You’ve probably read about declining Affordable Care Act (ACA) Marketplace enrollment in 2026. This year marks the first time since 2020 that ACA Marketplace enrollees are unable to take advantage of enhanced premium tax credits to reduce their out-of-pocket premium costs.
From 2021 to 2025, enhanced premium subsidies covered the full cost of a benchmark plan premium for those with incomes between 100% and 150% of the Federal Poverty Level. They also eliminated the income cap for subsidies, which allowed individuals at any income level to receive support if their premiums exceed 8.5% of their income.
According to an analysis by KFF of data from the Centers for Medicare & Medicaid Services (CMS), ACA sign-ups for 2026 are down by more than one million as compared to last year. But that decline may be just the beginning. The proposed 2027 Notice of Benefit and Payment Parameters, released in February 2026 by CMS, anticipates a reduction of up to two million in 2027. Overall enrollment, potentially, could decline by up to 57% when combined with declines that have already taken place.
Things that could further undermine enrollment include:
- Allowing non-network plan certification, which permits plans with no provider network (non-network plans) to be certified as Qualified Health Plans (QHPs).
- Eliminating standardized plans and limits on non-standardized plans in the Federally Facilitated Marketplace (FFM).
- Expanding access to catastrophic plans and permitting higher maximum out-of-pocket costs for Bronze-tier plans.
In 2027, the annual limit on cost-sharing for ACA plans is $12,000 for individuals. That’s an amount that many Americans simply do not have – and it’s a significant jump from the 2026 limit of $10,600. Originally, the annual maximum out-of-pocket limit was intended to provide financial protection to plan enrollees; however, as it continues to climb, it has become less meaningful for most Americans.
What the ACA Enrollment Decline Means for Your Book of Business
At its core, the decline in Americans with ACA coverage means increased out-of-pocket costs for those who want to maintain coverage. Or much greater costs for those who choose to go without insurance.
However, it presents potential sales opportunities to brokers. If you sell Individual & Family Plan (IFP) coverage, you may see a bump in inquiries from prospects. Or some of your former clients may reach out to re-engage you in their search for IFP coverage. If you sell Group Health, you may have clients with employees who declined group coverage in the past and want to now join or re-join those plans.
If you’re a California broker and you want to help clients interested in IFP coverage, you can partner with Duncan Shader. He is W&B’s IFP Sales Representative, and his focus is exclusively IFP. Plus, he has 30+ years of experience at Word & Brown. Duncan can help you find the right coverage at the right price for your California IFP clients. Send an email to dshader@wordandbrown.com or give him a call at 714.567.4657.
Your group clients could get inquiries from employees interested in joining or re-joining their employer-sponsored health plan. Of course, they need to experience a “qualifying life event (QLE),” or they may have to wait for the employer’s next open enrollment. QLEs include aging off a parent’s health plan at age 26, getting married or divorce, having a baby, adopting a child, or death of a family member. A change in residence is also a QLE. Changes in income affecting subsidy eligibility or becoming a U.S. citizen also qualify. For more information about QLEs, visit HealthCare.gov.
Your W&B rep will help you implement changes with your existing client’s plans or shop for alternatives if they want to consider a move to a different plan. We work with health plans, insurers, and administrators in California and Nevada, We have the expertise and technology to help you find the right plan at the right price – with the right provider network.
For Nevada clients, there may be another reason to consider a coverage review right now. Prominence Health Plan is leaving the ACA Small Group plan market as of 9/30. Existing ACA plans will all end then, regardless of their planned expiration. It’s important to begin shopping alternatives, so clients have new coverage lined up before that date. Contact Mona and Josh to learn more.
If you are not already working with W&B, we make it easy to get started. Call 800-869-6989, register online, or connect with our Broker Success team.
