ACA deductibles up $1k, enrollment projected to drop 5 million, KFF analysis finds

The expiration of enhanced ACA premium tax credits at the end of 2025 has triggered unprecedented disruption in the individual insurance market, a KFF research has found (Source: “ACA Marketplace Deductibles Surge $1000 in 2026 as Enhanced Tax Credits Expire,” American Journal of Managed Care, May 20).
 
Two new analyses published May 19 by KFF document historic increases in deductibles, a projected enrollment drop of nearly 5 million people, and a dramatic shift toward high-deductible plans as consumers scramble to afford coverage without enhanced subsidies.
 
The average ACA Marketplace deductible rose 37%, or more than $1,000 from $2,759 in 2025 to $3,786 in 2026 — the steepest increase in the program's history. The jump was driven primarily by a large-scale migration from silver to bronze plans, with the share of consumers selecting bronze plans climbing from 30% (7.3 million people) in 2025 to 40% (9.2 million people) in 2026. Meanwhile, the share selecting silver plans fell from 57% to 43%, marking a record low.
 
Plan sign-ups declined by more than 1 million during the 2026 Open Enrollment Period to 23.1 million, the sharpest single-year drop since the ACA Marketplaces launched. KFF projects that average effectuated Marketplace enrollment could decline by 21.5%, falling from 22.3 million in 2025 to approximately 17.5 million in 2026.