ACA enrollment declines as fewer enrollees pay their premiums

ACA enrollment declines as fewer enrollees pay their premiums Insurers can expect shrinkage in the individual market and a deterioration in the risk pool, says Wakely report.

Reimbursement By Susan Morse , Executive Editor | April 17, 2026 | 11:13 AM Photo: Fly View Productions/Getty Images Affordable Care Act enrollment in 2026 declined by 17% to 26%, according to a Wakely Consulting Group report. Sicker consumers kept their coverage, leading to a deterioration in the risk pool and questions for insurers over future ACA pricing.The expiration of the enhanced premium tax credits at the end of December – and the resulting rate increases – was a major reason for decreased ACA enrollment. An estimated 14% of consumers did not pay their premium in January, the report said. "The general expectation is that these changes could dramatically shrink the size of the individual market," the report said. For insurers in the ACA market, the decline means a deterioration in the risk pool, meaning a decrease in the number of healthier, less costly consumers. Sicker ACA members are remaining in the market to keep healthcare coverage, and some are lowering their costs by switching from silver to bronze plans. In 2026, there was a 17% decrease in enrollment in silver plans, compared to 6.3% in gold plans. Bronze enrollment expanded by almost 11%, according to the report."We estimate that morbidity could be, on average, between 2.9% and 6.5% worse," the report said. "Coupled with significant changes in market composition, these impacts introduce considerable uncertainty for issuers as they develop 2027 premium rates." ACA insurers are expected to raise rates by approximately 4% because of worsening morbidity, Wakely said, citing Kaiser Family Foundation data.There's variability in data on enrollment. Enrollment decreased by 5% approximately, according to early indications from Marketplace Open Enrollment Plan (OEP) selection data, the report said. This compares to Congressional Budget Office (CBO) projections that the individual market would decline by approximately 20%, from an average enrollment of 25.4 million in 2025 to an average enrollment of 20 million in 2026.Wakely is now estimating that average enrollment in the individual market could shrink 17% to 26% in 2026 compared to 2025, with significant variation by state. "As we consider forthcoming changes to 2027 premium rates, issuers will be examining their data to determine whether their 2026 rate increases were sufficient," Wakeley said. The ACA market in 2026 experienced a significant upheaval, the report said. This included higher premiums resulting from the expiration of the enhanced premium tax credits, increased costs because of higher medical utilization and inflation, rate correction from potential historical underpricing, changes in premium tax credit eligibility as a result of legislation and general uncertainty, the report said. Email the writer: [email protected] Topic: Accounting & Financial Management, Business Intelligence, Operations, Policy and Legislation, Reimbursement