Enrollment in ACA marketplace plans fell in 49 of the 50 states plus D.C. between February 2025 and February 2026, according to CMS data published in late June.
Ohio, Oklahoma and Arizona posted the steepest year-over-year declines, each shedding roughly 30% of enrollees, while New Mexico was the only state to post a gain (up 14%). New Mexico was the only state that fully replaced the expired federal enhanced premium subsidies for 2026 coverage.
Total marketplace enrollment stood at nearly 19.2 million in February, down 12% from nearly 21.8 million at the same time last year. Effectuated ACA marketplace enrollment (people actually covered after paying their first premium) peaked at 22.5 million in August 2025, while the record for total enrollment was 24.3 million, set during the open enrollment period for 2025 coverage.
The national decline has coincided with insurer exits from the exchanges, with nine insurers announcing this year alone that they will stop offering ACA marketplace plans nationally or in specific states after the 2026 plan year amid declining enrollment, rising premiums, a deteriorating risk pool and the expiration of the enhanced subsidies.
States ranked by ACA enrollment changes since 2025:
1. Ohio
Feb. 2025: 497,443
Feb. 2026: 336,058
32% enrollment decrease
2. Oklahoma
Feb. 2025: 265,157
Feb. 2026: 179,600
32% decrease
3. Arizona
Feb. 2025: 363,110
Feb. 2026: 255,927
30% decrease
4. South Carolina
Feb. 2025: 546,335
Feb. 2026: 387,145
29% decrease
5. Minnesota
Feb. 2025: 145,967
Feb. 2026: 104,788
28% decrease
6. Indiana
Feb. 2025: 281,215
Feb. 2026: 203,119
28% decrease
7. Michigan
Feb. 2025: 488,139
Feb. 2026: 357,350
27% decrease
8. Mississippi
Feb. 2025: 260,289
Feb. 2026: 191,631
26% decrease
9. Louisiana
Feb. 2025: 264,790
Feb. 2026: 195,759
26% decrease
10. Missouri
Feb. 2025: 347,424
Feb. 2026: 260,999
25% decrease
11. Nebraska
Feb. 2025: 130,407
Feb. 2026: 100,622
23% decrease
12. Alabama
Feb. 2025: 418,815
Feb. 2026: 324,504
23% decrease
13. Wyoming
Feb. 2025: 44,267
Feb. 2026: 34,514
22% decrease
14. North Carolina
Feb. 2025: 774,226
Feb. 2026: 609,544
21% decrease
15. Kansas
Feb. 2025: 179,920
Feb. 2026: 143,880
20% decrease
16. Oregon
Feb. 2025: 129,546
Feb. 2026: 105,911
18% decrease
17. Delaware
Feb. 2025: 44,290
Feb. 2026: 36,282
18% decrease
18. Iowa
Feb. 2025: 124,311
Feb. 2026: 103,253
17% decrease
19. Utah
Feb. 2025: 400,330
Feb. 2026: 337,266
16% decrease
20. Wisconsin
Feb. 2025: 291,329
Feb. 2026: 245,753
16% decrease
21. Kentucky
Feb. 2025: 90,443
Feb. 2026: 77,526
14% decrease
22. Tennessee
Feb. 2025: 513,772
Feb. 2026: 441,515
14% decrease
23. West Virginia
Feb. 2025: 56,962
Feb. 2026: 49,508
13% decrease
24. Alaska
Feb. 2025: 27,052
Feb. 2026: 23,546
13% decrease
25. Maine
Feb. 2025: 62,381
Feb. 2026: 54,800
12% decrease
26. Montana
Feb. 2025: 72,195
Feb. 2026: 63,975
11% decrease
27. South Dakota
Feb. 2025: 51,268
Feb. 2026: 45,888
10% decrease
28. Florida
Feb. 2025: 4,292,372
Feb. 2026: 3,849,587
10% decrease
29. Vermont
Feb. 2025: 32,287
Feb. 2026: 28,968
10% decrease
30. Arkansas
Feb. 2025: 144,140
Feb. 2026: 129,699
10% decrease
31. Hawaii
Feb. 2025: 23,025
Feb. 2026: 20,974
9% decrease
32. Washington
Feb. 2025: 296,073
Feb. 2026: 269,993
9% decrease
33. Georgia
Feb. 2025: 1,298,071
Feb. 2026: 1,188,140
8% decrease
34. Virginia
Feb. 2025: 368,519
Feb. 2026: 338,768
8% decrease
35. North Dakota
Feb. 2025: 40,650
Feb. 2026: 37,472
8% decrease
36. New Hampshire
Feb. 2025: 62,584
Feb. 2026: 57,716
8% decrease
37. New York
Feb. 2025: 201,997
Feb. 2026: 186,497
8% decrease
38. Nevada
Feb. 2025: 107,749
Feb. 2026: 99,663
8% decrease
39. Colorado
Feb. 2025: 260,973
Feb. 2026: 242,970
7% decrease
40. California
Feb. 2025: 1,971,965
Feb. 2026: 1,847,315
6% decrease
41. New Jersey
Feb. 2025: 499,872
Feb. 2026: 471,801
6% decrease
42. Maryland
Feb. 2025: 235,924
Feb. 2026: 223,483
5% decrease
43. Rhode Island
Feb. 2025: 41,994
Feb. 2026: 39,991
5% decrease
44. Texas
Feb. 2025: 3,423,543
Feb. 2026: 3,277,198
4% decrease
45. Massachusetts
Feb. 2025: 351,117
Feb. 2026: 338,197
4% decrease
46. District of Columbia
Feb. 2025: 13,432
Feb. 2026: 12,973
3% decrease
47. Idaho
Feb. 2025: 116,478
Feb. 2026: 113,957
2% decrease
48. Connecticut
Feb. 2025: 150,483
Feb. 2026: 148,596
1% decrease
49. Pennsylvania
Feb. 2025: 478,353
Feb. 2026: 472,627
1% decrease
50. Illinois
Feb. 2025: 423,727
Feb. 2026: 421,852
0.4% decrease
51. New Mexico
Feb. 2025: 69,915
Feb. 2026: 80,047
14% increase
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