Enrollment Drop in ACA Health Insurance: What to Expect by 2026

As of December 23, the U.S. Centers for Medicare and Medicaid Services reported a projected decrease in enrollment for health insurance plans under the Affordable Care Act (ACA). Enrollment is expected to drop to 15.6 million by 2026, following the expiration of enhanced federal subsidies at the end of 2025. This anticipated decline correlates with changes in regulatory compliance requirements impacting both providers and carriers.

Impact of Expiring Subsidies on Premiums

The expiration of pandemic-era subsidies is predicted to trigger a significant rise in insurance premiums. Subsidized ACA plans are projected to see average annual costs increase from $888 in 2025 to approximately $1,904 in 2026. These changes could influence consumer decisions; recent surveys suggest a quarter of current enrollees might opt out if premiums double, affecting both payers and providers.

Enrollment Trends and Industry Response

The insurance industry anticipates reduced enrollment numbers in 2026, with renewal statistics indicating a slight decrease in the percentage of enrollees maintaining coverage—from 20.5% to 19.9%. Historically, enrollment has increased due to subsidy expansions, but impending cost hikes prompt insurers and state health authorities to prepare for lower figures. Stakeholders remain focused on risk management and potential regulatory adjustments as the market responds to these changes.