ACA enrollees face steep cost hikes as subsidies shrink in 2026

Many Americans enrolled in the Affordable Care Act (ACA) are facing steep cost increases this year. With subsidies cut back and premiums rising, a growing number of people are struggling to keep their coverage. Some have already dropped out, while others are making tough financial choices to stay insured.

Nearly 70% of last year's ACA enrollees signed up again for 2026. But most now report higher premiums, deductibles, or out-of-pocket costs compared to 2025. The main reason is the expiration of enhanced tax credits, which previously lowered expenses for many households.

About 28% of returning enrollees switched to cheaper plans, often accepting higher deductibles to reduce monthly payments. Even so, over half say they must cut back on other essential spending to afford their health insurance. Meanwhile, 17% fear they may not manage payments for the full year. The financial strain has already pushed some out of the system. Around 9% of last year's enrollees did not renew their coverage, with affordability as the top concern. Younger adults, in particular, are dropping out—14% of those aged 18-29 who were previously insured now have no coverage. Congress's failure to extend the enhanced subsidies has worsened the situation. Without these supports, more enrollees face higher bills, forcing difficult trade-offs between health care and other basic needs.

The return to pre-pandemic subsidy levels has left many ACA enrollees with fewer options and greater financial pressure. Some have switched to less comprehensive plans, while others risk losing coverage entirely. Without further policy changes, the trend of rising costs and reduced access is likely to continue.