Obamacare Enrollment Set to Drop by 1 Million in 2026 - Key Factors

Enrollment in Obamacare plans appears to be trending toward a decline of more than 1 million Americans in 2026 amid an increase in monthly premiums and the expiration of enhanced federal subsidies for health insurance premiums that were implemented during the COVID-19 pandemic.

The Centers for Medicare and Medicaid Services (CMS) released a report on Wednesday that showed 23 million consumers signed up for individual health insurance coverage through the Marketplaces during the 2026 open enrollment period. That included 15.8 million selections in states using the HealthCare.gov platform and 7.2 million using state-based exchanges.

The COVID-era enhanced subsidies for health insurance expired at the end of last year after Congress failed to reach an agreement on an extension, although the original subsidies implemented under the Affordable Care Act remain in effect. Total premium costs for subsidized Obamacare enrollees are expected to increase to an average of $1,904 for 2026 from $888, according to KFF's data.

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An analysis by healthcare industry research firm KFF noted that as of mid-January, enrollment was down about 1.2 million consumers compared with the 24.2 million who had enrolled at this point last year.

Congress failed to reach an agreement to extend the COVID-era enhanced subsidies for Obamacare plans. (Anna Moneymaker/Getty Images)

KFF noted that the enrollment data released at this stage represents automatic renewals and plan selections, which don't necessarily translate into effectuated enrollments as some may ultimately choose not to pay for their plan.

Over four in 10 sign-ups in 2025 were from automatic renewals, and KFF explained that as returning consumers get their initial bills from insurers and see the cost, they can choose not to pay the premium and eventually lose coverage or could opt to disenroll. 

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Health insurance costs are expected to surge in 2026. (Getty Images)

The group cautioned that without the enhanced premium tax credits, the effectuation or premium payment rate may drop relative to past years, which could result in the final enrollment data showing a deeper drop.

KFF conducted a poll that indicated premium payments were expected to more than double on average in 2026, and about 25% of enrollees said they would forgo health insurance this year if their premiums doubled as expected.

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Obamacare enrollment figures won't be finalized until after the 90-day grace period for paying premiums expires. (Matt McClain/The Washington Post via Getty Images)

Analysts said they expect total enrollment in Obamacare plans to fall in the coming months as consumers see the higher premiums and choose to let their coverage expire rather than paying that much more to keep their coverage.

"Given the 90-day grace period, which should apply to the majority ACA members, we see potential for strong disenrollment activity during this period, leading to a lower final enrollment number," said Evercore ISI analyst Elizabeth Anderson.

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Enrollment on HealthCare.gov ran through Jan. 15, 2026, though state-based exchanges' enrollment deadlines vary.

Reuters contributed to this report.