Montana saw the largest increase in catastrophic plan enrollment from 2025 to 2026, while Pennsylvania saw the largest decrease, according to CMS data analyzed by KFF.
Catastrophic plan enrollment grew nearly 25% nationally, from 54,000 to almost 68,000, even as total ACA enrollment fell 5% to 23.1 million in 2026.
States ranked by catastrophic plan enrollment growth in 2026
Montana
2026: 3,238
2025: 296
Change: +994%
Delaware
2026: 1,123
2025: 177
Change: +534%
South Dakota
2026: 1,672
2025: 290
Change: +477%
Michigan
2026: 8,045
2025: 1,657
Change: +386%
Oklahoma
2026: 1,127
2025: 261
Change: +332%
New Hampshire
2026: 1,343
2025: 355
Change: +278%
Arizona
2026: 737
2025: 235
Change: +214%
Iowa
2026: 184
2025: 84
Change: +119%
Kentucky
2026: 999
2025: 464
Change: +115%
North Dakota
2026: 791
2025: 373
Change: +112%
Massachusetts
2026: 889
2025: 432
Change: +106%
Hawaii
2026: 446
2025: 233
Change: +91%
Virginia
2026: 3,195
2025: 1,707
Change: +87%
Vermont
2026: 188
2025: 108
Change: +74%
New Jersey
2026: 1,719
2025: 1,052
Change: +63%
Idaho
2026: 563
2025: 361
Change: +56%
New York
2026: 4,036
2025: 2,610
Change: +55%
Washington
2026: 753
2025: 579
Change: +30%
Florida
2026: 3,437
2025: 2,816
Change: +22%
District of Columbia
2026: 433
2025: 360
Change: +20%
California
2026: 15,592
2025: 13,272
Change: +17%
Connecticut
2026: 1,741
2025: 1,502
Change: +16%
Maryland
2026: 2,564
2025: 2,328
Change: +10%
Missouri
2026: 791
2025: 797
Change: -1%
Nevada
2026: 291
2025: 297
Change: -2%
Kansas
2026: 130
2025: 141
Change: -8%
Texas
2026: 2,669
2025: 2,973
Change: -10%
Alabama
2026: 1,718
2025: 1,997
Change: -14%
Wisconsin
2026: 1,238
2025: 1,470
Change: -16%
Maine
2026: 550
2025: 667
Change: -18%
Colorado
2026: 1,375
2025: 1,992
Change: -31%
Illinois
2026: 282
2025: 519
Change: -46%
Georgia
2026: 574
2025: 1,180
Change: -51%
Pennsylvania
2026: 497
2025: 1,128
Change: -56%
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
