A recent report reveals a significant drop in individual health insurance enrollment, with an 18% decline from June 2025 to June 2026. This market primarily consists of individuals covered under the Affordable Care Act (ACA) Marketplace, along with others purchasing similar plans outside the exchange.
The number of people enrolled dropped more significantly than earlier reports indicated, with ACA Marketplace enrollment data revealing a 12% decrease from February. This individual market enrollment decline started during the 2026 Open Enrollment Period for ACA Marketplaces and persisted throughout the year.
Enrollment Decline
During the 2026 Open Enrollment Period, plan selections declined by 1.2 million compared to 2025. However, these sign-ups may include individuals who fail to pay premiums and consequently never obtain coverage. Subsidized enrollees also benefit from a three-month grace period for nonpayment.
Enrollees that did not make their January premium payment likely were not recorded as terminated until after March 31, with coverage terminated retroactively to the end of January. As a result, February ACA Marketplace effectuated enrollment (measured retrospectively after the grace period elapsed on May 15, 2026) fell by 12%, from 21.8 million to 19.2 million.
March enrollment in the composite individual market decreased 16% year-over-year, and by June, enrollment had dropped 18% compared to the same period in 2025. These figures encompass off-exchange enrollment, though most individual market coverage is purchased through ACA Marketplaces on-exchange.
Decline Factors
The enrollment decline coincides with the expiration of the enhanced premium tax credits and other policy changes that are expected to reduce enrollment. As of earlier this year, ACA Marketplace enrollment had fallen in every state except New Mexico, with wide variation in the size of the declines.
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Further enrollment declines may continue this and in upcoming plan years. The second-quarter data provide a mid-year snapshot, and enrollees who fall behind on premiums later in the year may still lose coverage. These June enrollment figures do not account for the drop in enrollment expected from the recent announcement of plan cancelations, which occurred after the end of the second quarter.
Premiums are projected to keep rising in 2027. Marketplace insurers have proposed a median 15% premium increase for 2027, marking the second straight year of double-digit hikes. Insurers typically added an extra four percentage points to premiums, anticipating further enrollment drops and a sicker risk pool in 2027.
The Congressional Budget Office (CBO) projected a roughly 25% enrollment drop through 2026 after enhanced tax credits expired. This decline matches KFF polling of Marketplace enrollees, which found 17% of returning enrollees lacked confidence in affording their premiums for all of 2026.
Among all 2025 Marketplace enrollees, 22% said they had moved to another source of coverage, and nearly one in ten (9%) said they were now uninsured. The data used in this analysis come from the Mark Farrah Associates Health Coverage Portal.
Enrollment counts were adjusted to exclude Children’s Health Insurance Program (CHIP) enrollment that may be captured as individual market enrollment for all plans with available data in the Policy Experience exhibit. Among insurers that report quarterly, there was a 5% drop in enrollment between March and June 2026, with 20.5 million people enrolled in the individual market as of June 2026.
Implications for Market Composition
Because the majority of individual market coverage continues to be purchased through the exchange, the loss of premium subsidies has a pronounced effect on overall numbers.
