Over 3 Million Americans Drop ACA Coverage as Premiums Jump 114% in 2026

More than 3 million Americans who selected Affordable Care Act health plans for 2026 have already dropped or lost coverage, putting new attention on the cost of health insurance after enhanced federal subsidies expired at the end of 2025.

The U.S. Department of Health and Human Services reported that about 19.2 million people were enrolled in ACA marketplace plans as of February 2026. That is down from 23.1 million people who selected coverage during the 2026 enrollment period and below the 24.2 million plan selections recorded in January 2025.

The decline affects people who buy insurance on their own, including self-employed workers, contractors, gig workers, early retirees, small-business owners and families without affordable employer-sponsored health coverage.

Why ACA enrollment fell sharply in 2026

The biggest pressure point is affordability. Enhanced ACA subsidies, which had lowered monthly premiums for millions of marketplace customers, expired at the end of 2025 after Congress did not renew them.

According to KFF, average costs for ACA enrollees who wanted to keep their plans increased by about 114% in 2026. For households already managing rent, groceries, utilities and medical bills, a premium increase that large can quickly make coverage difficult to keep.

Plan selection is not the same as active coverage

A key detail in the ACA numbers is the difference between selecting a plan and actually staying insured. Consumers can choose a marketplace plan during open enrollment, but coverage generally continues only after monthly premiums are paid.

Health policy experts call this “effectuated enrollment.” By that measure, ACA enrollment declined from 22.1 million in 2025 to 19.2 million in February 2026. That suggests many people either did not complete payment or could not keep coverage once the higher bills arrived.

For readers keeping track of monthly household budgets and federal benefit schedules, it is also worth checking the latest Social Security Checks July 2026 payment dates, which explain when beneficiaries can expect their July deposits.

HHS says improper signups also played a role

HHS said the enrollment drop also reflects efforts to stop improper marketplace signups. The department said Trump administration actions blocked or ended subsidies for about 2.9 million people who were allegedly receiving financial help they did not qualify for.

That figure included about 1.5 million people prevented from receiving subsidies they were not eligible for and another 1.4 million enrollments that were ended or blocked.

HHS also said nearly half of ACA enrollment growth from 2021 to 2024 was suspected to be improper, phantom or fraudulent. The department estimated that about 2.6 million questionable enrollments may still remain, although the report did not provide detailed public evidence for every part of that estimate.

Unauthorized broker enrollments remain a concern

Fraud concerns are not limited to broad estimates. In a Federal Register document, the Centers for Medicare & Medicaid Services said it received nearly 342,000 complaints in 2025 involving “unauthorized enrollment.”

Unauthorized enrollment generally refers to cases where a broker or agent signs up a consumer for an ACA plan without that person’s consent. For affected consumers, the problem can create confusion over coverage, tax credits, doctor networks and medical bills.

Consumers can review official marketplace coverage rules and enrollment information through HealthCare.gov.

Experts say affordability may explain most of the decline

Independent health policy experts say fraud is a real issue, but higher premiums are likely the main reason many consumers are leaving ACA coverage. When insurance becomes more expensive, fewer people can afford to keep it.

Sabrina Corlette, co-director of Georgetown University’s Center on Health Insurance Reforms, said higher prices naturally reduce how many people can keep coverage. Cynthia Cox, vice president and director of the ACA program at KFF, has also noted that the decline was expected because insurers and the Congressional Budget Office had projected enrollment losses once consumers had to pay more.

A KFF survey found that 17% of ACA enrollees were not confident they could afford their health insurance premiums for all of 2026. That means enrollment could fall further if more households struggle to make monthly payments later in the year.

2027 premiums could add more pressure

The affordability problem may continue into the next coverage year. A Georgetown Center on Health Insurance Reforms report published June 18 reviewed insurer filings in nine states and Washington, D.C. Proposed 2027 rate increases ranged from 6.5% in Vermont to 22.4% in Washington state.

Filings for the federal marketplace, which covers most ACA customers, are expected around mid-July. Those filings will give consumers and policymakers a clearer look at whether marketplace premiums may rise again next year.

What this means for ACA consumers

The 2026 ACA enrollment drop shows two problems moving at the same time. Federal officials are trying to remove improper or fraudulent signups, while millions of consumers are facing higher monthly costs after enhanced subsidies expired.

For households, the risk is practical. Some people may switch to cheaper plans with higher deductibles. Others may delay care, reduce coverage or go uninsured. That can create larger financial risk if they need emergency care, prescriptions, surgery or ongoing treatment.

As 2027 rate filings approach and lawmakers continue debating ACA subsidy policy, affordability is likely to remain the central issue for Americans who depend on the marketplace for health insurance.