Health insurance is becoming more expensive for millions of Americans who buy coverage through the Affordable Care Act Marketplace—and the rising cost appears to be changing who can afford to remain insured.

Enrollment in ACA Marketplace plans has fallen to approximately 19.2 million people in 2026, nearly 3 million fewer than the roughly 22.1 million enrolled the previous year.

At the same time, consumers who remain enrolled are paying substantially more.

According to KFF, average monthly premium payments after tax credits increased from $113 in 2025 to $178 in 2026—a 58% increase. Average deductibles rose approximately 37%, increasing by more than $1,000 per person to nearly $3,800 annually.

Those increases followed the expiration of the enhanced Affordable Care Act premium tax credits at the end of 2025.

The result is a health insurance market where many households are paying more each month while also taking on greater out-of-pocket exposure when they actually need medical care.

Why ACA Coverage Became More Expensive in 2026

The Affordable Care Act has long provided premium tax credits that reduce the amount eligible consumers pay for Marketplace insurance.

Those subsidies became substantially more generous under temporary enhancements first enacted through the American Rescue Plan and later extended through the Inflation Reduction Act.

The enhanced credits reduced premiums for existing participants and expanded assistance to households that previously earned too much to qualify.

They expired at the end of 2025.

CMS projected before the 2026 enrollment period that consumers receiving subsidies would generally pay more once those additional credits disappeared. The agency estimated that the average premium for the lowest-cost plan after tax credits would rise to approximately $50 per month for eligible HealthCare.gov enrollees, compared with $37 in 2025.

But the experience across the entire Marketplace has been broader.

KFF found that average enrollee premium payments rose 58%, reflecting both the loss of enhanced assistance and changes consumers made in response to higher prices.

Consumers Responded by Switching to Cheaper Plans

One reason the actual 58% increase was smaller than earlier projections is that many consumers did not simply keep the same insurance plan.

They changed coverage.

KFF had previously estimated that subsidized enrollees could see average premium payments more than double if they kept identical plans after the enhanced tax credits expired.

Instead, many shoppers moved toward less expensive options.

That helped reduce monthly premiums—but often came with a tradeoff.

Cheaper plans frequently carry higher deductibles, meaning consumers must pay more of their healthcare expenses themselves before insurance begins covering a larger share of costs.

Average deductibles increased approximately 37% in 2026, reaching nearly $3,800 per enrollee.

That means some households reduced one financial burden by accepting another.

A Lower Premium Does Not Always Mean Lower Healthcare Costs

Health insurance affordability can be difficult to evaluate because the monthly premium is only one part of the cost.

A household may also face:

• Annual deductibles

• Copayments

• Coinsurance

• Prescription drug costs

• Out-of-network charges

• Services that are not fully covered

Consider a consumer paying the average $178 monthly premium.

That equals approximately $2,136 per year in premiums before the person receives any medical care.

If the same consumer also has a deductible approaching $3,800, their potential healthcare spending can quickly become substantial.

The exact amount depends on the plan and medical needs, but the distinction matters:

Insurance can become more expensive both when the monthly bill rises and when consumers must pay more before coverage meaningfully begins.

Marketplace Enrollment Has Fallen by Nearly 3 Million

The increase in costs coincides with a significant decline in enrollment.

KFF Health News reported that approximately 19.2 million people had ACA Marketplace coverage in 2026, compared with roughly 22.1 million in 2025.

That represents a decline of about 13%.

The reasons behind that drop have become politically contested.

The Trump administration argues that much of the decline reflects efforts to remove improper, fraudulent or so-called "phantom" enrollments from the Marketplace.

Federal officials say tighter verification requirements and anti-fraud measures have removed people who should not have been receiving subsidized coverage.

According to KFF Health News, the administration has pointed to an HHS analysis estimating millions of questionable enrollments during 2025.

The federal government has also tightened Marketplace verification procedures and removed some consumers who failed to meet eligibility or documentation requirements.

Researchers Say Higher Prices Are Also Driving People Out

Independent health-policy researchers cited by KFF argue that fraud enforcement does not fully explain the enrollment decline.

Their reasoning is straightforward: when insurance becomes substantially more expensive, some consumers stop buying it.

Brookings Institution researcher Matthew Fiedler told KFF Health News that attributing the entire enrollment decline to improper enrollment was not credible, pointing to evidence that higher premiums cause people to drop coverage.

KFF's own consumer research supports the role of affordability.

A follow-up survey of ACA Marketplace enrollees found that eight in 10 people who changed their coverage or became uninsured cited cost as a factor.

Among people who remained in Marketplace plans, many reported concern about being able to continue paying their premiums throughout 2026.

The evidence therefore points to multiple forces operating simultaneously: stronger enrollment verification, the removal of some improper coverage, and genuine consumers responding to substantially higher prices.

Fraud in the ACA Marketplace Is a Real Issue

The affordability debate does not mean concerns about Marketplace fraud are imaginary.

Investigations have documented cases involving brokers enrolling consumers without permission, switching insurance plans without authorization and using inaccurate information to obtain subsidies.

The federal government has taken steps to address those practices.

CMS has strengthened identity and income verification requirements, while regulators have changed enrollment procedures designed to make unauthorized plan changes more difficult.

That enforcement can protect both consumers and taxpayers.

But identifying fraudulent enrollment and understanding why legitimate consumers leave coverage are separate questions.

A household that drops insurance because its premium became unaffordable represents a different policy problem from an enrollment created without the consumer's knowledge.

Both can exist at the same time.

Higher Deductibles Can Discourage People From Using Coverage

The financial consequences continue even after someone manages to keep insurance.

A nearly $3,800 average deductible means many policyholders may still face thousands of dollars in healthcare spending before their insurer covers a larger portion of certain services.

That can influence how consumers use healthcare.

Someone facing a large deductible may postpone:

• Doctor visits

• Diagnostic testing

• Specialist appointments

• Non-emergency procedures

• Prescription refills

Delaying care can sometimes create larger medical and financial problems later.

For households already balancing housing, food, transportation and debt payments, an unexpected $1,000 or $2,000 medical bill can also push spending onto credit cards.

Healthcare affordability therefore connects directly to debt and broader financial wellness.

Health Insurance Can Change the Entire Household Budget

For many families, health insurance is one of the largest recurring expenses outside housing and childcare.

A monthly premium increase from $113 to $178 equals an additional $65 per month, or $780 per year.

That money has to come from somewhere else in the household budget.

It may mean less available for:

• Emergency savings

• Credit card repayment

• Retirement contributions

• Groceries

• Transportation

• Childcare

• Homeownership goals

• Other insurance

The pressure can become even greater for families covering multiple household members.

When medical expenses are unpredictable, households also need more financial flexibility than the premium alone suggests.

Going Without Insurance Creates a Different Financial Risk

Some consumers facing sharply higher premiums may decide that coverage is simply too expensive.

That can reduce monthly expenses immediately.

But it also transfers more healthcare risk directly to the household.

A routine medical visit may be manageable without insurance.

A hospitalization, surgery, serious illness or emergency could generate bills worth tens of thousands of dollars or more.

That creates a difficult tradeoff for households priced out of Marketplace coverage:

Pay a significant amount every month for insurance—or accept the financial risk of being uninsured.

Neither option may feel affordable.

Cheaper Plans Can Help—but Consumers Need to Compare More Than Price

Consumers shopping for Marketplace coverage often have several plan tiers available.

Bronze plans generally offer lower premiums but higher out-of-pocket expenses.

Silver and Gold plans typically involve higher monthly premiums but may cover more of the cost when medical care is needed.

The cheapest premium is therefore not automatically the least expensive plan overall.

Before selecting coverage, consumers should consider:

Annual premium cost.
Multiply the monthly payment by 12.

Deductible.
Understand how much you may have to pay before broader coverage applies.

Out-of-pocket maximum.
Know the maximum amount you could be responsible for during a high-cost medical year for covered in-network services.

Prescription coverage.
Check whether medications are included and what cost-sharing applies.

Provider network.
Confirm that preferred doctors, hospitals and specialists participate.

Expected medical use.
Someone who rarely needs care may evaluate the tradeoffs differently from someone managing a chronic condition.

Health insurance is ultimately a risk-management decision, not simply a monthly subscription.

Another Premium Increase Could Be Coming in 2027

The affordability pressure may not end with 2026.

A July KFF analysis found that ACA Marketplace insurers across 16 states and Washington, D.C., were proposing a median premium increase of approximately 14% for 2027.

Those filings are preliminary and may change before final rates are approved.

But if increases remain near that level, 2027 could become the second consecutive year of substantial Marketplace premium growth.

That makes the longer-term affordability picture especially important for households relying on individual health insurance.

Consumers should review plan options each year rather than automatically renewing the same coverage.

Healthcare Belongs in the Financial Plan

Healthcare is difficult to budget because nobody knows exactly when they will need it.

But households can still prepare.

That preparation can include:

• Tracking insurance premiums as a fixed monthly expense

• Understanding the deductible

• Knowing the out-of-pocket maximum

• Maintaining emergency savings

• Reviewing HSA eligibility when applicable

• Comparing plans during enrollment

• Keeping medical and insurance documents organized

• Avoiding unnecessary high-interest debt for predictable healthcare expenses when possible

The goal is not predicting every medical bill.

It is understanding the amount of financial exposure your insurance leaves behind.

The Affordability Problem Goes Beyond Enrollment Numbers

The debate over why ACA enrollment declined will continue.

The administration emphasizes fraud enforcement and program integrity.

Health-policy researchers emphasize rising prices and the expiration of enhanced subsidies.

Both issues deserve scrutiny.

But for households deciding whether they can afford coverage, the practical reality is simpler.

Average premium payments rose 58%.

Average deductibles rose 37%.

Marketplace enrollment fell by nearly 3 million people.

Those numbers show that health insurance affordability has changed significantly in 2026.

For consumers, the most important question is no longer simply:

“Can I afford the monthly premium?”

It is:

“Can my household afford the total financial risk this health plan leaves me with?”

Make Healthcare Part of Your Complete Financial Picture

Medical expenses can appear suddenly, but they do not exist separately from the rest of your finances.

Copiafy helps you organize bills, financial documents, credit, budgets and long-term goals in one financial workspace—so you can see how healthcare expenses fit alongside everything else your household needs to manage.

Understanding your complete financial picture can make it easier to prepare for both predictable premiums and unexpected costs.

Create your free Copiafy account and start organizing the financial decisions that affect your household.