Nearly 23 million people have enrolled in ACA marketplace plans for 2026, down from 24.2 million in 2025, according to the latest data from CMS published Jan. 28.
For the 30 HealthCare.gov states, the data is through Jan. 15. For the 20 state-based exchanges plus D.C., the data is through Jan. 10.
The 1.2 million enrollment decline (roughly 5%) hit both new and returning enrollees. New enrollees fell to 3.4 million from 3.9 million, while returning consumers dropped to 19.6 million from 20.2 million.
Since 2025, North Carolina enrollment has decreased 22% (975,110 to 761,457), Ohio enrollment has decreased by 20% (583,443 to 469,616), and West Virginia, Indiana, Delaware, and Arizona all declined by at least 15%.
Texas has seen the largest gain, adding 206,000 enrollees (up 5% to 4.17 million). Florida, despite losing nearly 197,000 enrollees year-over-year, remains the largest marketplace state at 4.54 million enrollees. New Mexico enrollment has grown 14% to more than 80,000.
The latest enrollment figures come nearly a month after the enhanced subsidies expired on Dec. 31, following months of failed negotiations that included the longest government shutdown in U.S. history. The House passed a three-year extension on Jan. 8, but the measure faces slim chances in the Senate, where a similar bill failed in December.
A bipartisan group of senators has continued negotiating a compromise. Sen. Bernie Moreno, R-Ohio, said Jan. 28 that Republicans are preparing a “best and final” offer to Democrats on a two-year extension that would impose new income limits and expand health savings account eligibility, Politico reported.
