Updated Ohio enrollment in the federal ACA marketplace

Created as part of the ACA in 2010, health insurance marketplaces are a source of coverage for people whose income is too high for Medicaid, but don’t have access to affordable insurance through their employer. In 2025, HPIO released a policy explainer on federal policy changes to the federal health insurance marketplace. 

This new Data Snapshot provides updates on Ohio enrollment in ACA marketplace plans following the expiration of enhanced premium subsidies.

Marketplace enrollment in Ohio fell by 161,000 people from the previous year, a 32.4% decrease. Even among Ohioans who selected a plan for 2026, many are now losing coverage after missing premium payments. The decline followed the expiration of enhanced federal subsidies at the end of 2025.

Those subsidies had helped drive recent enrollment gains. In Ohio, marketplace enrollment remained relatively low until 2021, when Congress passed the American Rescue Plan Act, which included enhanced subsidies for ACA marketplace plans. The legislation also expanded eligibility for these credits, making coverage more affordable and significantly increasing enrollment. Congress did not renew the enhanced subsidies at the end of 2025.

As a result, premiums rose this year for nearly all consumers. Marketplace insurers also increased premiums by an average of 18% in 2026, citing higher prices for health services and uncertainty about the future of the Marketplace insurance pool. Higher premiums are the main reason marketplace coverage dropped substantially in Ohio and across the country.

About HPIO's Healthcare access and affordability in Ohio series

This series of HPIO publications includes data and analysis about the current challenges facing working Ohioans and examines how recent federal and state policy changes will impact access to care and affordability in Ohio. Support for this project was provided by HPIO’s core funders.