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ACA Marketplace Sign-Ups Slip to 23 Million for 2026 as Premiums Jump

The lapse of enhanced subsidies drove steep price increases that forecasters say will trigger additional attrition by April.

Overview

  • CMS reports roughly 22.97 million plan selections for 2026, down about 1.2 million from last year, with 15.8 million on HealthCare.gov and 7.2 million on state exchanges.
  • New sign-ups fell to about 3.4 million and returning consumers to about 19.6 million, with experts noting many auto-reenrolled members may not keep coverage once higher bills arrive.
  • KFF estimates average total premiums for subsidized enrollees rose to about $1,904 from $888, pushing more consumers toward higher-deductible options or out of the market.
  • Enrollment shifts varied widely by state: Texas added about 206,000 enrollees, while North Carolina fell 22% and Ohio 20%; New Mexico and Washington, D.C., posted gains.
  • Policy relief remains uncertain after House passage of a three-year subsidy extension, as Senate talks continue over narrower options and analysts look to early April for paid-enrollment data.