Early Enrollment Trends in Affordable Care Act Coverage

Recent early enrollment figures from various states suggest that more individuals may choose to opt out of Affordable Care Act (ACA) coverage or switch to more affordable options in 2026 compared to last year.

Health officials in New York, Pennsylvania, Idaho, Colorado, and California reported their initial numbers for the first month of ACA open enrollment, which runs from November 1 to January 15 in most states. Interestingly, Idaho started two weeks early.

Officials caution that it’s still early to predict whether this trend will persist. Some individuals might delay finalizing their insurance decisions until the last minute—December 15 for those aiming for coverage starting January 1. However, these initial figures could hint at the financial challenges individuals face, particularly with the expiration of enhanced federal aid at year-end.

The situation appeared to worsen when the Senate rejected a Democratic proposal aimed at extending these subsidies for another three years. This development raises concerns that many could see significant premium increases without the tax credits, which could impact millions.

Jessica Altman, who leads Covered California, a state marketplace for ACA plans, noted, “There’s quite a bit we’re still trying to understand, but some early signs indicate that consumers might have tough choices ahead due to shifts in federal policy.”

Last week, the Centers for Medicare and Medicaid Services (CMS) released data showing a slight uptick in national sign-ups compared to the previous year. Yet, experts warn that early indicators from state and federal levels might not present a complete picture.

Ellen Montz, former deputy administrator at CMS, pointed out that uncertainty surrounds this year’s enrollment data since many may hold off on decisions while awaiting news about the enhanced subsidies. Additionally, she remarked that people may be attracted to cheaper plans as premium prices rise.

“This open enrollment is unlike anything we have ever seen,” Montz stated in an email. She further emphasized the need for caution in interpreting initial data, unlike previous years.

According to CMS data, around 5.8 million individuals selected ACA plans during the first 29 days of enrollment—a rise of nearly 400,000 compared to last year. About 4.8 million renewed their insurance.

Warnings from State Officials

In Pennsylvania, anticipated monthly premiums are projected to increase by over 100% next year. Here, applications from first-time enrollees in the ACA are down roughly 20% from the previous two years, as noted by Devon Trolley, head of the state’s health insurance marketplace, Penny.

He also mentioned that more people have dropped their coverage this year—about 40,000—compared to 19,000 during the same time last year, more than doubling the previous total. Overall, approximately 30,000 fewer individuals enrolled in ACA insurance this year versus last.

Trolley expressed concern about the uncertainty influencing decisions, suggesting that while some might cancel their coverage now, they could reconsider if enhancements to tax credits occur.

In Idaho, where enrollment began on October 15, state officials report a trend of shifting from gold and silver plans to less expensive bronze plans, which carry higher deductibles. The uptake of bronze plans has risen by about 5% since last year, with much of that shift occurring from silver plans.

Kelly, the executive director of Your Health Idaho, remarked that this uptick underscores worries about affordability. He added that requests to cancel policies are showing a threefold increase in mention of affordability struggles compared to the prior year, with expectations that about 25,000 Idaho residents might lose their insurance by the open enrollment’s conclusion.

Interestingly, Kelly noted that while many drop their insurance, new enrollments seem to offset them, though the reasons behind this trend remain unclear.

Trolley expresses concern that some individuals may enroll with the intention of securing insurance but may drop later when they find the costs untenable. “We might witness significant drops in February and March,” she stated, “as people struggle to pay their premiums.”

Montz added that a clearer picture of enrollment might emerge after HealthCare.gov automatically renews plans on December 15, during which individuals will have more time to decide whether to maintain their renewals.

“I anticipate that when the administration releases the final numbers, we’ll likely see a larger wave of disenrollments than currently reported,” she said.

Rising Premium Concerns

In New York, enrollment has decreased by about 8% year-on-year, according to Daniel Holohan, director of the New York State Department of Health. While he noted a drop in renewals, he hasn’t yet gathered data regarding those switching to less expensive plans.

Many New Yorkers are already enrolled in bronze plans, and officials expect numbers to climb as the December 15 deadline approaches. Holohan pointed out, “We’re seeing increased traffic on our website and call center, indicating people are exploring their options and perhaps experiencing some sticker shock.”

Altman from Covered California confirmed a significant decline in enrollment—over 30% from last year. “They’re reviewing their choices, but it seems too costly,” she remarked.

State officials also reported a notable increase in the shift towards bronze plans, with over a third of new ACA enrollees selecting those, as opposed to about one in five last year. Additionally, around 74,000 cancellations have occurred this year, slightly more than the 68,000 from last year, although Altman noted that figures might stabilize as open enrollment nears its conclusion.

Enrollment in Colorado has also dipped about 5% from last year, according to Nina Schwartz, director of policy and external affairs at Connect for Health Colorado, the state’s ACA marketplace.

“Some customers previously in Gold or Silver tier plans are opting for Bronze for their 2026 coverage,” she mentioned via email.