Decline in Marketplace Plan Selections in Ohio Counties

Analysis of federal enrollment data reveals a notable decline in marketplace plan selections across Ohio's Cuyahoga and Summit counties, with reductions ranging from 20.4% to 25% between 2025 and 2026. This decrease follows the conclusion of enhanced federal premium subsidies in 2025. Conducted by the Health Policy Institute of Ohio, based in Columbus, the analysis utilized data from the Centers for Medicare and Medicaid Services.

Neighboring areas like Ashtabula, Trumbull, Mahoning, and Columbiana experienced similar trends. Plan selections in Lorain, Portage, and Stark counties declined by 15.9% to 19.2%, whereas Lake, Geauga, and Medina counties saw decreases between 1.2% and 15.7%. All 88 counties registered declines, varying from 1.2% in Holmes County to a sharp 42.6% in Vinton County. Clark County led with a significant 161% increase in marketplace premiums from 2025 to 2026. This contrasted with the statewide reduction of 161,385 Ohioans with active marketplace insurance. Monthly premiums after subsidies rose markedly, from $126 in 2025 to $233 in 2026, indicating an 85% increase.

The preference for more affordable plans is evident, with increased bronze plan selections rising to 60% in 2026, a jump from 43% in 2025, despite higher deductibles. Conversely, silver plan selections fell from 52% to 36%. Importantly, choosing a plan during open enrollment does not guarantee maintained policy coverage, as reflected in the drop from 497,443 to 336,058 paid enrollments, a 32.4% decrease. Brian O'Rourke of the Health Policy Institute emphasized that while some may initially handle increased premiums, sustaining them over time could be challenging.

Legislatively, the extension of premium tax credits is uncertain, with the U.S. House approving a measure until 2028, but not yet law. The lack of enhanced subsidies could influence consumers' decisions between monthly premiums and potential medical expenses in the near future.