- CMS identified approximately 189,000 Affordable Care Act enrollees with duplicate government health coverage or death records, estimating $738 mn in savings for 2026.
- A separate enforcement action canceled 315,000 unauthorized enrollments covering more than 760,000 people, with projected recoveries of $2.2 bn in federal subsidies.
- US individual health insurance enrollment declined 18% to 20.5 mn by June 2026, while 87% of ACA marketplace plan selections received premium tax credits, down from 92% in 2025.
The Trump administration has announced the termination of Affordable Care Act (ACA) premium subsidies for approximately 189,000 people identified as having overlapping government health insurance coverage or being deceased, with projected taxpayer savings of $738 mn in 2026.
The Centers for Medicare & Medicaid Services (CMS) estimates that eliminating these payments could save approximately $1.5 bn over the following year and prevent more than 1 mn months of improperly subsidized coverage by the end of 2026.
US individual health insurance enrollment fell 18% year over year to 20.5 mn people in June 2026, from 25.2 mn a year earlier, according to KFF, marking the steepest annual decline since 2015.
The reduction of more than 4.6 mn policyholders followed the expiration of enhanced Affordable Care Act (ACA) premium tax credits at the end of 2025, which substantially increased insurance costs for millions of Americans.
The action targets people receiving federal premium tax credits through HealthCare.gov while also enrolled in Medicare, Medicaid or the Children’s Health Insurance Program (CHIP), as well as individuals whose death records indicate they should no longer receive coverage.
When the federal government pays a subsidy for a healthcare.gov plan, we have an obligation to check whether that payment is owed.
Robert F. Kennedy Jr., Health Secretary
According to CMS, approximately 120,000 people had overlapping Medicaid coverage, another 58,000 were enrolled in Medicare, and roughly 11,000 were identified as deceased through July. Officials expect to identify another 3,500 deceased enrollees by the end of October.
People flagged for duplicate coverage receive 30 days to dispute the findings before their ACA subsidies are terminated. They may also appeal afterward or demonstrate that their existing Medicaid or CHIP coverage is ending.
CMS said approximately half of the cases identified in an earlier Medicaid review were resolved during the response period. Officials maintained that the cancellations had not left affected individuals uninsured because they retained other coverage or were deceased.
The latest action follows a broader federal effort to identify improper ACA enrollment and subsidy payments.
In 2025, CMS ended premium subsidies or coverage for nearly 1.5 mn people found to be ineligible for financial assistance or enrolled without their authorization. That included approximately 551,000 people whose subsidized marketplace coverage overlapped with Medicaid.
A separate enforcement action announced in September 2026 canceled approximately 315,000 unauthorized enrollments involving more than 760,000 individuals.
CMS estimates those cancellations could recover $2.2 bn in advance premium tax credit payments. Administrator Mehmet Oz said the September action is separate from the latest review of duplicate and deceased enrollees.
The agency has also increased oversight of insurance agents and brokers. Since January, CMS has sent termination notices to more than 200 agents and brokers for noncompliance and issued 569 notices of intent to terminate agreements involving applications submitted without required identifying information.
Separately, Medicaid officials identified an estimated 1.2 mn people per month potentially enrolled in Medicaid or CHIP across multiple states. States will be required to verify enrollee addresses beginning in January 2027.
The enforcement measures come as the US individual health insurance market experiences a sharp decline in enrollment and rising premiums.
According to KFF research published October 14, individual market enrollment fell 18% between June 2025 and June 2026, declining from 25.2 mn to 20.5 mn people. The reduction of more than 4.6 mn represents the steepest annual decline since 2015.
The figures cover both ACA marketplace policies and individual insurance purchased outside the exchanges. KFF attributed much of the contraction to the expiration of enhanced federal premium tax credits at the end of 2025, alongside other policy changes.
CMS reported that 23.1 mn consumers selected or were automatically re-enrolled in marketplace plans during the 2026 open enrollment period. That figure measures plan selections rather than the number of people maintaining active coverage throughout the year.
Federal subsidies remain central to marketplace affordability. In 2026, approximately 87% of marketplace consumers selected plans with advance premium tax credits, compared with 92% in 2025.
The average monthly premium before subsidies increased from $619 in 2025 to $741 in 2026. Among consumers receiving premium tax credits, average monthly payments after subsidies rose from $74 to $96.
KFF also found that 17% of returning ACA marketplace enrollees were not confident they could afford their premiums throughout 2026, raising the prospect of further coverage losses.
For CMS, the immediate objective is to eliminate duplicate subsidy payments and recover federal funds associated with unauthorized enrollment. The projected savings remain government estimates, while the broader decline in ACA coverage reflects additional factors, particularly higher premiums and reduced financial assistance.
