How might carriers respond to drop in ACA enrollment?

By Susan Rupe

More than 1 million fewer people enrolled in Affordable Care Act marketplace coverage in 2026 than in 2025, and that number is expected to increase as the year progresses.

Enrollment data from the Centers for Medicare and Medicaid Services show that approximately 23 million people were enrolled in ACA coverage for 2026, down from 24.2 million in 2025. However, KFF said that many who signed up for coverage may end up dropping it after failing to pay higher premiums that took effect this year.

When enhanced ACA premium tax credits expired at the end of 2025, many ACA enrollees face sharply rising out-of-pocket costs. This is leading people to either drop coverage or enroll in plans with lower premiums but higher deductibles.

Gross premiums on the ACA marketplace are up about 20%–22% on average, the Commonwealth Fund reported. What people actually pay after the tax credits are applied is up about $1,000 more per year, or an average increase of about 114%, according to KFF.

Some fear that if millions of healthy individuals leave the ACA marketplace, it could trigger a chain reaction that could push premiums higher for those who remain insured.

The result is a risk pool that becomes older, sicker and significantly more expensive to insure, placing upward pressure on pricing across the broader insurance system.

Cristin Bishop Hopkin is chief operating officer and insurance expert for The Brokerage Inc., a field marketing organization for life and health insurance. She told InsuranceNewsNet that she expects carriers who sell products on the ACA marketplace to begin adjusting their offerings to attract younger, healthier consumers into the risk pool.

“When premiums go up in price, healthy people in the 26- to 40-year-old age range are those most likely to give up their coverage,” she said. “It’s unfortunate, but you just give up your coverage, especially those in this age group, who are saving for their first home or trying to pay their school loans.”

Hopkin said she believes carriers in the ACA space “will go back to their drawing boards and bring out new plans.

“I think the actuaries are saying, We have to come up with alternate solutions to the ACA, and we have to be able to bring more out to the marketplace. I think we'll start to see more different products, not necessarily within the ACA realm. I think we'll start to see more private plans become available.”

Some ACA alternative plans could emerge

Proposed federal regulations announced earlier this month would certify some non-network health plans as qualified health plans under the ACA. In addition, CMS wants to allow insurers to offer catastrophic coverage in one-year terms or in longer terms of consecutive years, up to 10. The agency also proposes to rethink hardship exemptions for certain individuals over age 30, allowing more people to choose a catastrophic plan if they want to.

The proposed rule further aims to expand affordable options by allowing for plans that include lower deductibles but higher out-of-pocket maximums.

“I think we'll start to see more carriers coming out with different types of plans that are available to fill the gaps,” Hopkin said. “Maybe someone was on a gold ACA plan previously, but because the premiums went up, have to drop down to a bronze plan, and so they just don't have as much coverage. What an insurance agent is really good at doing is going in there and telling a client, ‘You have all these gaps. Now let's take these other private plans and fill those gaps with cancer plans or hospital indemnity or other types of products that are out there.

“I definitely think carriers will start to come out with more of those to fill the gaps for these clients.”

Susan Rupe is editor in chief, magazine, for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].