper percentage declines. Ohio and Oklahoma each lost more than 32% of their Marketplace enrollees, the largest share reductions in the AP’s analysis. Florida’s significance comes from the size of its remaining enrollment and the roughly 443,000-person drop.

What changed after 2025

The enhanced premium tax credits that began in 2021 expired at the end of 2025 and were not renewed by Congress. KFF says many Marketplace enrollees therefore received less financial assistance for 2026, while some no longer qualified for a premium tax credit at all.

That can raise monthly costs even when the underlying plan is unchanged. Consumers may respond by dropping coverage, choosing a cheaper plan with higher deductibles and copayments, or looking for coverage elsewhere. CMS reported that the average monthly premium for 2026 plan selections was $619 before tax credits and $178 after credits.

CMS has also pointed to enforcement actions as another factor in the decline. The agency said it ended advance premium-tax-credit payments or coverage for nearly 1.5 million people in HealthCare.gov states who were found to be ineligible for assistance or enrolled without authorization. Analysts and state officials cited by AP said affordability, particularly the loss of subsidies, was a major driver as well.

Why 2027 could bring more pressure

The next affordability test is already emerging. KFF’s analysis of publicly available insurer filings found a median proposed premium increase of 15% for ACA Marketplace plans in 2027. The figure is based on proposed rates, not final decisions, and approved rates may differ.

Insurers cited rising health care prices, general inflation and labor shortages among the drivers of proposed increases. KFF also said insurers pointed to the expiration of enhanced premium tax credits and changes in the health of the individual-market risk pool.

What consumers can do

Marketplace consumers should compare plans rather than automatically renewing the prior year’s selection. Open Enrollment runs from November 1 through January 15. Updating income and household information can affect eligibility for financial assistance, and people who lose coverage outside the enrollment period may qualify for a Special Enrollment Period.

A lower-premium replacement plan may carry higher deductibles, copayments or narrower provider networks. People who no longer qualify for Marketplace assistance should also check whether employer coverage, Medicaid or CHIP is available to them.

Sources

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