News|Articles|May 20, 2026

ACA Marketplace Deductibles Surge $1000 in 2026 as Enhanced Tax Credits Expire

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Key Takeaways

Average Marketplace deductibles rose from $2,759 (2025) to $3,786 (2026), predominantly reflecting plan-mix changes; holding 2025 selection constant would have yielded a 6% increase.
Bronze enrollment increased from 30% to 40% while silver fell from 57% to 43%, and cost-sharing reduction silver enrollment dropped to a record-low 37%, increasing out-of-pocket risk.
Plan selections declined by >1 million to 23.1 million, with average effectuated enrollment projected to fall 21.5% to ~17.5 million; ~86% paid the first premium.
Net monthly premiums increased from $113 to $178, but high-premium enrollees disproportionately exited; the share receiving tax credits declined from 92% to 87%.
Disenrollment was concentrated among 400%–500% FPL and unsubsidized enrollees, plus ages 18–34; states with supplemental subsidies/outreach mitigated losses, including New Mexico growth.

ACA enrollment drops 21.5% in 2026 after enhanced subsidies end. Deductibles hit record $3786 as enrollees shift to high-deductible bronze plans.

The expiration of enhanced Affordable Care Act (ACA) premium tax credits at the end of 2025 has triggered unprecedented disruption in the individual insurance market. Two new analyses published May 19 by KFF document historic increases in deductibles, a projected enrollment drop of nearly 5 million people, and a dramatic shift toward high-deductible plans as consumers scramble to afford coverage without enhanced subsidies.^1,2

Deductibles Surge to Record Highs

The average ACA Marketplace deductible rose 37%, or more than $1000, from $2759 in 2025 to $3786 in 2026—the steepest increase in the program's history.¹ The jump was driven primarily by a large-scale migration from silver to bronze plans, with the share of consumers selecting bronze plans climbing from 30% (7.3 million people) in 2025 to 40% (9.2 million people) in 2026.² Meanwhile, the share selecting silver plans fell from 57% to 43%, marking a record low.

This behavioral shift, rather than underlying premium increases, accounts for most of the deductible surge, as had plan selection remained the same as in 2025, the average deductible would have risen by just 6%, to $2912. Sixty-seven percent of Marketplace enrollees said they would likely cut spending on basic household needs if their annual health costs increased by $1000, a KFF survey found.¹ Additionally, the share of Marketplace enrollees selecting cost-sharing reduction silver plans—which reduce out-of-pocket costs for lower-income enrollees—fell to a record low of 37%.

Enrollment Collapse Underway

Plan sign-ups declined by more than 1 million during the 2026 Open Enrollment Period to 23.1 million, the sharpest single-year drop since the ACA Marketplaces launched.² KFF projects that average effectuated Marketplace enrollment could decline by 21.5%, falling from 22.3 million in 2025 to approximately 17.5 million in 2026.¹

Approximately 86% of January 2026 enrollees paid their first month's premium, with considerable variation across states, according to an analysis by Wakely Consulting Group.² A KFF survey fielded in late February and early March 2026 found that 9% of 2025 Marketplace enrollees had already become uninsured, and 1 in 6 returning enrollees were not confident they could afford coverage for the full year.

Premium Payments Rise, Middle-Income and Young Adults Exit

Average monthly premium payments rose 58%, from $113 to $178 per month, lower than the 114% increase KFF had projected because many consumers switched to cheaper plans and high-premium consumers left the market at disproportionately high rates. The share of enrollees receiving premium tax credits fell from 92% in 2025 to 87% in 2026, the first decline since 2020.

Consumers with incomes between 400% and 500% of the federal poverty level—just 3% of 2025 sign-ups—accounted for 27% of the overall decline, with sign-ups in this group falling by 44%. Overall, consumers above the subsidy cliff made up just 7% of 2025 enrollment but nearly half (48%) of the total decline.¹Young adults aged 18 to 34 accounted for more of the decrease than any other age group, with sign-ups falling 8%, or 542,000 people, comprising 46% of the total decline.²

Geographic Disparities and State Responses

Marketplace sign-ups fell in 41 states, with the steepest declines in North Carolina (22%), Ohio (20%), and West Virginia (17%). State-based exchanges with their own subsidy programs and robust outreach tended to retain higher shares of enrollees than federally facilitated exchanges. New Mexico, which offers supplemental financial assistance, experienced an 18% increase in plan selections. The projected decline aligns with the Congressional Budget Office's earlier projection of a roughly 25% Marketplace contraction following enhanced credit expiration.

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