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.
- US individual health insurance enrollment declined by more than 4.6 mn people to 20.5 mn in June 2026, the steepest annual decrease since 2015, according to KFF.
- Average monthly ACA Marketplace premium payments increased 58% to $178 in 2026, while deductibles rose 37% to a record $3,786.
- Insurers are proposing a median 15% premium increase for 2027, as declining enrollment and a potentially higher-risk pool increase pressure on healthcare costs and pricing.
The KFF analysis covers the broader individual health insurance market, including ACA Marketplace plans, policies purchased directly from insurers and certain non-ACA products. Approximately 90% of individual market enrollment is through ACA Marketplaces.
The decline accelerated during 2026. Enrollment was down 16% year over year in March before reaching an 18% decrease in June.
Earlier federal figures showed that ACA Marketplace enrollment among people who had paid their premiums declined 12% in February, falling from 21.8 mn to 19.2 mn.
The difference reflects continued policy cancellations and nonpayment after the annual enrollment period, which are not fully captured by initial plan sign-ups.
ACA premiums rise as subsidies expire
The enhanced federal subsidies introduced in 2021 and extended through 2025 had reduced monthly insurance payments and expanded eligibility for financial assistance.
Their expiration increased costs, particularly for households earning more than 400% of the federal poverty level, which lost access to premium tax credits.
According to KFF, average monthly ACA Marketplace premium payments increased 58%, from $113 in 2025 to $178 in 2026.
Consumers also shifted toward lower-premium plans with higher out-of-pocket costs. The share selecting bronze plans increased from 30% to 40%, representing 9.2 mn people in 2026, compared with 7.3 mn the previous year. Silver plan enrollment fell from 13.7 mn to 9.8 mn.
Consequently, average Marketplace deductibles increased 37%, or $1,027 per person, reaching a record $3,786.
The financial pressure is affecting coverage retention. A KFF survey conducted in February and March found that 17% of returning ACA enrollees were not confident they could afford premiums throughout 2026.
Among people enrolled in Marketplace coverage in 2025, 9% reported becoming uninsured, while another 22% had moved to other forms of coverage.
More than half of returning enrollees, 55%, said healthcare expenses were forcing them to reduce spending on food or other basic household necessities.
Insurance enrollment declines vary across states
KFF found that ACA Marketplace enrollment declined in every state except New Mexico during the early months of 2026.
New Mexico recorded a 14% increase in February enrollment after introducing state-funded assistance that fully replaced the expired enhanced federal subsidies.
States operating their own insurance exchanges experienced an average enrollment decline of 6%, compared with 15% in states using the federal HealthCare.gov platform.
The findings indicate that additional state subsidies helped limit coverage losses, although differences in market characteristics and enrollment administration also influenced results.
Despite the contraction, June 2026 individual market enrollment remained 53% higher than in June 2019, representing more than 7 mn additional covered individuals.
Health insurers seek further premium increases for 2027
Rising medical expenses and changes in the insured population are creating additional pricing pressure. Centene and UnitedHealth have reported higher medical costs in their ACA businesses during 2026.
Insurers have also warned that healthier policyholders may be more likely to cancel coverage when premiums become unaffordable, leaving a smaller pool of members with greater healthcare needs.
An updated Peterson-KFF analysis covering 276 insurers across all 50 states and Washington, DC, found a median proposed premium increase of 15% for 2027. The earlier estimate of 14% covered a smaller group of insurers in 16 states and Washington, DC.
The proposed 2027 increases follow a median finalized rate increase of 20% for 2026. Approximately 63% of insurers are seeking increases between 10% and 25% for next year.
KFF found that insurers’ assumptions about worsening enrollee health contributed approximately four percentage points to proposed 2027 premium increases on average.
Underlying medical cost growth, including hospital services, physician care and prescription drugs, remains another major driver.
The Congressional Budget Office had previously projected that ACA Marketplace enrollment could contract by roughly 25% following the expiration of enhanced subsidies.
KFF expects enrollment losses to continue as additional policyholders struggle to maintain premium payments. The proposed 2027 rate increases could add further pressure when consumers select coverage for the next plan year.
