Millions drop ACA marketplace coverage ahead of open enrollment as costs climb

If you rely on the Affordable Care Act marketplaces for your health insurance, the coming weeks demand your close attention. As open enrollment begins on November 1, millions of Americans are navigating an individual insurance market that has grown substantially more expensive over the past year [Medicare Rights Center].

Recent data reveals that more than 4.6 million fewer people were enrolled in Affordable Care Act (ACA) marketplace plans as of June 2026 compared to the same period in 2025 [KFF]. The sharp decline follows the expiration of federal enhanced premium tax credits at the end of 2025, which had kept monthly payments manageable for low- and middle-income households [Medicare Rights Center]. With those subsidies gone, families across the country are facing steep out-of-pocket hikes that threaten to put basic coverage out of reach.

The fallout from expired tax credits

The current coverage drop reflects a policy shift that took effect when Congress chose not to extend pandemic-era subsidies late last year [Medicare Rights Center]. Those enhanced premium tax credits, first enacted during the COVID-19 public health emergency, had lowered premiums across income brackets and drawn record enrollment into the marketplaces.

Without those financial buffers, policy analysts warned that widespread coverage losses were inevitable. Before the credits lapsed, researchers projected that more than 22 million people would see their premiums surge by an average of 75% heading into 2026 [KFF]. In rural areas, where healthcare costs and insurer participation present unique challenges, premium increases were estimated to reach 90% on average [KFF]. The mid-year enrollment drop of 4.6 million people confirms that many individuals found the higher monthly payments unsustainable.

Why older adults feel the steepest pinch

For adults between the ages of 50 and 64—those who are not yet eligible for Medicare—the loss of subsidies carries an especially heavy burden [Medicare Rights Center]. Under marketplace rules, insurers are permitted to charge older enrollees up to three times more for standard premiums than younger individuals [AARP].

When enhanced subsidies were active, tax credits helped absorb those age-related price jumps. Without them, older adults living on fixed or modest incomes before retirement face compounding costs [KFF]. Advocacy groups had warned that this group would be among the hardest hit, forcing some older individuals to delay care, skip routine screenings, or risk going without coverage altogether in the critical years leading up to their 65th birthday [AARP].

Navigating your options this open enrollment

Facing higher premiums can feel discouraging, but dropping coverage entirely leaves you exposed to catastrophic medical expenses. If you purchase your own health plan, taking deliberate steps during this open enrollment window can help you manage your healthcare expenses for the year ahead:

• Do not let your plan auto-renew: Insurers frequently alter their provider networks, prescription drug formularies, and cost-sharing tiers from year to year. Even if you like your current policy, visiting HealthCare.gov or your state marketplace allows you to review what other carriers are offering in your area.
• Examine total costs, not just monthly premiums: While plans with the lowest monthly payments can be tempting, higher deductibles and copayments can quickly erase your savings if you manage chronic conditions or take ongoing medications.
• Check eligibility for standard subsidies: While enhanced subsidies have expired, original baseline premium tax credits remain in law for households that meet federal income thresholds [Medicare Rights Center]. Ensuring your household income projection is accurate on your application guarantees you receive any financial assistance for which you still qualify.
• Seek free, certified assistance: Marketplace navigators and state-certified enrollment counselors provide unbiased help to walk you through plan comparisons at no charge.