About 3 million fewer Americans had active Affordable Care Act marketplace coverage in February 2026 than a year earlier, as expired federal subsidies and higher monthly costs made health insurance harder to maintain.
The U.S. Department of Health and Human Services reported that around 19.2 million people had active ACA plans in February 2026, down from 22.1 million in 2025. The decline mainly affects self-employed workers, contractors, gig workers, early retirees and families without affordable workplace insurance.
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Why ACA enrollment fell in 2026
The biggest reason appears to be affordability. Enhanced federal premium tax credits expired at the end of 2025 after Congress did not extend them for the new coverage year.
Those credits had lowered monthly payments for millions of households. KFF estimated that subsidized customers renewing coverage would pay an average of 114% more toward their premiums in 2026. The figure refers to what consumers pay after tax credits, not a 114% rise in every plan’s full price.
Why active coverage is lower than plan selections
Around 23.1 million people selected marketplace plans during the 2026 enrollment period, but coverage generally begins only after the first premium is paid. Some consumers may have cancelled plans, missed payments or decided the higher monthly cost was unaffordable.
Enrollment checks also affected the total
Florida recorded the largest numerical decline, with more than 440,000 fewer people covered. Even after the drop, it remained the country’s largest ACA marketplace.
HHS said stronger eligibility checks and efforts to remove improper or unauthorized enrollments also contributed to the lower total. Federal regulators have investigated cases involving inaccurate applications, ineligible subsidies and consumers signed up without clear permission.
Independent analysts agree that fraud and enrollment errors are real concerns, but they say higher consumer costs likely explain much of the nationwide decline. Consumers who notice unfamiliar account changes can review official guidance through HealthCare.gov.
What higher costs mean for consumers
When insurance becomes too expensive, some people move to plans with higher deductibles or narrower doctor networks. Others reduce household spending, delay treatment or leave the insurance market.
A KFF survey found that 17% of marketplace customers were not confident they could continue paying premiums throughout 2026. Cost concerns are also affecting the wider insurance industry, including UnitedHealth’s Medicare reimbursement and benefit pressures and the company’s earnings and Medicare outlook.
Before switching or cancelling coverage, consumers should compare deductibles, prescription benefits, provider networks, copayments and out-of-pocket limits. Changes in income or family size should also be reported because they can affect tax-credit eligibility.
The 2026 decline shows that rising costs and tighter verification rules are reshaping the ACA marketplace, leaving many households to decide whether they can continue affording comprehensive health coverage.
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