Affordable Care Act enrollment falls by 3 million as premiums double

The unwinding of enhanced Affordable Care Act subsidies is now showing up in the numbers. ACA marketplace enrollment fell to 19.2 million in February 2026 from 22.1 million at the end of 2025 — a drop of roughly 3 million people, or about 13 percent, CNBC reported, citing data issued by the Department of Health and Human Services.

With enhanced ACA subsidies gone, many people are facing much higher net premiums; KFF estimates that average premium payments roughly doubled for subsidized ACA enrollees in 2026, while deductibles also rose sharply as many consumers shifted into bronze plans.

The premium math tells the story. KFF estimated that enrollees faced an average premium increase of 114 percent — to $1,904 in 2026 from $888 in 2025 — after the enhanced ACA subsidies expired at the end of 2025. About 17 percent of returning ACA enrollees told KFF pollsters they were not confident they could afford their premium for all of 2026.

The Congressional Budget Office in February projected total ACA marketplace enrollment will fall to 12.5 million by 2028 — nearly half of 2025 levels. CBO also estimated the U.S. population without health insurance will rise from 7.6 percent in 2025 to 10.4 percent by the end of the decade.

There's a lot of back-and-forth about the cause. Republicans blame fraud, Democrats blame higher premiums. But put that aside for a minute. What can a consumer do to maintain healthcare coverage?

The first rule is: do not simply drop coverage without checking every fallback route first.

Here’s what consumers can do.

1. Re-shop the marketplace — don’t auto-renew

Even if the current plan doubled, another plan may be cheaper. Consumers should compare:

• Bronze plans with lower premiums but higher deductibles.
• Silver plans, especially for people with lower incomes who may still qualify for cost-sharing reductions.
• Narrow-network plans that may be cheaper but require checking doctors and hospitals carefully.
• HSA-compatible high-deductible plans, if the consumer can afford the exposure and wants the tax benefit.

Open enrollment for marketplace coverage generally runs November 1 through January 15, with December 15 usually the deadline for January 1 coverage, so take careful note of the date and be ready when November 2026 rolls around.

2. Recheck income — carefully and legally

ACA subsidies are based on estimated annual household income. A consumer whose income has dropped, who lost work, or whose family size changed may qualify for more help than expected.

But this must be done honestly. Understating income can trigger repayment at tax time. The safer advice is: update the marketplace application with current, realistic income and household information, then see whether the subsidy changes.

3. Check Medicaid and CHIP

Medicaid and the Children’s Health Insurance Program (CHIP) are available year-round; they are not limited to ACA open enrollment. HealthCare.gov says people can apply for Medicaid or CHIP at any time.

This is especially important for:

• Children.
• Pregnant women.
• People with disabilities.
• Adults in Medicaid expansion states.
• Households with income that recently fell.

Even if the adult does not qualify, children in the household may qualify for CHIP.

4. Look for a Special Enrollment Period

Outside open enrollment, consumers usually need a qualifying life event to get or change marketplace coverage. Common triggers include losing job-based coverage, moving, marriage, divorce, birth or adoption, certain income changes, or loss of Medicaid. HealthCare.gov provides a screener to check whether someone can enroll now.

5. Check job-based coverage — including a spouse’s plan

If ACA coverage has become unaffordable, consumers should revisit employer coverage options. That includes:

• Their own employer plan.
• A spouse’s or domestic partner’s employer plan.
• COBRA, if recently laid off.
• Coverage through a professional association or union, where available.

COBRA is often expensive, but it can be useful as a bridge if someone is between jobs, in treatment, or waiting for Medicare.

6. Consider catastrophic coverage, if eligible

Catastrophic plans are mainly for people under 30 or people who qualify for a hardship or affordability exemption. They have low premiums and very high deductibles, but they preserve protection against ruinous hospital bills.

They are not a good fit for people with regular medical needs, but they may be better than going uninsured.

7. Be very cautious with short-term plans and “health sharing” plans

Short-term health plans can look attractive because the premiums are lower, but they are not the same as ACA coverage. They can exclude preexisting conditions, omit essential benefits, impose dollar limits, and deny claims that an ACA plan would have to cover. Healthinsurance.org notes that short-term plans do not have to follow ACA rules or cover the ten essential health benefits.

Health care sharing ministries and discount cards are also not comprehensive insurance. They may help with some bills, but consumers should not assume they will pay for cancer care, hospitalization, mental health care, prescriptions, pregnancy, or emergency treatment.

8. Preserve prescription coverage

For consumers who cannot afford full coverage, the next priority is preventing medical deterioration. They should ask doctors and pharmacists about:

• Generic alternatives.
• Manufacturer assistance programs.
• State pharmaceutical assistance programs.
• Community health centers.
• 90-day prescriptions when cheaper.
• Discount programs, while comparing prices carefully.

This is not a substitute for insurance, but it may keep chronic conditions from becoming emergencies.

9. Use community health centers and safety-net clinics

Federally qualified health centers treat patients regardless of ability to pay and use sliding-fee scales. They can be especially important for people who lose ACA coverage but still need primary care, diabetes care, blood-pressure medication, vaccines, prenatal care, or behavioral health treatment.

10. Avoid a total coverage gap if at all possible

The worst outcome is usually going completely uninsured. A cheaper bronze plan with a high deductible may feel like “not real insurance,” but it can still protect against a $60,000 hospitalization, cancer diagnosis, appendectomy, accident, or emergency surgery.

A practical hierarchy for consumers is:

Consumer takeaway

The consumer’s goal should be to stay inside the regulated insurance system if at all possible. That means marketplace coverage, Medicaid, CHIP, Medicare, or employer coverage — even if it requires switching plans, changing metal tiers, or accepting a narrower network. The dangerous move is replacing ACA coverage with something that sounds like insurance but can disappear when the bills get large.

What's the cause of the increase?

The Trump administration and health-policy experts disagree on the cause.

HHS said "improper, phantom and fraudulent enrollment" peaked at 5.6 million people in 2025 and that CMS canceled coverage for 250,000 people enrolled without their consent. But experts pointed to price.

"It's basic economics that making something more expensive makes people less likely to buy it," Matthew Fiedler, a senior fellow at The Brookings Institution, told CNBC. "There is also abundant empirical evidence that when premiums go up, many fewer people buy coverage (especially in the low-income population that the Marketplaces serve). So if doubling enrollees' premiums did not result in a big enrollment decline, that would be a major surprise."

Jonathan Oberlander of the University of North Carolina at Chapel Hill was blunter: "The enrollment drop is absolutely not about fraud. [Republicans] are exaggerating the scope of the fraud issue to obscure the cuts they have pursued in health insurance coverage. This is just the beginning."