Nevada sees drop in health insurance marketplace enrollment as subsidies lapse

The number of Nevadans enrolled in Affordable Care Act plans has fallen 12.5 percent in the months since an open enrollment period closed this January — a dropoff that's double what the state saw last year and suggests higher prices and reduced subsidies were too much for some consumers to afford.

Nevada — and the country at large — are experiencing a decline in enrollment in the marketplace created through Obamacare. Nationally, there was a 13 percent drop as about 3 million fewer people in the U.S. had Obamacare marketplace health insurance plans in February compared with the same time last year. For Nevada, that change was 6 percent from February 2025 to February 2026.

In the report released in late June, the U.S. Department of Health and Human Services suggested the drop could be attributed to a federal crackdown on fraudulent or "phantom" enrollment. But health analysts said it was more likely related to the Jan. 1 expiration of federal subsidies that caused a surge in plan costs, resulting in many people being unable to pay their premiums.

"We know that real people lost their health insurance coverage," said Cynthia Cox, a vice president and director of the ACA program at the healthcare research nonprofit KFF, citing survey findings on people who had left their plans. "This coverage loss happened at the same time millions of people faced double or even triple digit increases in their premium payments."

Data from Nevada Health Link shows that the average net premiums for subsidized enrollees increased by $82 from 2025 to 2026. While state officials said they cannot point to a single cause, the enrollment declines come as costs have increased.

"The biggest change within the ACA over the last year has been the expiration of the enhanced federal tax subsidies that were available," said Jennifer Krupp of Nevada Health Link, noting that some consumers are now facing higher out-of-pocket costs.

For 2026, experts say rising premiums caused an initial decline during open enrollment, followed by a second drop after bills began to hit pocketbooks. After the 2026 open enrollment period, enrollment dropped by 12.5 percent. That's more than the 5.7 drop in the same few months following the 2025 open enrollment period.

Data from the State Marketplace Network indicate that disenrollments are rising across most state-based marketplaces and are up 24 percent compared with March 2025.

"We are seeing more disenrollments this year," Krupp said.

During the 2026 open enrollment period, 104,286 Nevadans selected plans through Nevada Health Link, including more than 20,900 new enrollees and more than 42,600 who actively returned to compare or change coverage options. State officials reported 10 percent of enrollees chose the new Battle Born State Plans — a type of public health insurance option offered at a lower price by reducing premiums.

This plan offers Nevadans lower monthly costs regardless of income and expands access to coverage across the state, available through Anthem, Health Plan of Nevada and Ambetter from Silver Summit.

A reinsurance program known as Governor Lombardo's Market Stabilization Program will also be implemented in 2026 and is expected to reduce premiums by 7 percent overall.

"Without it, we would have had another 7 percent increase on top of the current increase," said Stacie Weeks, director of the Nevada Health Authority, the agency that oversees a variety of government health programs, including Nevada Health Link, in hopes of aligning each program's strategies and bringing down costs.

"With rising costs, it doesn't matter which market you're in right now … we're struggling across all markets," she said.

Rep. Dina Titus (D-NV) blamed Republicans who are in control of the Congress for not extending expiring subsidies last year.

"This comes on top of the bill's draconian cuts to Medicaid, which are projected to strip health coverage from 22,000 more people in my district," Titus added. "Nevadans are paying more for less and are being left sicker and poorer."

Affordability is not the only factor that is contributing to declining enrollment. Some residents leave the marketplace after gaining employer-sponsored insurance, qualifying for Medicaid or moving out of state. Enrollment data also shows a shift in plan selection — as of this year, there has been a 20 percent enrollment increase in the Expanded Bronze plan and a 20 percent decrease in enrollment for the Silver plan. Meanwhile, enrollment in catastrophic plans saw a slight decline in enrollment.

"Within those difficult decisions that Nevadans are having to make, they want to choose the plan that has the lower premium, but still comprehensive coverage," said Janel Davis, exchange executive officer of Nevada Health Link.

Even as health care costs continue to rise, health officials said maintaining coverage remains critical.

"It's designed to protect you and your family from financial ruin in the event of a medical issue or emergency," said Davis. "We're aware that Nevadans are faced with difficult decisions as costs increase, but having coverage is still the most important thing in the event a medical emergency might happen to you or a family member."