Individual health insurance enrollment fell by more than 4.6 million people between June 2025 and June 2026. The decline comes as consumers prepare to review 2027 coverage, with open enrollment beginning November 1. For the households still shopping on their own, this is the year to find an insurance agent or another trusted way to compare plans before renewing, because the market they are shopping in has changed.
According to KFF’s October 2026 analysis, enrollment in the individual market dropped 18%, from 25.2 million to 20.5 million. KFF attributes the decline to the expiration of enhanced premium tax credits and other policy changes. Enrollment fell in every state except New Mexico, according to the analysis.
The report also says insurers’ median requested premium increase for 2027 is 15%, marking a second consecutive year of double-digit increases. Those are proposed increases, not a final rate for every plan or state. On average, insurers added about four percentage points in anticipation of fewer enrollees and a potentially sicker risk pool.
The numbers explain why the 2027 review is different from a routine renewal. Many people who left the market either picked up employer coverage, shifted to Medicaid or Medicare, bought off-exchange, or stopped carrying coverage altogether. Someone still shopping on their own this fall is comparing plans in a smaller market with higher proposed rates, which makes the estimated net premium after financial assistance, not the sticker price, the number that matters. The individual market is shrinking, but it has not returned to its pre-expansion size: enrollment in June 2026 remained 53% higher than in June 2019.
What the Enrollment Decline Means for 2027
KFF’s count includes both Marketplace coverage and similar off-exchange policies. Roughly nine in ten people in the individual market are enrolled through ACA Marketplaces. The number reflects a significant year-over-year decline, but it does not mean coverage options have disappeared.
A smaller pool can affect the people who remain enrolled. If people who are healthier or less likely to use care leave coverage at a higher rate, insurers may be left with a pool that has greater average health care needs. KFF reports that insurers included an average of four additional percentage points in their proposed increases in anticipation of this kind of risk-pool change. That is one factor insurers cited, not a guarantee of the final rate for any particular consumer or plan.
The Congressional Budget Office projected roughly a 25% enrollment decline through 2026 after the enhanced credits expired. It also projected that the number of uninsured people would rise by 2.2 million in 2026 and 3.7 million in 2027. KFF’s observed decline is approaching the enrollment projection; actual results may differ from forecasts.
What Other Marketplace Enrollees Reported
A KFF follow-up survey offers additional context on how households responded to higher costs. Among people who had Marketplace coverage in 2025, 22% said they had moved to another source of coverage, 9% said they were uninsured, and 69% said they had re-enrolled in a Marketplace plan.
Among returning enrollees, 17% were not confident they could afford premiums for all of 2026. Half said health care costs were a lot higher, and a majority said they had cut or planned to cut spending on food or other basic household expenses to afford care.
These survey findings describe respondents’ 2026 coverage status and reported expectations. They do not establish what any individual household will qualify for in 2027. They do show why it is important to compare more than the monthly premium when reviewing options.
2027 Open Enrollment Dates
The federal Marketplace dates listed by HealthCare.gov are:
| Date | Marketplace milestone |
|---|---|
| November 1, 2026 | Open enrollment begins. Consumers can apply, renew, or change plans. |
| December 15, 2026 | Deadline for coverage to begin January 1, 2027. |
| January 15, 2027 | Open enrollment ends under the federal Marketplace schedule. |
| February 1, 2027 | Coverage generally begins for consumers enrolling December 16 through January 15. |
The first premium must be paid for coverage to take effect. State-based Marketplaces may set different deadlines. The applicable dates should be confirmed with the consumer’s state Marketplace.
A Four-Part Decision Framework
The 2026 survey reported that 22% of prior-year Marketplace enrollees moved to another source of coverage and 9% became uninsured. For 2027, the appropriate option depends on household income, eligibility, plan availability, and coverage needs.
1. Review Renewal and Verify the Subsidy Estimate
A renewal notice is a starting point for comparison, not a complete review of the next year’s costs. Check the 2027 premium, benefits, provider network, and drug coverage. Review the Marketplace application using a realistic estimate of household income and household size for 2027. Do not assume that last year’s subsidy estimate will carry forward unchanged.
2. Check Medicaid or CHIP Eligibility if Income Changed
A change in household income may affect eligibility for Medicaid, CHIP, or Marketplace financial assistance. Applications for Medicaid and CHIP are accepted year-round. Eligibility rules vary by state and household circumstances, so the relevant state program should confirm eligibility. Households managing chronic conditions or working with a lower income that may qualify for premium tax credits can also review options through getaca.com, which focuses on Marketplace-based coverage.
3. Compare Off-Exchange and Private Options Carefully
Some individual coverage is available outside the Marketplace. Premium tax credits generally apply only to Marketplace plans, so an off-exchange premium should be compared against the net Marketplace premium after any eligible financial assistance. Review the plan’s benefits, exclusions, cost-sharing, and eligibility requirements. Plan labels alone do not establish that coverage is equivalent.
4. Check Whether a Spouse’s Employer Plan Is Available
If a spouse or partner has access to employer coverage, review the employer’s enrollment window and eligibility rules. Compare the employee contribution, dependent costs, start date, and benefits with available individual-market plans. Employer enrollment dates may not match Marketplace dates.
Checklist to Complete Before November 1
Gather the following information before comparing 2027 plans:
- Recent pay stubs or a reasonable estimate of 2026 household income.
- The current plan’s renewal notice and projected premium.
- Names of current doctors, clinics, and hospitals.
- Prescription names, dosage, and preferred pharmacy.
- Current household size and any expected changes.
- The current agent’s National Producer Number (NPN), if applicable.
When plan options become available, compare monthly premiums alongside deductibles, copays or coinsurance, covered services, provider networks, and prescription formularies. For the annual out-of-pocket maximum, use the figure shown in the plan’s Summary of Benefits and Coverage and confirm it with the insurer or Marketplace.
Finding and Checking an Insurance Agent
An insurance agent may help explain plan features and compare available products. Agent licensing and Marketplace arrangements vary by state and product. Ask for the agent’s full name and NPN, then check current license status with the relevant state insurance department. Confirm that the agent is authorized to discuss the type of coverage under consideration.
VerifiedAgent provides searchable directory records by location. State pages are available for Florida, Texas, and California, with additional locations listed through the state directory. Profiles may include an NPN, recorded categories, reviews, and other available details.
For example, a directory record for Kristy Dunn lists NPN 13596113 and Jacksonville, Florida. The record’s update date is not confirmation of current licensure. A directory profile is a research starting point, not proof that a license is active or that an agent is authorized to sell a specific plan. License status and product availability should be independently confirmed with state regulators and the relevant Marketplace or insurer.
Summary
Individual-market enrollment declined by more than 4.6 million people from June 2025 to June 2026, while remaining above 2019 levels. KFF’s survey found that some previous Marketplace enrollees moved to other coverage and others became uninsured. For 2027, consumers can review renewal options, update income estimates, check public program eligibility, compare off-exchange coverage, and consider an employer plan if available. Open enrollment begins November 1, 2026; state deadlines may vary. Plan prices, eligibility, agent authority, and license status should be independently confirmed before a coverage decision is made.
