The Affordable Care Act marketplace continued to show broad reach in 2026. However, total enrollment dipped for the first time in recent years. According to a March 27 report from the Centers for Medicare and Medicaid Services, ACA enrollment reached 23.1 million consumers this year — a 5% decline from 2025.
Despite the drop, the 2026 figure still holds strong in historical context. Enrollment is 8% higher than 2024 and a striking 41% above 2023 levels. These numbers reflect sustained growth over the longer term, even as short-term headwinds have begun to appear.
Overview of 2026 ACA Enrollment Numbers
The CMS report covered all 30 states using HealthCare.gov, plus the 20 states and the District of Columbia that operate their own state-based exchanges. Together, these markets form the full picture of ACA marketplace activity for the 2026 open enrollment period.
Overall, 23.1 million consumers selected a plan. That figure is approximately 1.2 million fewer than the prior year. Nevertheless, the ACA marketplace remains a critical source of coverage for tens of millions of Americans, and the data points to both structural strength and emerging pressure points.
New vs. Returning Consumer Trends
New Enrollee Numbers Fell Sharply
New consumer sign-ups dropped 13% year over year, falling from 4.1 million in 2025 to 3.6 million in 2026. This decline suggests that outreach and affordability challenges may be reducing first-time enrollment, particularly among younger or lower-income populations.
Returning Consumers Showed Stronger Commitment
By contrast, returning consumers demonstrated increased loyalty. Plan selections among returning enrollees rose 15%, climbing from 9.4 million to 10.7 million. This trend indicates that existing marketplace participants are actively re-engaging with coverage options rather than dropping off.
Automatic Re-Enrollees Declined
Automatic re-enrollment, which captures consumers who do not actively select a new plan, also fell significantly. This category dropped 19%, from 10.8 million in 2025 to 8.8 million in 2026. The reduction may reflect the expiration of enhanced ACA subsidies, which prompted some consumers to re-evaluate their coverage or exit the market entirely.
Shift in Plan Type Preferences
Bronze Plans Surge in Popularity
One of the most notable shifts in 2026 involves plan-type selection. The share of consumers choosing bronze plans jumped from 30% in 2025 to 40% in 2026. This marks a substantial change in consumer behavior. Bronze plans carry lower monthly premiums but higher out-of-pocket costs, suggesting that affordability concerns are driving enrollment decisions.
Insurance leaders in Texas had already flagged this trend in conversations with Becker’s, noting rising price sensitivity among marketplace consumers.
Silver Plans Lose Ground
Silver plans, which had held a steady share of around 55% from 2021 through 2025, dropped to 43% in 2026. Moreover, this shift reflects broader market forces — specifically, the end of enhanced premium tax credits, which had made more comprehensive plans more accessible for mid-income consumers in recent years.
State-by-State Enrollment Breakdown
Florida and Texas Lead Total Enrollment
Florida retained its position as the state with the highest ACA enrollment, surpassing 4.5 million consumers. Texas followed closely, with just under 4.2 million enrolled. Both states also led the country in new consumer additions. Texas contributed 764,316 new enrollees, while Florida added 725,149. California, Georgia, and North Carolina rounded out the top five states for new enrollment.
Key States at a Glance
| State | Enrollment Status | New Consumers |
|---|---|---|
| Florida | Highest total (4.5M+) | 725,149 |
| Texas | Second highest (4.2M) | 764,316 |
| California | Top five for new consumers | — |
| Georgia | Top five for new consumers | — |
| North Carolina | Top five for new consumers | — |
Enrollment Losses and Gains by State
North Carolina and Florida Faced the Biggest Losses
Despite ranking among the top states for new consumers, North Carolina and Florida experienced the steepest year-over-year declines. North Carolina lost 213,653 exchange plan selections. Florida was close behind, losing 196,643. These losses likely reflect the expiration of enhanced ACA subsidies, which disproportionately affected states with large low-income marketplace populations.
Texas, Massachusetts, and New Mexico Gained
Texas posted the strongest growth, adding 206,007 consumers net year over year. Massachusetts and New Mexico also posted gains — 14,433 and 12,730 respectively — after both states took proactive measures to offset the impact of expired federal subsidies. Their early action helped cushion the blow that other states absorbed more directly.
What These Numbers Mean for Payers
The 2026 ACA enrollment data carries important implications for health insurance payers. The overall decline in enrollment, combined with a shift toward bronze plans, points to a market under financial pressure. Consumers are increasingly choosing lower-cost options, which may affect payer revenue and risk pool stability.
Furthermore, the drop in new enrollees may signal growing awareness barriers or subsidy-related hesitation. Payers operating in high-loss states like Florida and North Carolina will need to monitor risk mix carefully. Meanwhile, states with targeted policy responses — such as Massachusetts and New Mexico — offer a model for sustaining enrollment through local action.
As the marketplace evolves, payers face both a challenge and an opportunity: adapting their product offerings and consumer outreach strategies to meet a more cost-conscious enrollee base.
