ACA enrollment on the skids as Americans face higher premiums
Despite early data showing that 2026 open enrollment for medical coverage through HealthCare.gov and state exchanges was a big success, new data released by the Centers for Medicare & Medicaid Services (CMS) shows that the number of signups is down significantly from 2025.
As of Nov. 29, nearly 5.8 million had signed up for coverage after the open enrollment period began on the first of the month—that represented an additional 400,000 people compared to the same timeframe in November 2024.
However, figures released by CMS on January 12 reveal that only 22.8 million Americans have used the exchanges to buy insurance, based on information valid through January 3. For context, that’s a 1.2 million reduction in enrollees when compared to 2025.
Looking further at the data, CMS said 2.8 million Americans are new enrollees, meaning that 20 million had purchased coverage sold on Affordable Care Act (ACA) marketplaces the year prior and opted to enroll again—either with the same plan or a new one.
The most popular way to get medical coverage remains HealthCare.gov, which logged 15.6 million enrollees. State exchanges claimed a total of 7.2 million.
In most parts of the country, open enrollment ends on Jan. 15. New coverage for 2026 goes into effect on Feb. 1. Some states, however, closed enrollment on Dec. 15, which means coverage began on Jan. 1.
Lagging numbers align with higher prices
Notably, extended ACA subsidies that had been in place since 2020 expired last year, leaving most Americans with no choice but to pay higher premiums. Tax credits that made medical coverage more affordable expired on December 31, 2025 when Congress failed to renew them.
The issue of their extension caused a record-long six-week shutdown of the federal government. In the end, it reopened without a new deal for healthcare in place.
Because of the higher prices, the types of coverage people are buying will matter as much as the overall numbers. Whether or not there will be significantly more people left underinsured, or stuck with a high deductible plan, remains to be seen.
As reported previously by HealthExec, CMS said in 2024 that it would be cracking down on gray market, low-value insurance coverage being offered by brokers on ACA exchanges. Yet, these plans are still showing up in searches, offering enticing low premiums with little benefit. Those, too, will factor into overall quality data.
This is a developing story. We’ll know more as CMS releases more data in the coming months.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.