Dive Brief:
- Out-of-pocket premiums for Affordable Care Act plans increased 58% this year, after Congress allowed more generous subsidies for coverage to expire, according to new data from the CMS.
- Consumers on average are paying $65 per month — or $780 per year — more for coverage in 2026 than they were in 2025. As a result of higher premiums, many people left the exchanges entirely, or switched to cheaper coverage that comes with much higher out-of-pocket costs, the data shows.
- The CMS report highlights how the loss of enhanced financial assistance has contributed to a smaller insurance marketplace in which more consumers may be underinsured.
Dive Insight:
The CMS’ new ACA open enrollment report includes data from people who signed up for coverage or were reenrolled automatically for 2026.
It found total enrollment in ACA plans fell by 1.2 million people this year, to 23.1 million enrollees.
Market watchers had expected an even steeper enrollment drop after the expiration of enhanced tax credits at the end of 2025 left millions of Americans facing intense sticker shock for ACA coverage. The average ACA out-of-pocket premium jumped from $113 a month in 2025 to $178 a month in 2026, according to the new federal data.
The premium increase is less drastic than some experts projected. Last fall, health policy research group the KFF estimated that premiums would increase 114%. But that’s if people remained in the same plan, Larry Levitt, KFF’s executive vice president for health policy, wrote on X on Friday.
Instead, many consumers switched to plans with lower premiums but much higher deductibles.
Enrollment in bronze plans, which come with deductibles averaging more than $7,000 per person, jumped from 30% of all ACA enrollees in 2025 to 40% of all ACA enrollees this year — a concerning trend, given the high out-of-pocket costs could lead some consumers to put off care or saddle them with medical debt.
Meanwhile, though the CMS stressed total ACA sign-ups are still strong compared to pre-2025 numbers, enrollment could fall further as the year progresses. The CMS’ report includes data from individuals who have yet to pay premiums to lock in their coverage.
Some amount of ACA enrollees usually drop off throughout the year after they stop paying premiums — and more did so before enhanced tax credits for ACA plans were enacted in 2021.
How drastically that affects enrollment for 2026 won’t be known until the summer, when data on actual or “effectuated” enrollment is normally released. Attrition could be particularly high this year, given individuals that automatically reenrolled in coverage might choose not to pay their premium or disenroll themselves after seeing steep bills from their insurance carriers.
The Trump administration has been vocal about what it says is rampant fraud in the ACA exchanges. The CMS restarted stricter eligibility checks, which were paused during the coronavirus pandemic, last year. As a result, 1.5 million people lost ACA subsidies or coverage this year, according to the CMS’ report.
More than 1 million of those people lost subsidies because they were enrolled in another insurance program like Medicaid at the same time as their ACA plan, or failed to prove their eligibility for tax credits, the CMS said. Another quarter-million enrollees were enrolled in ACA plans without their knowledge or consent.
Most healthcare stakeholders and researchers agree that fraud is a problem in the ACA exchanges, though not to the extent the Trump administration suggests.
