ACA enrollment dropped from 22.1 million in February 2025 to 19.2 million people in February 2026, according to a June 26 HHS report.
Immediately following the open enrollment period for 2025 coverage, ACA enrollment reached a record high of 24.2 million. For 2026 coverage, 23 million had selected a plan, as published in late January.
The enrollment dip occurred amid a backdrop of enhanced subsidies expiring and the federal government’s push to crack down on improper participants.
Here are five other things to know from the report:
1. The report highlighted the removal of improper enrollments as context for the year-over-year decline. However, Cynthia Cox, a vice president and director of the ACA program at KFF, told the Associated Press that the coverage loss took place as “millions of people faced double or even triple digit increases in their premium payments.”
2. The report estimated improper, phantom and fraudulent enrollment reached 5.6 million people in 2025, and 2.6 million improper and phantom enrollments persist.
3. Historically, on average, 18% of those newly owing a premium following automatic re-enrollment from a $0 premium plan have their coverage terminated due to nonpayment. However, over the past three years, about half of those people are estimated to have not paid and, thus, lost coverage. This rate was 55% in 2026.
4. Through May 2026, 27.8% of $0 premium enrollees had already canceled their plans.
5. CMS found 1 million “highly suspicious agent- and broker- assisted enrollments” via Healthcare.gov that lacked Social Security numbers on applications and were also not paying a premium.
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