ACA enrollment reached 23.1 million in 2026, a 5% decrease from 2025, CMS reported March 27.
While enrollment is down about 1.2 million consumers from the open enrollment period last year, 2026 enrollment is still 8% and 41% higher than enrollment in 2024 and 2023, respectively. CMS’ report included the 30 states using HealthCare.gov, as well as the 20 states and the District of Columbia that use their own state-based exchanges.
For 2026, the average out-of-pocket premium (after advanced premium tax credits) for ACA enrollees is $178, compared to $113 in 2025.
There was a 13% drop in new consumers (4.1 million to 3.6 million), but also a 15% increase in returning consumer plans selections (9.4 million to 10.7 million), compared to 2025. Automatic re-enrollees dipped by 19%, down to 8.8 million from 10.8 million.
The percentage of consumers with bronze plans increased from 30% in 2025 to 40% in 2026, a trend Texan insurance leaders had suggested to Becker’s. From 2021 through 2025, the percentage of consumers with silver plans held steady at around 55%. Now, it is down to 43%.
Florida holds its title as the state with the largest ACA enrollment at over 4.5 million, trailed by Texas at under 4.2 million. Texas and Florida had the most new consumers by a landslide — 764,316 and 725,149, respectively — followed by California, Georgia and North Carolina.
However, North Carolina and Florida saw the greatest enrollment losses year over year. The number of consumers with an exchange plan selection in the states dropped by 213,653 and 196,643, respectively. Texas gained 206,007, a strong lead over Massachusetts and New Mexico, which respectively gained 14,433 and 12,730 consumers. Massachusetts and New Mexico took measures to compensate for the expired ACA enhanced subsidies.
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