Costs of Marketplace Plans Much Higher After Enhanced Credit Expiration

A new survey from KFF revealed that more than half of returning enrollees in Marketplace coverage under the Affordable Care Act (ACA) found their costs for health care to be a lot higher compared with last year after the expiration of the enhanced credits.¹ Premiums in particular were noted to be much higher in 40% of those returning to ACA coverage.

Enhanced premium tax credits for the ACA expired last year after a government shutdown resulted in no decision on whether to extend the tax credits or not.² This led to an increase in insurance costs for many enrollees on ACA Marketplace plans, leading to higher premiums and the potential for an increase in the number of uninsured people.³ Although experts expected these potential consequences, this survey gives a solid glimpse at how the expiration of these credits is affecting patients nationwide.

The KFF survey included 1117 individuals who had been previously surveyed at the end of 2025 about their ACA Marketplace coverage.¹ The participants could include those still on Marketplace coverage, those who left Marketplace for a different type of insurance, and those who are uninsured in the new year. The survey aimed to evaluate how individuals had reacted to the changes in the Marketplace.

A total of 80% of participants who are still enrolled in Marketplace said their premiums, deductibles, or coinsurance were higher year over year than their 2025 plan; 51% of enrollees said these costs were “a lot higher.” Affording costs of routine and unexpected medical care was a concern for 73% of enrollees, who said they were very or somewhat worried about being able to afford emergency care or hospitalizations. Affording routine medical visits (49%) or prescription drugs (45%) was also a concern for many enrollees.

Affordability extends to other areas that are affected by the increased prices. A total of 55% of Marketplace enrollees reported that they are or would be cutting back on basic household expenses so that they can continue to afford their coverage; 62% of those with chronic conditions expressed this sentiment as well. A total of 9% of those with Marketplace coverage in 2025 are now uninsured, and 28% have switched to a different Marketplace plan.

Voting in the midterms may be affected by this increase in price, as 48% of those surveyed who were registered to vote said that this would be a major factor in how they vote in the midterms, and 49% said that this would affect which party they would vote for in the midterm elections. Democrats were more likely to say that health costs would affect their decision to vote in 2026 compared with Republicans (67% vs 27%).

Re-enrollment in the ACA Marketplace was high despite the price increases, with 69% of surveyed participants re-enrolling for 2026; 39% of participants enrolled in the same plan as they had in 2025. However, 17% of returning enrollees are not confident they will be able to afford their premiums throughout the entirety of the year, which could leave them without insurance before the end of the year.

Overall, the rising costs of premiums have had a significant effect on enrollment in Marketplace plans and health care coverage in general. As the year goes on, taking note of how these costs further shape the health insurance landscape will be paramount to deciding what changes will need to be made to better help patients.

References

1. Lopes L, Valdes I, Sparks G, Mulugeta M, Kirzinger A. Cost concerns and coverage changes: a follow-up survey of ACA Marketplace enrollees. KFF. March 19, 2026. Accessed March 19, 2026. https://www.kff.org/public-opinion/a-follow-up-survey-of-aca-marketplace-enrollees/
2. Bonavitacola J. Government shutdown concluded but ACA subsidies still in limbo. AJMC. November 13, 2025. Accessed March 19, 2026. https://www.ajmc.com/view/government-shutdown-concluded-but-aca-subsidies-in-limbo
3. Steinzor P. 5 consequences if ACA premium subsidies end in 2026. AJMC. October 31, 2025. Accessed March 19, 2026. https://www.ajmc.com/view/5-consequences-if-aca-premium-subsidies-end-in-2026