Anticipated Decline in Health Insurance Enrollment Under ACA by 2026

Enrollment figures for health insurance plans under the Affordable Care Act (ACA) are expected to decrease to 15.6 million by 2026, as reported by the U.S. Centers for Medicare & Medicaid Services (CMS). This anticipated drop contrasts with the approximately 16 million participants recorded the prior year, highlighting challenges faced by the industry amid evolving regulatory compliance requirements.

The upcoming expiration of enhanced federal subsidies on December 31, initially introduced during the pandemic, is a key factor in this decline. The removal of these subsidies is likely to drive a significant increase in premiums. CMS estimates that average annual costs for subsidized ACA plans will rise dramatically, from $888 in 2025 to $1,904 in 2026. This scenario presents a considerable challenge for insurers and healthcare providers striving to ensure affordable coverage within regulatory constraints.

Anticipating Enrollment Challenges

CMS has partly attributed the anticipated enrollment reduction to measures addressing fraudulent and improper sign-ups, though comprehensive supporting data has yet to be released. Their report notes a decrease in policy renewals, which were at 19.9%, slightly down from 20.5% the previous year. Meanwhile, KFF, a health policy nonprofit, suggests that 25% of current enrollees may opt out of ACA coverage in 2026 due to expected premium hikes, impacting nearly 24 million Americans potentially facing substantial cost increases come January.

With ACA enrollment open until January 15, historical trends indicate a surge in sign-ups at the start of the year, particularly post-subsidy expansion when enrollments doubled from around 12 million in 2021. Insurers and state health officials now prepare for potential dips in participation for 2026, emphasizing the need for effective risk management strategies. The insurance industry is keenly observing congressional discussions on alternatives to the expiring subsidies, as these discussions are crucial for maintaining ACA's consumer protections and understanding future market dynamics.