Historic 37% increase in Affordable Care Act deductible rates

The average deductible for people enrolled in Affordable Care Act Marketplace plans increased by more than $1,000 in 2026, the steepest increase in the program’s history, after enhanced federal premium tax credits expired, according to a new KFF analysis.

Average Marketplace deductibles rose 37%, from $2,759 in 2025 to $3,786 in 2026, the analysis found. Researchers attributed the jump to a major shift in the types of plans Americans are selecting after the end of the enhanced subsidies that had lowered monthly premium costs for millions of enrollees in recent years.

Following the expiration of the enhanced tax credits, many consumers moved toward plans with lower monthly premiums but substantially higher out-of-pocket costs. Enrollment in bronze Marketplace plans, which generally carry the lowest monthly premiums and highest deductibles, climbed from 30% of all plan selections in 2025 to 40% in 2026, representing an increase from 7.3 million people to 9.2 million.

Meanwhile, enrollment in silver plans, which typically have higher premiums but lower deductibles and cost-sharing requirements, dropped to the lowest level in Marketplace history. Silver plan enrollment fell from 57% to 43% of plan selections, decreasing from 13.7 million people to 9.8 million.

The share of Marketplace enrollees selecting cost-sharing reduction silver plans also reached a record low of 37%. These plans help lower-income individuals reduce out-of-pocket healthcare expenses such as deductibles, copayments and coinsurance.

Although lower-premium bronze plans may reduce monthly insurance payments, healthcare policy experts warn they can create significant financial strain when patients actually need medical care.

According to a KFF survey conducted last November, 67% of Marketplace enrollees said they would likely cut spending on basic household necessities if their annual healthcare costs increased by $1,000.

The report also projected substantial enrollment declines across the ACA Marketplace this year. Researchers estimate enrollment could fall by roughly 21.5%, declining from 22.3 million people in 2025 to approximately 17.5 million in 2026.

During the 2026 open enrollment period, about 23 million people signed up for Marketplace coverage. This was more than one million fewer than the year before and the largest single-year decline since the ACA Marketplaces launched.

Researchers say enrollment losses are expected to continue throughout the year as consumers struggle with rising premiums. Average monthly premium payments increased 58%, rising from $113 to $178 after the enhanced tax credits expired.

Many enrollees are expected to lose coverage because they fail to keep up with premium payments. Estimates from the Wakely Consulting Group suggest average effectuated enrollment in the individual insurance market could decline between 17% and 26% from 2025 to 2026 after accounting for unpaid premiums and midyear attrition.

Middle-income Americans appear to have been disproportionately affected by the changes. When the enhanced subsidies expired, the ACA’s so-called “subsidy cliff” returned, leaving some individuals earning too much to qualify for standard subsidies but still unable to afford unsubsidized premiums.

People earning more than 400% of the federal poverty level, approximately $62,600 annually for a single person in 2026, accounted for only 7% of Marketplace enrollment in 2025 but represented nearly half of the enrollment decline between 2025 and 2026.

Most states saw declines in Marketplace sign-ups, with some of the steepest drops occurring in North Carolina (22%), Ohio (20%) and West Virginia (17%). Researchers noted that states operating their own insurance exchanges generally retained more enrollees than states using the federally facilitated Marketplace, partly because some state-based exchanges offer supplemental subsidies and stronger outreach programs.