Nine percent of people who had ACA Marketplace coverage in 2025 are now uninsured, with healthcare costs as a major reason many enrollees either switched Marketplace plans or dropped coverage, according to a KFF poll.
The KFF follow-up survey of Marketplace enrollees was conducted Feb. 12 to March 2 and included 1,117 U.S. adults who had Marketplace insurance in 2025. The sample was drawn entirely from respondents to KFF’s original 2025 Marketplace survey, which included 1,350 participants.
The original survey was conducted amid debates over the expiration of enhanced premium tax credits to assess concerns about potential increases in healthcare coverage costs. The follow-up survey reinterviewed more than 80% of the original sample after those credits expired at the end of 2025 to examine how enrollees are navigating those changes.
Here are five things to know:
1. One in 10 Marketplace enrollees in 2025 are now uninsured, and 28% switched to a different Marketplace plan, with costs cited more often than changes in health needs among those who switched plans or became uninsured.
2. Among those who re-enrolled in ACA Marketplace coverage, 51% said their healthcare costs are “a lot higher” in 2026. Eight in 10 said their 2026 plan’s premiums, deductibles or coinsurance and copays are higher than in 2025.
3. Three in 4 returning enrollees said they are very or somewhat worried about affording costs for emergency care or hospitalizations. Nearly half are concerned about affording routine medical visits or prescription drugs, at 49% and 45%, respectively.
4. More than half of returning enrollees said they are cutting back or plan to cut back on food or basic household items to afford coverage and care. Among those with chronic health conditions, 62% said they are or will cut back on necessities.
5. Nearly 7 in 10 enrollees from 2025 said they re-enrolled in Marketplace coverage for 2026, including 39% who chose the same plan and 28% who switched plans.
