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• Around 1.4 million fewer Americans have enrolled in Affordable Care Act (ACA) health insurance plans in 2026 due to the expiration of federal subsidies that help offset monthly premium costs.
• People who enroll in Obamacare programs will pay an average of 114% more in premiums.
• There are various alternative plans available for those who can’t afford ACA premiums, but experts say many are still expensive or do not provide adequate coverage.

Fewer people will participate in Affordable Care Act (ACA) health insurance plans in 2026, and those who do will pay significantly more for their medical expenses.

The window for enrolling in ACA programs closed on January 15. This year, it appears fewer people will be enrolled in ACA health plans.

New data from the Centers for Medicare & Medicaid Services (CMS) show that 22.8 million people enrolled in ACA marketplace coverage in 2026, down from a record 24.2 million in 2025. That’s about 1.4 million fewer people.

The numbers for 2026 enrollment include those who signed up for ACA plans via Healthcare.gov through January 3, and those who enrolled via state-operated ACA marketplaces through December 27.

The downward enrollment trend this year is attributed to rising premium costs.

In 2025, an estimated 22 million people used federal subsidies to lower their health insurance premiums. Some of them paid no premiums at all. However, in 2026, none of the ACA enrollees will receive federal subsidies to help them pay their premiums.

That’s because Congress hasn’t renewed those assistance programs, which were approved in 2021 under the American Rescue Plan and then extended through 2025 under the Inflation Reduction Act of 2022.

In early January, the House of Representatives voted to extend the subsidies for three years, but the Senate hasn’t yet approved the extension. President Donald Trump has said he may veto legislation extending the subsidies, even if Congress approves it.

When the President unveiled “The Great Healthcare Plan” in mid-January, proposing lower costs and prescription drug pricing, experts said the affordability it promised is unlikely to be delivered.

“We know President Trump wants his plan to be a great health plan, but unfortunately, his plan keeps in place the infrastructure that is hurting patients, doctors, and prices today,” Twila Brase, RN, PHN, co-founder and president of Citizens’ Council for Health Freedom, said in a statement.

Here’s what you need to know about rising costs to ACA premiums and some of the available alternatives to Obamacare.

How much will ACA premiums go up in 2026?

Health insurers participating in the ACA marketplace are projected to raise their premiums by an average of 26%.

It’s been estimated that nearly 5 million people in the United States will decide to forgo health insurance this year rather than pay the additional costs.

Those who remain in the ACA system will pay an average of 114% more in health insurance premiums due to the lack of subsidies, according to a report by the organization KFF.

The Bipartisan Policy Center estimates that a family of four with a household income of $45,000 per year that paid $0 in ACA insurance premiums in 2025 could pay as much as $1,600 in 2026.

Many people won’t be able to afford those premium spikes and will look for policies outside the ACA for coverage.

Experts say most of these plans will probably be too expensive for many people who have relied on federal subsidies.

“A lot of people are going to lose coverage,” said Naomi Zewde, PhD, an assistant professor in the Department of Health Policy and Management at the UCLA Fielding School of Public Health, as well as a fellow at the UCLA Center for Health Policy Research in Los Angeles, CA.

“There’s a big difference in your medical premiums going from zero to several hundred dollars a month,” she told Healthline. “The math on that isn’t going to add up for a lot of families.”

Additionally, many alternative plans do not provide people with the medical coverage they truly need.

“There will be a whole range of services they won’t be getting,” noted Zewde. “It’s going to change their lives substantially.”

“All of these plans are cutting something. It’s important to know what,” she added.

ACA alternatives

If you’re shopping around for alternatives, the following is a snapshot of some available options.

Short-term medical insurance

Short-term health insurance are designed for people who need temporary coverage while they’re between jobs as well as gig workers and people who have retired but aren’t yet eligible for Medicare.

Like most alternative plans, short-term coverage allows an individual to sign up and start coverage the following day. You can enroll for a period of a few months to a year, with renewal up to three years in some states.

The monthly premiums typically range from $60 to $250.

However, many of the plans do not cover pre-existing conditions and exclude benefits such as maternity care and mental health services. There are sometimes limits on prescription benefits.

These plans are also only available in 36 states.

Fixed benefit medical insurance

These plans, sometimes called fixed indemnity health insurance, pay established cash amounts for specific services, such as hospital care, doctor visits, or lab tests.

These plans generally don’t require deductibles and allow enrollees to utilize the healthcare provider of their choice. The benefits are generally paid directly to the consumer. Premiums can be as low as $25 per month.

However, these plans may not cover all medical expenses, in particular those involving chronic conditions. It’s generally recommended they be paired with another insurance plan.

High-deductible health insurance

These plans generally have low premiums but high deductibles. They are often paired with a person’s health savings account (HSA).

Premiums range from $150 to $400 a month or higher. There are also tax incentives for enrolling in an HSA, and the ability to roll over these funds from year to year.

However, there can be high out-of-pocket costs and these plans may not be cost-effective for people who need frequent medical care.

Catastrophic medical insurance

Catastrophic health plans also have low premiums and high deductibles.

They are primarily designed for people under 30 or consumers with hardship exemptions.

Premiums generally range from $130 to $300 per month or higher, depending on various factors. They do cover preventive care and most programs covered under ACA plans, although specialists many times are not covered.

They do have limited provider networks in some areas.

Concierge health insurance

Concierge health plans are a type of direct-pay model where the enrollee subscribes with a physician for routine medical services.

These plans typically cost between $50 and $150 per month for individuals and $100 to $250 a month for families.

They allow for unlimited visits as well as a personal relationship with a physician. There can also be discounts on lab tests and imaging exams.

However, these plans are not insurance and many times don’t cover hospitalization and specialist care. It’s recommended that they be paired with a high deductible or catastrophic health insurance plan.

Risks of inadequate health insurance

Kevin Schulman, MD, a professor of medicine at Stanford University, said many of these options won’t make sense for lower-income households.

“For low-income populations, none of these options will be affordable,” he said. “The major issue is to avoid low-cost ‘alternative’ plans such as primary-care coverage that provide minimal or no coverage for healthcare services, or dread disease policies which are very expensive and poor value.”

David Cutler, MD, a family medicine physician in Santa Monica, CA, said that many of the alternative plans have significant flaws.

“Non-ACA health plans may offer more affordable coverage,” he said. “However, limits to what is covered, pre-existing condition limitations, provider network restrictions, and the many other constraints which insurers can place on care which were addressed, eliminated, or at least made transparent in the Affordable Care Act would no longer be in place.” 

Experts interviewed by Healthline said that there are consequences for both individuals and society as a whole when people are either uninsured or underinsured.

“The major impact is on low-income populations in states that did not expand Medicaid under the ACA,” said Schulman. “These populations may find that they are no longer eligible for ACA subsidies and will face a higher premium even if they are eligible for subsidies.”

“This will increase the number of uninsured in the U.S., put financial pressure on physicians and hospitals for uncompensated care, and will result in worse health outcomes for patients,” he added.

Cutler said the effects will be widespread.

“The resulting fallout could be quite substantial,” Cutler said. “People with illnesses and diseases may not get cared for. Pregnant mothers may not receive prenatal care jeopardizing the health of their babies. Children may not receive vaccines such as measles.”

“And the providers of these healthcare services may be deprived of their livelihood, which was supported by insurance payments now eliminated when these policies are no longer in place,” he added.

Zewde noted the United States has the highest healthcare costs per person in the world. Yet, we have fewer doctors and fewer services than many high-income nations.

“We use less healthcare, but we pay more overall,” she said.

“The fact remains that the United States has the most expensive healthcare in the world and does not have better health to show for it,” Cutler noted.