State-based Marketplaces (SBMs) are closely monitoring enrollment patterns this year as markets shift alongside significant policy changes over the past year, including the expiration of federal enhanced premium tax credits (EPTCs). In this report, recent data from 17 SBMs provide insights into early 2026 enrollment trends across their states (through plan selections as of March 1, 2026).1
Exact enrollment trends and patterns significantly vary across reporting SBMs. This is a result of multiple factors, such as actions by certain states to mitigate enrollment losses expected as a result of federal policy shifts. General market dynamics also influenced a variety of factors across states, including overall health insurance costs and accessibility of coverage, including job-based and Medicaid coverage. Despite these variations, there are a few emerging trends across SBMs — including higher disenrollment rates, enrollment losses amongst older adults, and increased prevalence of consumers purchasing lower premium, higher-cost-sharing plans.
Key Takeaways
- Disenrollments are accelerating across most State-based Marketplaces (SBMs). Data indicate that disenrollments are up 24 percent compared to March 2025.
- Although enrollment trends are state and population-specific, enrollment has most consistently decreased for older adults (aged 55 and older) among reporting SBMs.
- Higher rates of disenrollments, lower rates of new enrollments, and greater shifts into lower metal level plans are likely driven by increased premiums, exacerbated by expiration of federal enhanced premium tax credits.
- State actions to provide state subsidies for Marketplace consumers has slowed disenrollments, but impact is limited to the smaller number of states implementing these programs.
Data showed mixed enrollment trends at the start of this year; however, disenrollments are accelerating for most SBMs as the year progresses.
As of January 1, 2026, 7 of 17 SBMs reported enrollment gains (CT, DC, ID, MA, MD, NM, PA) when compared to January 1, 2025. However, by March 1, only four SBMs (CT, DC, MD, NM) have maintained enrollment gains, with the rest reporting losses when compared with last year.
Fluctuations in Marketplace enrollment throughout a coverage year are not uncommon. SBMs are purposefully built to be responsive to dynamic, state-specific markets and real-world consumer needs. State decisions to tailor or extend open enrollment windows drive continued enrollment for some states into January and February.2 General flexibility allows enrollees to drop their coverage at almost any time, while other enrollees rely on special enrollment periods to access coverage during the year in the event of certain circumstances like job loss, moving, or a change in household size.
So far in 2026, enrollment patterns are diverging from last year. Disenrollments are outpacing the 2025 rate, with reporting SBMs documenting over 900,000 disenrollments since January 1. SBMs are also not gaining new enrollments at a similar pace, and the proportion of new Marketplace enrollees dipped from 22 to 18 percent when compared with March 1 of last year.
Increases in disenrollments come as Marketplaces hit the 30-day grace period deadline by which consumers choosing new insurance plans had to pay their first premium or else lose their plan. SBMs are now closely watching enrollment figures for April and May, when most SBMs expect another round of attrition as the 90-day grace period expires for individuals who were auto-enrolled in coverage and make up 54 percent of their consumer base.
Impact of State Actions to Stabilize and Reduce Costs of Marketplace Plans
Overall coverage losses may have been tempered by the implementation of a variety of strategies across SBMs aimed at lowering costs or preserving access to their Marketplace plans. State subsidy programs, designed to lower premium or cost-sharing expenses for individuals purchasing coverage through a state’s Marketplace, are in effect across 10 SBMs included in this analysis (CA, CO, CT, MA, MD, NJ, NM, NY, VT, WA), although the parameters of their programs vary greatly. Most state-funded subsidy programs target premium support to Marketplace consumers below 400 percent federal poverty level (FPL), while other states more specifically target subsidies to specific populations like lowest-income enrollees (CA) or young adults (MD). New Mexico was the only state to establish a program designed to fully replace the cost of expired federal EPTCs, a likely key driver of New Mexico maintaining an exceptional 13.8 percent increase in enrollment over last year.
Other strategies to reduce the cost of Marketplace plans include:
- Reinsurance: Ten SBMs (CO, ID, MD, ME, MN, NJ, NV, PA, RI, VA) operate reinsurance programs through Section 1332 waivers, using federal pass-through funding to cover high-cost claims and lower premiums across their markets.
- Basic Health Plans: Three SBMs (DC, MN, and NY), offer Basic Health Plans, low- or no-cost coverage programs that specifically cover lower-income enrollees (typically populations from 133-200 percent FPL, though New York’s program covered households up to 250 percent FPL).
- Silver Loading: Most SBM states direct issuers to weight the cost of federally mandated cost-sharing reductions (CSR) into silver (CSR-eligible) plans, enabling them, in turn, to increase the value of federal tax credits available to their marketplace consumers.
Enrollment Shifts Vary by States and Populations
Precise patterns of enrollment vary across SBMs and their populations. One common trend, shared by 14 states (CA, CO, CT, MA, MD, ME, MN, NJ, NV, NY, PA, RI, VT, WA), is a reported loss of enrollment among adults aged 55 and older. Enrollment increases or losses vary among other age groups.
SBMs report a 47 percent increase in the number of enrollees who are not receiving advanced premium tax credits (APTCs), a result of several policy changes that made thousands of Marketplace consumers no longer eligible for tax credits.3 Most notably, households earning over 400% FPL ($63,840 for an individual or $132,000 for a family of four) no longer qualify for tax credits after the expiration of federal EPTCs in December 2025.
Affordability and Shifting Consumer Purchasing Trends
One of the most notable shifts this year was purchasing trends, particularly movement from one metal level — platinum, gold, silver, bronze, or catastrophic — to another. While the relative number of individuals making these changes was small, most SBMs reported an increase in the proportion of their enrollees switching plans this year. The greatest shift was enrollees moving from silver to bronze plans. In nine SBMs (CA, CO, CT, MA, MN, NJ, NV, PA, RI), these switches more than doubled, and in six SBMs (CA, CT, NJ, NV, PA, RI), they more than quadrupled.4
Rising premiums are likely the biggest driver behind these trends. Average per-enrollee premiums rose 10 percent or more across all metal levels in 7 of the SBMs (CO, ME, MN, NM, NV, PA, RI). Seven SBMs reported silver plan premiums up 20 percent or more (CO, ME, MN, NV, PA, RI, WA); four reported the same for gold plans (CO, ME, MN, NM). In 12 SBMs (CO, CT, ID, MD, ME, MN, NM, NV, PA, RI, VT, WA), average premiums for enrollees selecting a silver plan are higher than average premium of a gold plan in 2025.
While federal tax credits and state subsidy programs help offset these costs for some, monthly premium bills are up 2 to 74 percent on average across SBMs, even after the application of federal and/or state premium programs.5
Movement from gold to silver or bronze remained stagnant in most SBMs, as did enrollment from any metal level into catastrophic plans. The latter comes even as recent policy changes made access to catastrophic plans (very high-deductible, low-premium plans) easier by essentially allowing any individual with income outside of 100-250 percent of the FPL eligible to purchase a catastrophic plan.6 While average monthly per-person premiums for catastrophic plans are lower than monthly premiums for bronze plans, deductibles are typically much higher, capped at $10,600 for an individual or $21,200 for a family in 2026. The average per person deductible in SBMs’ bronze plans ranged from $3,434 – $9,904.7
Another major Marketplace change this year is an expansion of plans compatible with Health Savings Accounts (HSA), tax-advantaged accounts where individuals may contribute money to pay for medical expenses (including co-pays and deductibles, but not monthly premiums). Changes enacted under the One Big Beautiful Bill Act (OBBBA) allowed for all bronze and catastrophic plans to be classified as HSA-compatible, while prior policies restricted eligibility to only plans that met certain deductible and cost-sharing requirements. Because HSAs are set up independently by individuals and their selected HSA provider, SBM data on HSA uptake is limited. However, five SBMs report that enrollment in HSA-compatible plans has more than tripled from 2025 (CA, MA, MD NY, WA)8, and 27 percent of SBM enrollees selected bronze or catastrophic plans this year. Notably, federal law places a cap on HSA contributions of up to $4,400 for an individual and $8,750 for a family. SBMs reported the average per-person deductible for bronze enrollees in 2026 ranged from $3,424 to $9,904.
Trends through March 1, while mixed across the SBMs, may signal potential acceleration of coverage losses this year in certain states and the impact of increased premium cost pressures on consumers across Marketplaces. While state interventions have helped buffer increased costs for some enrollees, they have not entirely ebbed the trend of disenrollment so far this year. It also is too early to see the impact of federal efforts to expand access to HSA-eligible products and catastrophic plans.
As the coming months will provide more data, SBMs will monitor these trends, publish findings, and explore options for how they can support access to affordable coverage for their consumers.
1 Unless otherwise noted, 17 SBMs (California, Colorado, Connecticut, District of Columbia, Idaho, Massachusetts, Maryland, Maine, Minnesota, New Jersey, New Mexico, Nevada, New York, Pennsylvania, Rhode Island, Vermont, Washington) reported plan selections (enrollment) for coverage beginning or before March 1, 2026. Where applicable, 2025 comparisons are to data for plan selections (enrollment) on or before March 1, 2025.
2 Several SBMs leveraged state flexibility to set extended open enrollment deadlines as follows: January 23 (MA), January 30 (VA), January 31 (CA, CT, IL, NJ, NY, PA, RI); February 4 (DC).
3 Additional changes enacted under OBBBA that are driving disenrollments include policies to newly prohibit eligibility for federal premium tax credits from certain classes of non-citizens by limiting eligibility only to “eligible aliens,” meaning individuals lawfully admitted for permanent residence under the Immigration and Nationality Act; an alien granted the status of Cuban and Haitian entrant; or an individual who lawfully resides in the U.S. in accordance with a Compact of Free Association. In addition, recent immigrants under 100 percent FPL subject to the 5-year bar under Medicaid are newly prohibited from eligibility for premium tax credits.
4 Does not include data from ME and NY which were unavailable at the time of publication.
5 Range of monthly premium increases excludes Washington, where monthly net premium costs have declined by 16.1 percent, largely attributed to their newly implemented enhanced premium alignment methodology to address CSR reductions.
6 Guidance issued in September 2025 established a change to hardship exemptions used to qualify for catastrophic plans, allowing any individual who does not qualify for tax credits or cost-sharing reductions to qualify for a catastrophic plan. Prior policies allowed only individuals under 30 years old or those who could not find a Marketplace plan below 8.05 percent of their annual income to qualify for catastrophic coverage. In 2026, the revised policy was not applicable to CA, CT, DC, MD.
7 Does not include data from ID, NM, NV, and RI which were unavailable at the time of publication.
8 Does not include data from ID, MN, NV, NM, and VT which were unavailable at the time of publication.
